COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDARD 


HX64076881 
RA1051  T211  A  manual  of  medical 


RECAP 


I  Ololmnfata  Inm^rattg 


Srf^r^nr^  Htbrarg 


.>^A-^. 


.jj^^Jj^ 


C?<s., 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/manualofmedicalOOtayl 


THE  NATIONAL  DISPENSATORY,  Containing  the  Natural 
History,  Chemistry,  Pharmacy,  Actions  and  Uses  of  Medicines,  includ- 
ing those  recognized  in  the  Pharmacopoeias  of  the  United  States,  Great 
Britain  and  Germany,  with  numerous  Pieferences  to  the  French  Codex. 
By  Alfred  Still:e,  M.D.,  LL.D.,  and  John  M.  Maisch,  Phar.  D.  Fourth 
edition  revised,  and  covering  the  new  British  Pharmacopoeia.  In  one 
magnificent  imperial  octavo  volume  of  1794  pages,  with  311  elaborate 
engravings.  Price  in  cloth,  $7.25  ;  leather,  raised  hands,  $8.00  ;  half 
Russia,  $9.00.  *^*Z'A/s  work  will  he  furnished  with  Patent  Ready  Reference 
T  humh-letter  Index  for  $1.00  in  addition  to  the  price  in  any  of  the  above  styles 
of  binding. 


MANUAL  OF  CHEMISTRY.  A  Guide  to  Lectures  and  Labora- 
tory work  for  Beginners  in  Chemistry.  A  Text-hook,  specially  adapted 
for  Students  of  Pharmacy  and  Medicine.  By  W.  Simon,  Ph.  D.,  M.  D. 
New  (third)  edition.  In  one  8vo.  volume  of  477  pages,  with  44  wood-cuts 
and  7  colored  plates  illustrating  56  of  the  most  important  cliemical  tests. 
Cloth,  $3.25. 


CLINICAL  LECTURES  ON  MENTAL  DISEASES.  By 
Thomas  S.  Clouston,  M.D.,  F.R.C.P.,  L.R.C.S.  With  an  Appendix,  con- 
taining an  Abstract  of  the  Statutes  of  the  United  States  and  of  the  sev- 
eral States  and  Territories  relating  to  the  Custody  of  the  Insane.  By 
Chaeles  F.  Folsom,  M.D.  In  one  handsome  octavo  volume  of  541  pages, 
with  eight  lithographic  plates,  four  of  which  are  beautifully  colored. 
Cloth,  84.00. 

^l^-  Dr.  Folsom's  Abstract  may  also  be  obtained  separately  in  one 
octavo  volume  of  108  pages.     Cloth,  $1.50. 


ANATOMY,  DESCRIPTIVE  AND  SURGICAL.  By  Henry 
Gkat,  F.R.S.  Edited  by  T.  Pickering  Pick,  F.R.C.S.  A  new  American 
from  the  eleventh  enlarged  and  improved  London  edition,  thoroughly 
revised  and  re-edited  by  William  W.  Keen,  M.D.  To  which  is  added 
Landmarks,  Medical  and  Surgical,  by  Luther  Holden,  F.  R.  C.  S. 
Imperial  octavo  1098  pages,  685  elaborate  engravings  on  wood.  Price 
of  edition  printed  in  black  :  Cloth,  $6.00  ;  leather,  $7.00  ;  half  Russia, 
$7.50.  Price  of  edition  in  colors  :  Cloth,  $7.25  ;  leather,  $8.25  ;  half 
Russia,  $8.75. 

LEA  BROTHERS  ^   CO.,  Publishers,  Philadelphia. 


A  MANUAL 


MEDICAL   JUKISPRUDENCE. 


Br 
ALFRED  SWAINE  TAYLOR,  M.D.,  F.R.S. 


REVISED  AND  EDITED  BY 


THOMAS  STEYE:^rSO:N',  M.D.,  Lo^., 

FKLLOVV  OF  THE  ROYAL  COLLEGE  OF  PHYSICIANS  OF  LONDON  ;  LECTURER  ON  MEDICAL  JURISPRUDENCE 
AND  ON  CHEMISTRY  AT  GUY's  HOSPITAL ;  EXAMINEE  IN  FORENSIC  MEDICINE  IN  THE  UNIVER- 
SITY OF  LONDON  ;  EXTERNAL  EXAMINER  IN  FORENSIC  MEDICINE  IN  THE  VICTORIA 
UNIVERSITY;  OFFICIAL  ANALYST  TO  THE  HOME  OFFICE. 


ELEVENTH  AMERICAI^, 

EDITED  WITH  CITATIONS  AND  ADDITIONS  FROM  THE  TWELFTH  ENGLISH  EDITION. 

BY 


CLARK    BELL,  Esq., 


PRESIDENT  OF.  THE  AMERICAN  INTERNATIONAL  MEDICO-LEGAL  CONGRESS  OF  1893  ;  HONORARY  MEMBER 

OF  THE  MEDICO-LEGAL  SOCIETY  OF  FRANCE  ;  OF  THE  SOCIETY  OF  MENTAL  MEDICINE  OF  BELGIUM  • 

OF  THE   MEDICO-LEGAL  SOCIETY   OF  RHODE  ISLAND,  OF  CHICAGO,  OF  PHILADELPHIA,  OF  ' 

DENVER;    ASSOCIATE   MEMBER  OF  THE  SOCIETE   m£dICO-PSYCHOLOGIQUE   OF  PARIS  ; 

COBBESPONDING  MEMBER  OF  THE  SOCIETY  OF  PSYCHIATRY  OF  ST.  PETEES- 

BUEGH  ;  OF  THE  NETHERLANDS  ;  OF  LISBON,  PORTUGAL  ;  OF  THE 

SOCIETY'  OF  FRENIATRIA  OF  ITALY  ;  OF  THE  BELGIAN 

SOCIETY  OF  ANTHROPOLOGY,  AND  EX-PRESIDENT 

OF  THE   MEDICO-LEGAL  SOCIETY 

OF  NEW  YORK. 

Quod  hodie  exemplis  tuemur  mox  inter  exempla  ent. 


PHILADELPHIA: 
LEA     BROTHERS     & 

1892. 


CO 


Entered  according  to  the  Act  of  Congress,  in  the  year  1892,  by 

LEA    BROTHERS    &    CO., 
in  the  office  of  the  Librarian  of  Congress.     All  rights  reserved. 


PHILADELPHIA : 
COLLINS   PKINTING   HOUSK, 

705  Jayne  Street. 


PREFACE 


ELEVENTH  AMERICAN  EDITION. 


This  edition  is  an  entire  revision  of  all  prior  American  and 
London  editions,  and  includes  the  admirable  work  with  which  Dr. 
Stevenson  has  enriched  the  Twelfth  English  edition. 

Much  new  matter  has  been  added,  many  portions  of  the  work 
have  been  amended,  and  some  parts  have  been  re-written.  In  making 
additions  upon  legal  questions  and  the  present  state  of  the  law  bearing 
on  Medico-legal  matters  the  Editor  has  carefully  cited  nearly  700 
cases  and  authorities  to  aid  counsel  in  preparing  briefs,  and  to  extend 
the  sources  of  information  for  Medico-Leffal  Jurists. 

The  Editor  is  under  many  obligations  to  Doctors  John  J.  Reese 
and  Henry  Haetshorne,  and  to  Mr.  C.  B.  Penrose  for  their 
labors  upon  previous  American  editions,  which  have  been  utilized  as 
far  as  practicable ;  and  to  many  friends,  members  of  both  the  Medical 
and  the  Legal  Professions,  for  valuable  suggestions  and  aid, 

C.  B. 

New  York,  October,  1892. 


CONTENTS. 


MEDICAL  EVIDENCE. 

CHAPTER     I. 

PAGE 

The  Practice  of  Medical  Jurisprudence. — Medical  and  Medico-legal  Duties. — Inspec- 
tion of  Bodies  in  Death  troiu  Wounds  or  Poisoning. — Use  of  Notes. — Medico-legal 
Reports. — Dying  Declarations 17 

CHAPTER     II. 

Coroners'  Inciuests. — Trials. — Subpoenas. — Medical  Fees. — Duties  of  Medical  Wit- 
nesses.— ^Medical  Secrets. — Quotations  from  Books. — Presence  in  Court. — Techni- 
cal Terms. — License  of  Counsel. — Rules  for  the  Delivery  of  Evidence. — Experts, 
Expert  Testimonj',  and  Opinion  Evidence 33 

CHAPTER    III. 

Modes  of  Dying. — Syncope,  Asphyxia,  Coma. — Sudden  Death. — Signs  of  Death. — 
Cessation  of  Circulation  and  Respiration. — Cooling  of  the  Body. — Cadaveric  Ri- 
gidity.— Putrefaction. — Changes  Produced  in  the  Viscera. — Putrefaction  Mistaken 
for  Gangrene 63 


POISONING. 

CHAPTER    lY. 

Definition  of  the  Term  Poison. — Mechanical  Irritants. — luiluence  of  Habit,  Idiosyn- 
crasy, and  Disease. — Classification. — Special  Characters  of  Corrosive,  Irritant,  and 
Neurotic  Poisons 71 

CHAPTER    Y. 

Evidence  of  Poisoning  in  the  Living  Body. — Symptoms  Connected  with  Food  or  Medi- 
cine.— Several  Persons  Attacked  Simultaneously. — Evidence  from  the  Detection  of 
Poison  in  the  Food 80 

CHAPTER    YI. 

Evidence  of  Poisoning  in  the  Dead  Body. — Period  at  which  Poisons  Prove  Fatal. — 
Chronic  Poisoning. — Appearances  Produced  by  the  Different  Classes  of  Poisons. — 
Redness  of  the  Mucous  Membrane  Mistaken  for  Inflammation. — Ulceration  and 
Corrosion. — Softening. — Perforation  of  the  Stomach  from  Poison  and  Disease        .     86 

(vii) 


Viil  CONTENTS. 

CORROSIVE  AND  IRRITANT  POISONS. 
CHAPTER    YII. 

PAGE 

Sulphuric  Acid,  or  Oil  of  Vitriol. — Nitric  Acid,  or  Aqua  Fortis. — Hydrochloric  Acid, 
or  Spirit  of  Salt. — Symptoms. — Appearances  and  Analysis. — Nitro-hydrochloric 
Acid,  or  Aqua  Regia 94 

CHAPTER    YIII. 

Oxalic  Acid. — Symptoms  and  Appearances. — Chemical  Analysis. — Dialysis  of  Organic 
Liquids. — Acid  Oxalate  of  Potassium,  or  Salt  of  Sorrel. — Vegetable  Acids     .         .  103 

CHAPTER    IX. 

Alkalies  and  Alkaline  Salts.— ^Potash,  Soda,  and  Ammonia. — Nitrate  and  Sulphate 
of  Potassium. — Salts  of  Barium  . 109 

CHAPTER    X. 

Phosphorus. — Red  Phosphorus. — Symptoms  and  Appearances. — Chronic  Poisoning. — 
Chemical  Analysis 114 


METALLIC  IRRITANTS. 

CHAPTER    XI. 

Arsenic. —  Arsenious  Acid. —  Symptoms. —  Chronic  Poisoning. — Appearances  after 
Death. — Fatal  Dose. — Chemical  Analysis. — Arsenites. — Arsenic  Acid. — Orpiment 
and  other  Compounds 121 

CHAPTER    XII. 

Poisoning  hy  Mercury. — Corrosive  Sublimate. — Symptoms. — Chronic  Poisoning. — 
Appearances  after  Death. — Chemical  Analysis. — Process  for  Mercury  in  Organic 
Liquids. — Calomel. — White  and  Red  Precipitates. — Other  Compounds  of  Mercury    13S 

CHAPTER    XIII. 

Poisoning  with  Lead. — Sugar  of  Lead. — Symptoms. — Appearances  after  Death. — 
Chemical  Analysis. — Lead  in  Organic  Mixtures. — Red  Lead. — Carbonate  or  White 
Lead. — Chronic  Poisoning. — Poisoning  with  Copper. — Blue  Vitriol. — Symptoms. — 
Appearances. — Chemical  Analysis. — Copper  in  Organic  Liquids       .         .        .        .  145 

CHAPTER     XIV. 

Tartar  Emetic. — Antimonial  Wine, — Symptoms. — Appearances. — Chronic  Poisoning. 
— Chemical  Analysis. — Chloride  or  Butter  of  Antimony. — Poisoning  with  Salts  of 
Zinc  and  Iron. — Poisoning  with  Chromates 153 


CONTENTS.  ix 

VEGETABLE  AND  OTHER  IRRITAXTS. 
CHAPTER    XV. 

PAGE 

Vegetable  Irritants.— Aloes. —  Gelsemium.— Savin.—  Croton  Oil. —  Castor  Oil. —  Col- 
chicuni.— Hellebore.— Veratrine.— Carbolic  Acid. —  Kesorcin.— Petroleum.— Ani- 
mal Irritants  :  Cantharides. — Noxious  Animal  Food. — Fish.— Mui=sels.— Cheese.— 
Sausage  Poison. — Pork. — Trichinosis. — Poisoned  Game. — Ptomaines       .        .        .  163 


NEUROTIC  POISONS. 

CHAPTEE    Xyi. 

Opium. — S3'mptoms. — Appearances. — Its  Action  on  Infants. — Poisoning  with  Opiate 
Compounds. — Opium  Habit. — Morphine  and  its  Salts. — Meconic  Acid. — Process  for 
Detecting  Opium  in  Organic  Mixtures. — Dialysis. — Chlorodyne. — Cocaine       .        .  179 

CHAPTER    XVII. 

Prussic  Acid. — Symptoms  and  Appearances. — Tests  for  the  Acid. — Process  for  Orijanic 
Mixtures. — Cyanide  of  Potassium. — Essential  Oil  of  Bitter  Almonds. — Nitroben- 
zene.— Nitroglycerine 187 


CHAPTER    XVIII. 

Alcohol. — Ether. — Chloroform. — Iodoform. — Hydrate  of  Chloral. — Camphor      .         .  19,5 

CHAPTER    XIX. 

Tobacco  (Nicotiana  Tabacum). — Nicotine. — Cocculus  Indicus. — Picrotoxin. — Calabar 
Bean. — Mushrooms 0Q3 

CHAPTER    XX. 

Henbane. — Atropa  Belladonna,  or  Deadly  Nightshade. — Poisoning  by  Atropine. 

■  Datura  Stramonium,  or  Thorn-apple 209 

CHAPTER    XXI. 

Nux  Vomica. — Strychnine. — Symptoms  and  Appearances, — Chemical  and  Microscopi- 
cal Analysis  of  Nux  Vomica  and  Strychnine. — Process  for  Organic  Mixtures. 

Dialysis. — Brucine ^  215 

CHxlPTER     XXII. 

Conium  or  Hemlock. — Conine. — Water   Hemlock. — (Enanthe  Crocata. — ^^thusa. 

Cj-napium. — Fool's   Parsley. — Water-parsnip. —  Lobelia. — Foxglove. — Digitalin. 

Aconite. — Aconitine. — Laburnum 09r> 


X  CONTENTS. 

WOUNDS  AND  PERSONAL  INJURIES. 
CHAPTEE    XXIII. 

PAGE 

Definition  of  a  Wound. — Danger  to  Life. — Grievous  Bodily  Harm. — Examination  of 
Wounds. — Description  of  Wounds. — Characters  of  Wounds  Inflicted  on  the  Living 
and  Dead  Body. — Ecchymosis  in  the  Living  and  Dead. — Effects  of  Violence  on  the 
Dead  Body. — Ecchymosis  not  Always  a  Result  of  Violence 239 

CHAPTER    XXIV. 

Evidence  of  the  Use  of  a  Weapon. — Characters  of  Wounds  Caused  by  Weapons. — In- 
cised, Punctured,  Lacerated,  and  Contused  Wounds. — Stabs  and  Cuts. — What  are 
Weapons  ? — Examination  of  the  Dress. — Imputed  or  Self-inflicted  Wounds     .         .  247 

CHAPTER    XXY. 

Wounds  indicative  of  Homicide,  Suicide,  or  Accident. — Evidence  from  the  Situation 
of  a  Wound. — Evidence  from  its  Nature  and  Extent. — Evidence  from  the  Direction 
of  a  Wound. — Wounds  Inflicted  by  the  Right  or  Left  Hand. — Several  Wounds. — 
Use  of  Several  Weapons 256 

CHAPTER    XXYI. 

Evidence  from  Circumstances. — The  Position  of  the  Body. — Of  the  Weapon. — Evi- 
dence from  Blood,  Hair,  and  other  Substances  on  Weapons. — Marks  of  Blood  on 
Clothing  and  Furniture,  on  the  Deceased,  and  on  the  Assailant       ....  26;5 

CHAPTER    XXVII. 

Examination  of  Blood-stains. — Chemical  Analysis. — Spectroscopic  Examination. — 
Blood-crystals. — Microscopical  Evidence. — Blood  of  Man  and  Animals. — Stains 
of  Blood  on  Linen  and  other  Stuffs. — Age  or  Date  of  the  Stains. — Other  Stains 
Resembling  Blood. — Blood  on  Weapons. — Arterial  and  Venous  Blood. — Varieties 
of  Blood 270 

CHAPTER    XXVIII. 

The  Cause  of  Death  from  Wounds. — Wounds  Directly  or  Indirectly  Fatal. — Death 
from  Hemorrhage. — Internal  Bleeding. — Death  from  INIechauical  Injury. — From 
Shock. — Death  from  Numerous  Personal  Injuries,  Irrespective  of  any  Mortal 
Wound 285 

CHAPTER    XXIX. 

Death  of  Wounded  Persons  from  Natural  Causes. — Distinction  between  Real  and 
Apparent  Cause. — Death  from  Wounds  or  Latent  Disease. — Accelerating  Cause. — 
Death  from  Wounds  after  Long  Periods, — Avoidable  Causes  of  Death. — Neglect. — 
Imprudence. — Unskilful  Treatment. — Unhealthy  State  of  Body      ....  292 

CHAPTER    XXX. 

Wounds  Indirectly  Fatal. — Tetanus  Following  Wounds. —  Erysipelas. —  Delirium 
Tremens. — Gangrene. — Death  from  Surgical  Operations. — Anaesthetics. — Primary 
and  Secondary  Causes  of  Death. — Unskilfulness  in  Operations. —  Pyaemia. — 
Medical  Responsibility  in  Reference  to  Operations. — Actions  for  Malapraxis  .        .  o02 


CONTENTS.  xi 

CHAPTEE    XXXI. 

PAGE 

Cicatrization  ofWounds. — Evidence  from  Cicatrices. — Cliauf^esin  an  Incised  Wound. 
— Is  a  Cicatrix  Always  a  Consequence  of  a  Wound? — Aie  Cicatrices  when  Once 
Formed  Indelible? — Characters  of  Cicatrices. — Their  Age  or  Date. — Cicatrices  from 
Bleeding. — Cupping,  Setons,  and  Issues. — Cicatrices  from  Burns. — Cicatrices  from 
Disease  Distinguished  from  those  of  Wounds 310 

CHAPTER    XXXII. 

Medical  Evidence  of  Identity  from  Colored  Cicatrices  or  Tattoo-marks. — Mode  and 
Date  of  Production. — Durability  of  these  Marks. — Their  Alleged  Spontaneous  Dis- 
appearance.—  Cases  of  Identity  from  Tattooing. —  Simulated  Marks. —  Tattoo- 
marks  on  the  Dead. — Medical  Responsibility     ........  319 

CHAPTER    XXXIII. 

Wounds  of  the  Head. — Concussion. — How  Distinguished  from  Intoxication. — Effusion 
of  Blood  as  a  Result  of  Violence,  Disease,  or  Mental  Excitement. — Wounds  of  the 
Eace. — Deformity  as  a  Consequence  of  Wounds  of  the  Face. — Injuries  to  the  Spine 
and  Spinal  Marrow. — Fractures  of  the  Vertebrae        .        .        .        .        ,        .        .  327 

CHAPTER    XXXIY. 

Wounds  of  the  Chest. — Wounds  and  Ruptures  of  the  Lungs  and  Heart. — Wounds  of 
Large  Bloodvessels. — Wounds  and  Ruptures  of  the  Diaphragm. — Direction  of 
Wounds  of  the  Chest. — Wounds  of  the  Abdomen. — Death  from  Blows  on  the 
Cavity. — Ruptures  of  the  Liver,  Gall-bladder,  Spleen,  Kidneys,  Intestines,  Stomach, 
and  Urinary  Bladder. — Wounds  of  the  Genital  Organs 838 

CHAPTER    XXXV. 

Fractures. — Produced  by  a  Blow  .with  a  Weapon  or  by  a  Fall. — Brittleness  of  the 
Bones. — Fractures  Caused  by  Slight  Muscular  Exertion. — Fractures  in  the  Living 
and  Dead  Body. — Has  a  Bone  Ever  been  Fractured? — Locomotion. — Dislocations 
from  Violence  or  Natural  Causes. — Medical  Opinions. — Actions  for  Malapraxis     .  3.52 

CHAPTER    XXXYI. 

Gunshot-wounds. — In  the  Living  and  Dead  Body. — Was  the  Piece  Fired  Near  or  From 
a  Distance?  —  Accidental,  Suicidal,  or  Homicidal  Wounds.  —  Position  of  the 
Wounded  Person  when  Shot. — Wounds  from  Small-shot. — Wounds  from  Wadding 
and  Gunpowder 358 

CHAPTER    XXXVII. 

Death  from  Burns  and  Scalds. — Symptoms. — Stupor. — Cause  of  Death. — Post-mortem 
Appearances. — Burns  on  the  Dead  Body. — Accident,  Homicide,  or  Suicide. — 
Wounds  Caused  by  Fire. — Scalding. — Burns  by  Corrosive  Liquids  ....  366 


xii  CONTENTS. 

ASPHYXIA. 


DROWNING. 
CHAPTER    XXXVIII. 

PAGE 

Cause  of  Death.— Secondary  Causes.— Post-mortem  Appearances.— Medical  Proofs  cf 
Death  from  Drowning.— Specific  Gravity  of  the  Body.— Coincidental  Causes  of 
Death.— Marks  of  Violence.— Accidental  Fractures.— Homicidal  and  Suicidal 
Drowuintc ^'^ 


HANGING. 


CHAPTER    XXXIX. 

Cause  of  Death.— Death  from  the  Secondary  Effects.- Post-mortem  Appearances,— 
Mark  of  the  Cord  or  Ligature.— Was  Death  Caused  by  Hanging  ?— Hanging  After 
Death.— Summary  of  Medical  Evidence.— Marks  of  Violence  on  the  Hanged.- 
Was  the  Hanging  the  Result  of  Accident,  Suicide,  or  Homicide?— The  Position  of 
the  Body 394 


STRANGULATION, 


CHAPTER    XL. 


Cause  of  Death.— Appeatances  After  Death.— Was  Death  Caused  by  Strangulation, 
or  was  the  Constriction  Applied  to  the  Neck  after  Death? — Marks  of  Violence. — 
Accidental,  Homicidal,  and  Suicidal  Strangulation ilO 


SUFFOCATION. 

CHAPTER    XLI. 

SuflFocation  from  Mechanical  Causes.— Cause  of  Death. — Appearances  after  Death.— 
Evidence  of  Death  from  Suffocation. -^Accidental,  Suicidal,  and  Homicidal  Suffo- 
cation.— Smothering 425 

CHAPTER    XLII. 

CJaseous  Poisons.— Carbonic  Acid.— Symptoms. — Appearances.— Analysis.— Effects 
of  Charcoal-vapor.- Carbonic  Oxide.— Coal  and  Coke  Vapor.— Sulphuric  Acid.— 
—Vapors  of  Lime,  Cement,  and  Brick-kilns.— Confined  Air.— Coal-gas.— Water- 
rras.— Carburetted  Hydrogen. — Nitrous  Oxide.— Sulphuretted  Hydrogen.— Effluvia 
of  Drains  and  Sewers 433 


CONTENTS.  xiii 

lightjs^ing.   cold.   heat,   starvation. 

CHAPTER     XLIII. 

PAGE 

Effects  of  Electricity. — Post-mortem  Appearances. — Cold  an  Occasional  Cause  of 
Death. — Symptoms.— Circumstances  which  Accelerate  Death. — Post-mortem  Ap- 
pearances.— Effect  of  Heat. — Starvation  a  Rare  Cause  of  Death. — Symptoms. — 
Appearances  After  Death. — Legal  Relations 464 


PREGNANCY. 


CHAPTER    XLIV. 


Signs  of  Pregnancy. — Suppression  of  the  Menses. — Quickening. — Sounds  of  theFfEtal 
Heart. — Feigned  Pregnancy. — Concealed  Pregnancy. — Pregnancy  in  the  Dead. — 
Impregnation  in  a  State  of  Unconsciousness. — Legal  Relations       ....  4S8 


DELIVERY. 

CHAPTER    XLY. 

Delivery  in  the  Living. — Concealed  Delivery. — Signs  of  Abortion  in  the  Early  Stages 
of  Pregnancy. — Signs  of  Recent  and  Remote  Delivery. — Feigned  Delivery. — De- 
livery in  a  State  of  Unconsciousness. — Signs  of  Delivery  in  the  Dead. — True  and 
False  Corpora  Lutea. — Characters  of  the  Ovum  or  Embryo. — Moles. — Concealment 
of  Birth , 499 


CRIMINAL  ABORTION. 

CHAPTER    XLYI. 

Abortion  from  Natural  Causes. — Criminal  Causes. — Mechanical  Means. — Medicinal 
Substances. —  Signs  of  Abortion. —  Specific  Abortives. —  Local  Applications. — 
Feigned  Abortion. — Meaning  of  the  Word  "Noxious"  as  Applied  to  Drugs. — On 
Inducing  Premature  Labor. — Proof  of  Pregnancy  not  Necessary. — Abortion  of 
Monsters. — Moles  and  Hydatids         .        .        .        .' 513 


INFANTICIDE. 

CHAPTER    XLYII. 

Nature  of  the  Crime. — Medical  Evidence  at  Inquests. — LUerine  Age  or  Maturity  of  the 
Child. — Characters  of  the  Child  from  the  Sixth  to  the  Ninth  Month. — Signs  of 
Maturity. — Rules  for  Inspecting  the  Body 531 


XIV  CONTENTS. 


CHAPTEE    XLYIII. 

PAGE 

Evidence  of  Life  Before  Respiration. — Putrefaction  in  Utero. — Evidence  of  Life  After 
Respiration. — Color,  Volume,  Consistency. — Presence  of  Developed  Air-cells,  and 
Absolute  Weight  of  tbe  Lungs. — Static  Test. — Weight  Increased  by  Respiration    .  536 

CHAPTEE    XLIX. 

The  Hydrostatic  Test. — Sinking  of  the  Lungs  from  Disease  or  Atelectasis. — Life  with 
Perfect  Atelectasis  or  Entire  Absence  of  Air  from  the  Lungs. — Erroneous  Medical 
Inference  from  Sinking  of  the  Lungs. — Floating  of  the  Lungs  from  Putrefaction. — 
Effects  of  Putrefaction  on  the  Lungs 543 

CHAPTEE    L. 

Floating  of  the  Lungs  from  Artificial  Inflation. — Inflation  not  Distinguishable  from 
Imperfect  Respiration. — Results  of   Compression. — Improper  Objections  to  the  • 
Hydrostatic  Test. — Respiration  Before  Birth. — Respiration  a  Sign  of  Life,  not  of 
Live  Birth — General  Conclusions 549 

CHAPTEE    LI. 

On  the  Proofs  of  a  Child  Having  Been  Born  Alive. — Evidence  from  Respiration. — 
From  Marks  of  Violence. — From  Natural  Changes  In  the  Fostal  Vessels. — From 
the  Discovery  of  Air  and  Food  in  the  Stomach  and  Bovs^els. — Ear-test. — General 
Conclusions 554 

CHAPTEE    LII. 

Causes  of  Death  in  Newborn  Children. — Proportion  of  Children  Born  Dead. — Natural 
Causes  of  Death. — A  Protracted  Delivery. — Debility. — Bleeding  from  Laceration  of 
the  Navel-string. — Compression  of  the  Navel-string. — Malformation. — Destruction 
of  Monstrous  Births. — Death  from  Congenital  Disease 563 

CHAPTEE    LIII. 

Violent  Causes  of  Death. — Suffocation. — Drowning. — Death  of  the  Child  from  Cold 
and  Exposure. — Starvation. — Death  from  Immaturity. — Wounds  in  Newborn  Chil- 
(jren. — Fractures  of  the  Skull,  Accidental  and  Criminal. — Twisting  of  the  Neck. — 
Violence  in  Self-delivery. — Power  of  Locomotion  and  Exertion  in  Females  Alter 
Delivery ^569 

CHAPTEE    LIY. 

Death  of  the  Child  from  Strangulation. — Strangulation  by  the  Navel-string. — Acci- 
dental Marks  Resembling  those  of  Strangulation. — Constriction  Before  and  After 
Death. — Before  and  After  Breathing. — Before  and  After  the  Severance  of  the  Navel- 
Btring. — Examination  of  Women. — Medical  Responsibility 581 


BIRTH.     INHERITANCE. 


CHAPTEE    LV. 


Live  Birth  in  Civil  Cases. — Date  of  Birth. — Signs  of  Live  Birth  Independently  of  Re- 
spiration or  Crying. — Vagitus  Uterinus. — Tenancy  by  Curtesy. — Legal  Birth. — 
Post-mortem  Births. — Minority  aud  Majority. — Plural  Monstrous  Births         .        .  591 


CONTENTS.  XV 

LEGITIMACY. 
CPIAPTEE    LVI. 

PAGE 

Presumption  of  Legitimacy. — Natural  Period  of  Gestation. — Duration  of  Pregnancy 
from  One  Intercourse. — Premature  Births. — Short  Periods  of  Gestation. — Via- 
bility.— Earliest  Period  at  which  a  Child  may  be  Born  Living. — Evidence  from  the 
State  of  the  Child. — Protracted  Births. — The  Period  of  Gestation  not  Fixed  by 
Law ■ 602 


PATERNITY. 

CHAPTEE    LVII. 

Disputed  Paternity. — Parental  Likeness. — Affiliation. — Posthumous  Children. — Super- 
foetation  in  Relation  to  Legitimacy. — Supposititious  Children. — Sexual  Malforma- 
tion      .        .        .    ■ 619 


IMPOTENCY.     STERILITY. 

CHAPTER    LVIII. 

Impotency. — Causes. — Procreative  Power  in  the  Male. — Puberty. — Age  for  Virility. — 
Virility  of  Crypsorchides  and  Monorchides. — Sterility. — Procreative  Power  in  the 
Female. — Earliest  and  Latest  Periods  for  Childbearing. — Legal  Relations        .        .  629 


RAPE. 

CHAPTER    LIX. 

Sources  of  Medical  Evidence, — Rape  on  Infants  and  Children. — Marks  of  Violence. — 
Purulent  Discharges  from  the  Vagina. — Evidence  from  Gonorrhoea  and  Syphilis. — 
Rape  on  Girls  After  Puberty. — Defloration. — Signs  of  Virginity        ....  64J 

CHAPTEE     LX. 

Rape  on  Married  and  Adult  Women. — Circumstances  Under  which  it  may  be  Perpe- 
trated on  Adult  Women. — Loss  ol'  Physical  Evidence. — Pregnancy  Following  Rape. 
— Microscopical  Evidence. — Sodomy 662 


INSANITY. 

CHAPTER    LXI. 

What  is  Insanity? — Medical  Definitions. — Distinction  of  Sane  from  Insane  Persons. — 
Moral  Insanity. — Legal  Definitions. — "  Non  Compos  Mentis." — Symptoms  of  In- 
cipient InsanitJ^ — Hallucinations  and  Illusions.^Lucid  Intervals   ....  675 


xvi  CONTENTS. 

CHAPTEE    LXII. 

PAGE 

Varieties  of  Insanity. — Mania. — Abstinence  from  Food. — Delusions  Regarding  Poison. 
— Delirium  Distinguished  from  Mania. — Primary  Delusional  Insanity. — Dementia. — 
Idiocy. — Imbecility, — Hereditary  Transmission. — Feigned  Insanity. — Appearances 
After  Death.— Eccentricity 68i 

CHAPTER    LXIII. 

The  Lunacy  Laws. — Medical  Certificates. — Regulation  of  Lunatics  and  Idiots. — Ap- 
plication of  Restraint. — Illegal  Imposition  of  Restraint. — Violence  of  Temper. — 
Discharge  of  Lunatics.— Nullity  of  Marriage 693 

CHAPTER    LXIV. 

Lunatics  as  Witnesses. — Interdiction. — Commissions  in  Lunacy. — Examination  of 
Alleged  Lunatics.— Medical  and  Legal  Tests  of  Competency. — Conflict  of  Evidence 
and  Opinion TOC 

CHAPTER    LXY. 

Civil  Responsibility. — Testamentary  Capacity. — Wills  Made  by  the  Insane. — Test  of 
Capacity. — Evidence  of  Delusion. — Eccentricity 711 

CHAPTER    LXYI. 

The  Plea  or  Defence  of  Insanity. — Circumstances  under  which  it  is  Admissible. — 
Homicidal  Insanity. — Moral  Insanity. — Symptoms. — Legal  Tests. — Medical  Tests. 
— Delusion. — Tests  of  Irresponsibility. — Medical  Evidence 717 

CHAPTER    LXYII. 

Puerperal  Mania.  —  Pyromania.  —  Kleptomania.  —  Dipsomania.  —  Responsibility  of 
Drunkards. — Delirium  Tremens. — Somnambulism. — The  Deaf  and  Dumb      .        .  735 


LIFE  INSURANCE. 

CHAPTER    LXVIII. 

Principles  of  Life  Insurance. — Medical  Responsibility. — What  Diseases  Have  and  What 
Have  Not  a  Tendency  to  Shorten  Life? — Concealment  of' Diseases. — Concealment 
of  Habits. — Material  Concealment. — What  is  Intemperance? — Proximate  and  Re- 
mote Effects. — Opium-eating. — Inveterate  Smoking. — Insanity. — Voidance  of  Poli- 
cies by  Suicide. — Insurance  Murders  .........  746 


MEDICAL  JURISPRUDENCE. 


MEDICAL  EYIDENCE. 


CHAPTER    I. 

THE  PRACTICE  OF  MEDICAL  JURISPRUDENCE. MEDICAL  AND  MEDICO-LEGAL  DUTIES. INSPEC- 
TION OF    BODIES  IN  DEATH    FROM  WOUNDS  OR  POISONING. USE  OF    NOTES. MEDICO-LEGAL 

REPORTS. — DYING  DECLARATIONS. 

Medical  Jurisprudence — or,  as  it  is  sometimes  called,  Forensic, 
Legal,  or  State  Medicine — may  be  defined  to  be  that  science  which 
teaches  the  application  of  every  branch  of  medical  knowledge  to  the 
purposes  of  the  law  ;  hence  its  limits  are,  on  the  one  hand,  the  require- 
ments of  the  lav\^,  and  on  the  other,  the  whole  range  of  medicine. 
Anatomy,  physiology,  medicine,  surgery,  chemistry,  physics,  and  botany 
lend  their  aid  as  necessity  arises ;  and  in  some  cases  all  these  branches  of 
science  are  required  to  enable  a  court  of  law  to  arrive  at  a  proper  con- 
clusion on  a  contested  question  affecting  life  or  property. 

The  purpose  of  this  work  is  to  bring  as  far  as  possible  within  a  small 
compass  those  subjects  that  especially  demand  inquiry,  and  which  more 
particularly  concern  the  duties  of  the  educated  physician  and  surgeon. 
The  definition  above  given  necessarily  implies  that  a  medical  jurist  should 
have  a  theoretical  and  practical  knowledge  of  all  branches  of  the  profession, 
a  large  range  of  experience,  and  the  rare  power  of  adapting  his  knowl- 
edijre  and  experience  to  emergencies.  He  should  be  able  to  elucidate  any 
diffi'^ult  medico-legal  question  that  may  arise,  and  be  prepared  at  all  times 
to  make  a  cautious  selection  of  such  medical  facts,  and  a  proper  applica- 
tion of  such  medical  principles,  as  may  be  necessary  to  enable  a  judge  to 
place  the  subject  in  an  intelligible  light  before  a  jury,  and  to  enable  a  jury 
to  arrive  at  a  just  conclusion. 

The  variety  of  subjects  of  which  a  medical  jurist  is  required  to  have  a 
knowledge,  may  well  alarm  a  student  and  lead  him  to  suppose  that,  as  he 
cannot  make  himself  perfectly  acquainted  with  all,  he  may  well  forego  the 
labor  of  preparing  himself  in  any.  But  this  would  be  taking  an  erroneous 
view  of  his  position.  This  description  of  the  qualifications  necessary  to 
constitute  a  normal  witness  in  a  court  of  law  must  not  deter  him  from 
entering  on  the  study.  It  is  assuredly  beyond  the  mental  power  of  any 
individual  that  he  should  be  at  the  same  time  profoundly  versed  in  all  the 
principles  of  medicine  and  jurisprudence,  and  that  he  should  be  able  to 
answer  all  possible  questions,  and  encounter  and  remove  all  medical  diffi- 
culties, that  may  occur  during  the  trial  of  a  civil  or  criminal  case.  All 
that  the  law  expects  from  a  medical  man  is  a  fair  average  knowledge,  not 

2  .  (n\ 


18  DUTIES    OF    PHYSICIANS    AND 

merely  of  bis  profession,  but  of  that  which  falls  more  peculiarly  under 
the  province  of  a  medical  witness.  There  can  be  no  doubt  that  the  more 
perfectly  a  man  has  made  himself  master  of  his  profession,  the  better  will 
he  be  fitted  to  follow  the  principles  and  apply  himself  to  the  practice  of 
medical  jurisprudence;  but  he  must  divest  himself  of  the  notion  that 
these  principles  can  be  spontaneously  acquired,  or  that  the}^  are  neces- 
saril}"  derived  from  the  study  of  those  isolated  branches  of  medicine  upon 
which  medical  jurisprudence  is  based.  The  materials  for  the  medical 
jurist  undoubtedly  exist  in  these  collateral  sciences  ;  but  the}^  require  to 
be  assorted,  selected,  and  moulded  into  shape  before  they  can  be  applied 
to  any  useful  or  practical  purpose. 

The  duties  of  a  medical  jurist  are  distinct  from  those  of  a  mere  physician 
or  surgeon.  The  latter  looks  only  to  the  treatment  of  disease  or  accident, 
and  the  saving  of  life ;  but  the  object  of  the  former,  in  a  large  proportion 
of  cases,  is,  whether  in  reference  to  the  living  or  dead,  to  aid  the  law  in 
fixing  on  the  perpetrator  of  a  crime,  or  to  rescue  an  innocent  person  from 
a  falsely  imputed  crime.  Thus  he  may  be  required  to  determine  whether, 
in  a  particular  case,  the  cause  of  death  Avas  natural  or  violent  ;  and  for 
this  purpose  it  will  be  necessary  for  him  to  make  an  entirely  new  ap- 
plication of  his  professional  knowledge.  He  has  now  the  difiicult  task  of 
making  a  selection  from  those  parts  of  the  medical  sciences  which  bear 
upon  the  legal  proof  of  crime. 

Some  members  of  the  profession  have  been  inclined  to  look  upon  medico- 
legal practice  as  an  unnecessary  addition  to  their  ordinary  duties  ;  but 
there  are  few  that  have  been  long  engaged  in  medical  practice  who  have 
not  found  themselves  occasionaily  placed  in  situations  of  difficulty  from 
the  occurrence  of  cases  demanding  medico-legal  investigation.  A  medical 
man  is  summoned  to  attend  a  person  laboring  under  the  effects  of  poison 
criminally  administered  ;  but  at  the  time  he  may  have  no  knowledge,  or 
even  suspicion,  that  poison  is  the  cause  of  the  symptoms.  In  spite  of  the 
best  treatment,  death  ensues :  here  the  functions  of  the  medical  man  end, 
and  those  of  a  medical  witness  begin.  It  is  impossible  that  he  can  now 
avoid  giving  evidence,  or  shift  the  responsibility  on  another — the  law  will 
insist  on  his  appearance,  first  in  the  court  of  the  coroner,  next  before  the 
magistrates,  and  afterwards  at  the  assizes.  It  will  here  be  assumed  that, 
as  a  registered  member  of  the  profession,  he  is  fully  competent  to  answer 
every  question  put  to  him  by  judge  and  counsel  relative  to  the  general 
effects  of  poisons  ;  the  quantit}-  required  to  destroy  life  ;  and  the  time 
within  which  a  poison  may  prove  fatal.  It  may  be  olijected  to  his 
evidence,  that  the  deceased  had  died  from  the  effects  of  disease  and  not 
from  poison  ;  in  which  case  the  cross-examination  will  lead  to  a  searching- 
inquiry  into  all  of  those  diseases  which  resemble  the  effects  of  poison  in 
their  symptoms  and  post-mortem  appearances,  as  Avell  as  the  means  of 
making  an  unfailing  distinction  between  them  and  the  fallacies  to  which 
the  chemical  processes  for  the  detection  of  poison  are  liable. 

On  another  occasion  a  medical  man  may  be  called  to  render  assistance 
to  one  stabbed  in  a  quarrel  and  speedily  dying  from  the  wound.  The 
office  of  the  surgeon  here  ceases,  Avhilst  that  of  the  medical  jurist  begins. 
He  must  now  be  prepared  to  answer  numerous  questions,  all  bearing 
upon  the  legal  proof  of  crime,  all  necessary  in  law,  although  apparently 
superfluous  in  surgery.  Thus  he  may  be  asked  to  state  the  precise 
characters  of  a  wound  inflicted  upon  the  body  of  a  man  soon  after  death  ; 
and  by  what  means  a  particular  wound  was  inflicted.  Was  it  homicidal 
or  accidental?  The  amount  of  blood  lost?  Whether  the  person  could 
have   moved   or  performed   any  act  after    receiving  the  wound  ?     Are 


SURGEONS    IN    ACTING    AS    AVITNESSES.  19 

certain  spots  found  upon  his  clothes,  or  upon  a  knife  belonging"  to  him, 
due  to  effused  blood  or  to  other  causes  ?  Whether  any,  and  what  state- 
ments were  made  by  the  dying  man,  and  what  were  the  precise  circum- 
stances under  which  they  were  made?  It  need  hardly  be  observed  that 
questions  of  this  nature  are  rarely  noticed,  except  in  a  cursory  manner, 
by  chemists  and  surgeons  ;  and  a  medical  man  is  not  likely  to  acquire  the 
means  of  answering  them  by  intuition.  On  the  other  hand,  regarding 
ourselves  as  living  in  a  civilized  state,  in  M'hich  the  detection  and  punish- 
ment of  crimes  against  life  and  property  are  indispensable  to  the  security 
of  all,  it  is  impossible  to  overrate  their  importance.  Unless  a  witness  is 
able  to  return  answers  to  these  questions  when  a  public  necessity  occurs,' 
a  guilty  man  may  escape  punishment,  or  an  innocent  man  may  be  con- 
demned. A  witness  may  thus  most  seriously  injure  his  own  reputation; 
for  it  is  certain  that  his  qualifications  as  a  physician,  surgeon,  or  general 
practitioner,  however  great,  will  not  shield  him  from  general  reprobation. 

Thus,  then,  it  is  obvious  that  the  duties  of  a  medical  jurist  are  of  a 
highly  responsible  nature  and  of  great  importance  to  society,  while  the 
cases  which  call  them  into  exercise  are  of  purely  accidental  occurrence. 
A  medical  practitioner  who  thinks  himself  secui'e  in  the  most  retired 
corner  of  the  kingdom,  is  liable  to  find  himself  suddenly  summoned  as 
a  witness  on  a  trial,  to  answer  questions  which  perhaps  during  a  long 
period  of  practice  he  had  been  led  to  regard  as  unimportant.  Under  the 
circumstances  it  is  scarcely  possible  that  he  can  avoid  exposing  his 
deficiencies,  and  the  final  question  will  be.  Have  you  ever  attended  to  or 
thought  of  theae  subjects  be/ore?  A  negative  answer  to  this  question, 
while  it  commonly  brings  with  it  public  censure,  will  in  most  instances 
lead  to  the  acquittal  of  the  accused  in  spite  of  strong  presumptions  of  guilt. 

The  truth  of  this  picture  will  be  felt  and  acknowledged  by  those  who  have 
been  a  few  years  engaged  in  practice.  The  records  of  our  courts  of  law 
contain  many  unfortunate  exposures,  which  might  have  been  easily 
avoided  had  the  witnesses  only  availed  themselves  of  the  opportunities 
afforded  to  them  while  students  of  acquiring  a  knowledge  of  the  subject; 
but  they  had  unreflectingly  acted  on  the  principle,  that  medical  juris- 
prudence was  a  dry,  dull,  and  useless  study,  and  that  the  practice  of  it 
Avas  remote  and  speculative.  This  feeling  is,  however,  fast  disappearing. 
Those  who  have  been  compelled  by  circumstances  to  give  their  attention 
to  it  have,  in  subsequent  cases,  taken  care  to  prepare  themselves  for  the 
ordeal  through  which  every  medical  witness  must  pass. 

Some  medical  men  who  have  treated  legal  medicine  with  indifference 
have  ventured  to  act  as  witnesses,  thinking  that  the  subjects  on  which 
they  were  likely  to  be  examined  were  so  little  known  to  judge  and  counsel 
that  even  hazardous  or  rash  statements  would  escape  observation ;  such 
witnesses,  however,  have  often  found  to  their  cost  that  they  were  labor- 
ing under  a  delusion.  Various  circumstances  have  led  to  the  acquisition 
of  mnch  medico-legal  knowledge  by  lawyers,  especially  in  relation  to 
questions  connected  with  wounds,  child-murder,  and  poisoning;  and  they 
are  not  slow  in  detecting  and  exposing  a  mere  pretender  who  attempts  to 
shelter  himself  by  vague  or  evasive  statements  and  technical  language. 
Another  fact  must  be  borne  in  mind  : — there  are  few  counsel  engaged  in 
any  civil  or  criminal  case  of  importance  who  do  not  take  care  to  fortify 
themselves,  under  medical  advice,  with  a  full  knowledge  of  the  views  of 
standard  medical  writers  on  the  subject  in  dispute ;  and  with  these  works 
before  them,  and  with  their  proverbial  acuteness,  he  must  indeed  be  a 
clever  witness  who  can  succeed  in  passing  off  an  erroneous  or  evasive 
answer  to  a  medico-legal  question. 


20  MEDICAL    CONTRASTED    WITH 

It  is  a  frequent  charge  against  members  of  the  medical  profession  that 
they  are  the  worst  witnesses  on  matters  of  fact  and  opinion.  This  is  an 
unmerited  censure.  Those  Avho  are  ready  to  make  this  charge  overlook 
the  number,  complexity  and  difficulty  of  the  questions  that  are  put  to 
medical  men  compared  with  those  put  to  other  witnesses.  They  also 
forget  that  medical  men  are  much  more  frequently  summoned  as  witnesses 
than  the  members  of  other  learned  professions.  Their  evidence  obtains 
much  greater  publicity,  and  is  necessarily  exposed  to  a  wider  circle  of 
criticism.  The  fact  is,  that  good  and  bad  witnesses  are  to  be  met  with  in 
every  profession,  and  under  equal  conditions  there  is  no  reason  to  suppose 
that  one  would  furnish  a  greater  number  of  incompetent  witnesses  than 
another.  It  is  certainly  the  fault  of  medical  men  that  they  are  not 
always  prepared  for  the  questions  which  are  likely  to  arise  in  a  case  on 
which  they  know  they  will  be  required  to  give  evidence.  This  want  of 
preparation  frequently  applies  to  facts  as  well  as  to  opinions.  Thus,  in 
reference  to  a  case  on  which  a  charge  of  murder  or  manslaughter  may  be 
ultimately  founded,  a  medical  man  who  is  called  in  omits  to  observe  many 
circumstances,  because  at  the  time  they  appear  to  him  to  have  little  im- 
portance, although  at  the  subsequent  trial  he  may  find,  to  his  dismay, 
that  they  actually  become  the  turning-points  of  innocence  or  guilt. 
Medical  observation  as  a  result  of  professional  habits  is,  on  these 
occasions,  in  general  confined  to  only  one  set  of  circumstances — the 
recognition  and  treatment  of  accident  or  disease ;  but  medico-legal 
observation  should  take  a  much  wider  range  than  this,  and  should  be 
directed  to  all  the  surrounding  facts  and  incidents  of  a  case.  The 
essential  difference  in  the  two  kinds  of  practice  is,  that  circumstances 
which  are  of  no  interest  in  a  medical  or  surgical  point  of  view,  are  often 
of  the  greatest  value  and  importance  in  legal  medicine.  It  is  obvious 
that  if  they  are  not  observed  by  a  medical  witness  when  he  is  first  sum- 
moned to  the  injured  person,  whether  dying  or  dead,  it  will  be  out  of  his 
power  to  meet  many  of  the  questions  which  must  arise  in  the  progress  of 
the  case.  The  non-observance  of  these  facts  is  a  serious  evil,  and  often 
carries  with  it,  although  unjustly,  an  imputation  of  professional  ignorance. 

The  first  duty,  therefore,  of  a  medical  jurist  is  to  cultivate  a  faculty  of 
minute  observation  of  medical  and  moral  circumstances.  This,  combined 
v^ith  a  general  knowledge  of  what  the  law  requires  as  evidence,  will  enable 
him  to  meet  satisfactorily  the  scientific  questions  that  may  be  necessary 
for  the  elucidation  of  a  case.  The  exercise  of  this  faculty  is  by  no  means 
inconsistent  with  the  performance  of  his  duties  as  a  surgeon.  A  learned 
judge  on  one  occasion  remarked  that  "  a  medical  man,  token  he  sees  a  dead 
body,  should  notice  everything.''^  Undoubtedly  he  should  observe  every- 
thing which  could  throw  a  light  upon  the  production  of  wounds  or  other 
injuries  found  upon  it.  It  should  not  be  left  to  policemen  to  say  whether 
there  were  any  marks  of  blood  on  the  dress  or  on  the  hands  of  the  deceased, 
or  on  the  furniture  in  the  room.  The  dress  of  the  deceased,  as  well  as  the 
body,  should  be  always  closely  examined  on  the  spot  by  the  medical  man. 
It  may  stimulate  the  attention  of  a  medical  practitioner  in  reference  to 
these  inquiries  if  he  is  informed  that  one  art  of  counsel  defending  persons 
charged  with  murder  or  manslaughter  consists  in  endeavoring  to  dis- 
cover what  the  witness  omitted  to  do.  Although  sometimes  the  omis- 
sion may  be  really  of  no  medical  importance  whatever,  yet  it  is  usually 
placed  before  the  jury  in  such  a  strong  light  that  the  accused  obtains  the 
benefit  of  a  doubt.  The  omission  may  be  attributed  to  professional  igno- 
rance, or,  what  is  worse,  to  bias — a  determination  to  find  proofs  of  guilt — 


MEDICO-LEGAL    OBSERVATION.  21 

when  the  facts  might  be  innocently  explained  by  a  want  of  experience  on 
the  part  of  the  witness  in  dealing-  with  cases  of  this  nature. 

If  we  except  medical  experts,  who  are  selected  according  to  their  ex- 
perience in  different  branches  of  the  profession,  medical  men  have  no 
option  respecting  medico-legal  practice;  for  the  cases  which  give  rise  to 
medico-legal  questions  are  always  more  or  less  connected  with  the  prac- 
tice of  medicine  and  surgery.  Thus  before  any  inquiry  is  instituted  by  a 
magistrate  or  coroner,  and  before  any  suspicious  circumstances  have  come  to 
light,  a  medical  man  may  be  summoned  to  a  person  dying  from  the  effects  of 
a  wound,  or  from  the  secret  administration  of  poison.  The  dying  person  may 
make  to  him  a  declaration  or  statement  as  to  the  circumstances  under  which 
the  wound  was  inflicted  or  the  poison  administered  :  he  may  also  mention  the 
names  of  the  person  or  persons  concerned  in  the  assault  or  the  administration. 
This  dying  declaration  or  statement,  according  to  the  circumstances  under 
which  it  was  made,  may  become  of  material  importance  in  the  prosecution 
of  a  party  charged  with  murder  or  manslaughter.  It  is  therefore  proper 
that  a  practitioner  should  observe  and  make  notes  of  the  exact  condition 
of  the  patient ; — whether,  when  he  makes  the  statement,  he  is  under  the 
conviction  or  belief  that  he  is  about  to  die.  It  has  been  thought  that  it 
was  also  necessary  to  prove  that  the  wounded  man  had  lost  all  hope  of 
recovery  :  but,  as  a  judge  has  justly  remarked,  it  is  very  difficult,  if  not 
impossible,  to  say  on  these  occasions,  when,  if  ever,  the  feeling  of  hope 
completely  deserts  a  man.  Again,  a  man  may  express  an  opinion  that  he 
shall  "not  recover,"  but  this  is  not  sufficient.  The  law  admits  these 
declarations,  not  because  recovery  is  impossible,  but  because  the  person 
making  the  statement  has  in  his  mind  at  the  time  of  making  it  a  full  con- 
viction of  approaching  death.  It  is  therefore  the  duty  of  the  medical  at- 
tendant on  these  occasions,  to  see  how  far  the  person  making  the  statement 
believes  that  his  death  is  impending  or  nearly  approaching.  This  belief 
is  considered  in  law  to  be  equivalent  to  the  obligation  of  an  oath. 

Hence,  when  the  case  is  likely  to  prove  fatal,  the  medical  man  should 
warn  the  patient,  in  the  presence  of  his  relatives  or  friends,  of  his  danger- 
ous condition.  If  the  wound  or  poison  is  not  likely  to  prove  rapidly  fatal, 
the  attendance  of  a  magistrate  to  take  down  the  statement  in  due  legal 
form  would  relieve  the  medical  man  of  all  responsibility.  Should  any 
statement,  however,  be  made  to  him  under  these  circumstances,  it  is  his 
duty  to  make,  on  the  spot,  a  note  of  the  words  actually  used.  There 
should  be  no  paraphrase  or  translation  of  them,  but  they  should  be  the 
very  words  of  the  dying  man.  It  is  not  for  the  witness,  but  for  the 
court,  to  interpret  what  is  thus  stated.  A  medical  man  on  these  occa- 
sions should  not  render  himself  officious  in  extracting  information.  He 
may  receive  that  which  is  voluntarily  uttered,  and.  either  immediately  or 
on  the  earliest  possible  opportunity,  wn-ite  down  the  statement  as  it  was 
made.  Any  question  should  be  simply  confined  to  the  purpose  of  explain- 
ing what  mav  appear  to  be  ambiguous  or  contradictory  in  the  declaration 
itself. 

In  reference  to  persons  who  have  died  from  the  effects  of  wounds,  poison 
or  other  violent  causes,  the  initiatory  proceedings  connected  with  the  inquiry 
usually  take  place  in  the  court  of  the  coroner  ;  and  unless  the  medical  man 
in  attendance  is  supposed  to  be  implicated,  by  maltreatment  or  otherwise, 
in  the  death  of  the  person,  the  duty  of  making  an  examination  of  the  dead 
body  devolves  upon  him.  He  may  not  have  seen  the  person  while  living  ; 
and  in  this  case  it  will  be  necessary  that  he  should  give  his  attention  to 
those  circumstances  which  may  be  of  importance  in  the  future  inquiry. 
He  should  note,  as  far  as  it  can  be  ascertained: — 1.  The  exact  time  of 


22  DYING    DECLARATIONS. 

death,  if  known,  and  thus  determine  how  long  a  period  the  person  sur- 
vived.    2.   The  attitude,  position,  and  condition  of  the  body.     3.  The  state 
of  the  dress.     4.  All  surrounding  objects.     Any   bottles,  paper-packets, 
weapons,  or  spilled  liquids  lying  about  should  be  collected  and  preserved, 
and  their  position  with  regard  to  the  body  of  the  deceased  should  be  noted. 
5.  Any  vomited  matters  near  the  deceased  should  be  collected. — In  mak- 
ing a  post-mortem  examination  of  the  body  the  following  additional  points 
should   be   attended   to.     6.    The  external  appearance  of  the  body,  and 
whether  the  surface  is  livid  or  pallid.     7.  The  state  of  the  countenance. 
8.  All  marks  of  violence  on  the  person,  discomposure  of  the  dress,  marks 
of  blood,  etc.     9.  The  situation,  form,  and  direction  of  all  wounds.     10. 
The  presence  or  absence  of  warmth  in  the  legs,  arms,  abdomen,  mouth,  or 
armpits.     11.  The  presence  of  cadaveric  rigidity  in  any  part  of  the  body. 
To  give  any  value  to  the  two  last-mentioned  characters,  it  is  necessary 
for  the  practitioner  to  observe  the  nature  of  the  floor  on  which  the  body 
is  lying, — whether  the   body  is  clothed  or  naked,  young  or  old,  fat  or 
emaciated.     These  conditions  create  a  difference,  in  respect  to  the  cooling 
of  the  body  and  the  access  of  rigidity.     12.  If  found  dead — when  was  the 
deceased  last  seen  living,  or  known  to  have  been  alive?     13.  All  circum- 
stances leading  to  a  suspicion  of  suicide  or  murder.     14.  The  time  after 
death  at  which  the  inspection  was  made.     15.  The  state  of  the  abdominal 
viscera.     If  the  stomach  and  intestines  are  found  inflamed,  the  seat  of  in- 
flammation should  be  exactly  specified ;  also  all  marks  of  softening,  ulcer- 
ation, effusion  of  blood,  corrosion,  or  perforation.     The  stomach  should  be 
removed  and  placed  in  a  separate  vessel,  a  ligature  being  applied  to  each 
end.     If  cut  open  for  examination  at  this  period,  this  operation  should  be 
performed  in  a  clean  dish,  and  with  such  care  that  none  of  the  contents 
are  lost  or  are  allowed  to  mix  with  the  contents  of  the  intestines.     16. 
The  contents  of  the  stomach,  if  this  organ  was  opened  during  the  inspec- 
tion, should  be  collected  in  a  clean  graduated  vessel : — notice  a,  the  quan- 
tity ;  b,  the  odor  tried  by  several  persons ;  c,  the  color ;  d,  acid  or  alka- 
line reaction  ;  e,  presence  of  blood,  mucus,  or  bile  ;  /,  presence  of  undigested 
food  •  and  it  may  be  as  well  to  observe,  that  the  presence  of  farinaceous 
matters  (as  bread)  would  be  indicated  by  the  addition  of  iodine  water,  if  the 
contents  were  not  alkaline — of  fat,  by  warming  ;  g,  other  special  characters, 
n.  The  contents  of  the  duodenum  should  be  separately  collected,  ligatures 
being  applied  to  it.     18.  The  state  of  the  large  intestines,  especially  the 
rectum,  and  the  condition  of  their  contents.     The  discovery  of  hardened 
feces  in  the  rectum  would  prove  that  purging  had  not  existed    shortly 
before  death.     19.     The  state  of  the  windpipe,  throat,  and   gullet,  and 
whether  there  are  in  these  parts  any  foreign  substances,  or  marks  of  in- 
flammation and  corrosion.     This  is  of  essential  importance,  as  it  throws  a 
light  upon  a  variety  of  questions  which  may  arise  respecting  death  by 
suffocation  from  mechanical  causes,  or  the  nature  of  a  substance  swallowed. 
20.  The  state  of  the  lungs  and  heart ;  morbid  changes,  etc.     21.  The  state 
of  the  brain  and  spinal  marrow.     22.  The  condition  of  the  womb,  ovaries, 
and  genital  organs,  as  in  the  female  poison  has  been  sometimes  introduced 
into  the  body  by  the  vagina,  or  wounds  have  been  inflicted  internally. 
23.  The  kidneys  and  the  spleen  should  be  submitted  to  examination.     24.  • 
The  liver  with  the  gall-bladder  should  be  removed  for  chemical  examina- 
tion.    25.  The  urinary  bladder,  with  any  fluid  contained  in  it,  should  be 
removed  and  placed  in  a  separate  jar. 

Such  are  the  points  to  which,  in  the  greater  number  of  cases  of  violent 
death,  a  medical  jurist  should  give  his  attention.  By  means  of  these 
data,  noted  according  to  the  particular  case  to  which  they  are  adapted, 


EXHUMATION    OF    BODIES.  23 

he  will  in  general  be  enabled,  without  difficulty,  to  determine  the  probable 
time  of  death,  and  the  actual  means  by  which  death  was  brought  about. 
He  may  thereby  liave  it  in  his  power,  if  the  case  be  one  of  poisoninir,  to 
point  out  the  dish  or  article  of  f(jod  which  had  contained  the  poison,  and 
to  throw  light  upon  any  disputed  (piestion  of  suicide  or  murder  in  relation 
to  the  deceased.  Many  cases  of  death  from  wounds  or  poison  are  rendered 
obscure,  owing  to  these  points  not  having  been  attended  to  in  the  tirst 
instance. 

It  is  not  necessary  in  this  place  to  enter  into  any  details  respecting  the 
mode  of  performing  an  inspection.  A  medical  practitioner  is  supposed  to 
have  acquired  a  knowledge  of  this  part  Df  his  duties  during  his  studv  of 
anatomy;  and  any  additional  information  which  may  be  required  will  Ije 
found  in  the  appropriate  sections  of  this  work.  The  only  essential  points, 
in  addition  to  those  alcove  mentioned,  are,  1.  To  examine  all  the  important 
organs  for  marks  of  natural  disease;  and  2.  To  note  down  any  unusual 
pathological  appearances  or  abnormal  deviations;  although  thev  may  at 
the  time  appear  to  have  no  bearing  on  the  cause  of  death.  It  is  useful  to 
l)ear  in  mind  on  these  occasions  that  the  body  is  inspected,  not  merely  to 
show  that  a  person  has  died  from  poison,  Init  to  prove  that  he  has  not 
died  from  any  natural  caune.  Medical  practitioners  commonly  give  their 
attention  exclusively  to  the  first  point;  while  lawyers,  defending  accused 
parties,  very  properly  direct  a  most  searching  examination  to  the  last- 
mentioned  point,  i.  e.,  the  healthy  or  unhealthy  state  of  those  organs 
which  are  essential  to  life.  The  usual  cau.ses  of  sudden  death  have  their 
seats  commonly  in  the  brain,  the  heart  and  its  great  vessels,  or  in  the 
lungs.  Marks  of  effusion  of  blood,  congestion,  inflammation,  suppuration, 
or  a  diseased  condition  of  the' valves  of  the  heart,  should  be  sought  for  and 
accurately  noted.  It  has  also  been  recommended  that  an  examination  of 
the  spinal  marrow  should  be  made.  If  the  cause  of  death  is  obscure  after 
the  general  examination  of  the  body,  there  is  good  reason  for  inspecting 
the  condition  of  this  organ.  [In  medico-legal  cases,  involving  questions 
of  life  and  death,  the  examination  of  the  body  cannot  be  too  thorough  and 
exhaustive  ;  the  omission  of  any  one  organ  is  a  radical  and  sometimes  a 
fatal  defect.  This  was  well  illustrated  in  1872  by  two  leading  cases  in 
the  United  States — that  of  Mrs.  E.  G.  Wharton,  charged  with  poisoning 
General  Ketchum,  and  that  of  Dr.  Paul  Schoeppe,  charged  with  poisoning 
Miss  Steinnecke.  In  neither  case  was  the  post-mortem  sufficiently 
complete. 

In  the  first  case,  where  the  symptoms  of  the  deceased  were  certainly 
more  in  accordance  with  disease  than  with  tartar  emetic  (the  alleged) 
poisoning,  and  where  competent  medical  authority  ascribed  it  to  cerebro- 
spinal meningitis,  no  examination  of  the  spinal  marrow  Avas  made.  In 
the  latter  case,  in  which  the  symptoms  were  those  of  apoplexy  and  of 
uraemic  poisoning,  the  kidneys  and  several  other  organs  were  overlooked. 

In  certain  obscure  cases  it  may  become  necessary  to  institute  a  micro- 
scopic examination,  especially  of  the  brain  and  heart.] 

Exhumation  of  Bodies. — Sometimes  the  inspection  of  a  body  is  required 
to  be  made  long  after  interment.  So  long  as  the  coffin  remains  entire, 
there  may  be  the  expectation  of  discovering  certain  kinds  of  mineral 
poison  in  the  organs;  but  decomposition  may  have  advanced  so  far  as  to 
destroy  all  pathological  evidence.  The  inspection  in  such  cases  is  com- 
monly confined  to  the  abdominal  viscera.  The  stomach  is  often  found  so. 
thin  and  collapsed  that  the  anterior  and  posterior  walls  appear  to  form  only 
one  coat.  This  organ  should  be  removed,  with  the  duodenum,  and  ligatures 
should  be  applied  to  each.     The  liver,  kidneys,  spleen  and  brain  should 


24  IDENTITY    OF    SUBSTANCES. 

also  be  removed,  in  order  that,  if  necessary,  they  may  be  separately 
analyzed.  If  poison  is  not  found  in  one  of  these  parts,  it  is  not  likely 
that  it  will  be  discovered  in  other  parts  of  the  body.  It  has  been  recom- 
mended that  a  portion  of  earth  immediately  above  and  below  the  coffin 
should  be  removed  for  analysis,  as  it  may  contain  arsenic  ;  but  this  appears 
to  be  an  unnecessary  piece  of  refinement  when  the  coffin  is  entire,  or  when 
the  abdominal  parietes  still  cover  the  viscera.  If  decomposition  has  so  far 
advanced  as  to  have  led  to  an  admixture  of  earth  with  the  viscera,  and 
the  poison  is  found  in  minute  quantity  in  the  tissues  only,  the  source  of 
the  poison  may  be  regarded  as  doubtful;  and  in  this  case  the  earth  in 
which  the  remains  ai-e  found  should  undergo  a  chemical  examination. 

The  body  of  a  deceased  person,  when  exhumed,  should  be  identified  by 
some  friend  or  relative  in  the  presence  of  the  medical  examiner.  In  a  case 
of  murder  by  poison,  the  evidence  almost  failed,  owing  to  this  precaution 
not  having  been  taken. 

It  is  important  that  the  viscera  taken  from  a  body  which  has  been  long 
in  the  grave  should  be  sealed  up  imn)ediately.  They  should  not  be 
allowed  to  come  in  contact  with  any  metal,  nor  with  any  surface  except 
that  of  clean  glass,  porcelain,  or  wood.  It  has  been  recommended  that 
they  should  be  washed  with  chlorinated  lime  or  carbolic  acid  ;  but  this  is 
decidedly  improper  ;  the  use  of  any  preservative  chemical  liquid  would 
not  only  embarrass  the  future  analysis,  but  w^ould  render  a  special  exami- 
nation of  an  unused  portion  of  the  liquid  necessary,  the  purity  of  which 
would  have  to  be  unequivocally  established.  Preservation  from  air  in 
clean  glass  vessels,  with  well-fitted  corks  covered  with  gutta-percha  tissue, 
is  all  that  is  required  in  practice. 

Identity  of  Substances. — It  is  necessary  to  observe  that  all  legal  authori- 
ties rigorously  insist  upon  proof  being  adduced  of  the  identity  of  the 
vomited  matters  and  substances  taken  from  the  body  of  a  deceased  person, 
when  poisoning  is  suspected.  Supposing  that,  during  the  examination, 
the  stomach  and  viscera  are  removed  from  the  body,  they  should  never 
be  placed  on  any  surface  or  in  any  vessel  until  it  has  been  first  ascertained 
that  the  surface  or  vessel  is  perfectly  clean.  [It  is  safer  and  more  satis- 
factory that  all  the  vessels  and  apparatus  used  should  be  perfectly  new  as 
well  as  clean.^  If  this  point  be  not  attended  to,  it  will  be  in  the  power  of 
counsel  for  the  defence  to  raise  a  doubt  in  the  minds  of  the  jury,  whether 
the  poisonous  substance  found  might  not  have  been  accidentally  present 
in  the  vessel  used.  This  may  be  regarded  as  a  very  remote  presumption ; 
but,  nevertheless,  it  is  upon  technical  objections  of  this  kind  that  acquittals 
follow  in  spite  of  the  strongest  presumptions  of  guilt.  This  is  a  question 
for  which  every  medical  Avitness  should  be  prepared,  whether  he  is  giving 
his  evidence  at  a  coroner's  inquest  or  in  a  court  of  law.  Mariy  might  feel 
disposed  to  regard  matters  of  this  kind  as  involving  unnecessary  nicety 
and  care ;  but  if  they  are  neglected  it  is  possible  that  a  trial  may  be  at 
once  stopped,  so  that  the  care  bestowed  upon  a  chemical  analysis  Avill  be 
labor  thrown  away.  Evidence  of  the  presence  of  poison  in  the  contents 
of  a  stomach  was  once  rejected  at  a  trial  for  murder,  because  they  had  been 
hastily  thrown  into  a  jar  borrowed  from  a  neighboring  grocer's  shop, 
and  it  could  not  be  satisfactorily  proved  that  the  jar  was  clean  and 
entirely  free  from  traces  of  poison  (in  which  the  grocer  dealt)  when  used 
for  this  purpose.  When  the  life  of  a  human  being  is  at  stake,  as  in  a 
charge  of  murder  by  poisoning,  the  slightest  doubt  is  always  very  properly 
interpreted  in  favor  of  the  accused.  [Prof  R.  Bridges  reports  a  case  in 
which  the  search  for  arsenic  in  the  body  failed  to  detect  that  poison,  but 
where  zinc  in  considerable  quantities  was  found.     It  turned  out  on  inquiry 


PRESERVATION    OF    ARTICLES    FOR    ANALYSIS.  25 

that  the  stomach,  etc.,  had  been  carelessly  thrown  into  an  old  tin  can  which 
had  been  formerly  used  for  holdiny  zinc  paint  before  it  had  been  sent  to 
the  analyst.] 

Not  only  must  clean  vessels  be  used  for  receiving  any  article  destined 
for  subsequent  analysis,  but  care  must  be  taken  that  the  idenlily  of  a  sub- 
stance is  preserved,  or  the  most  correct  analys^is,  afterwards  made,  will  be 
inadmissible  as  evidence.  The  suspected  substance,  when  once  placed  in 
the  hands  of  a  medical  man,  should  never  be  let  out  of  his  sight  or  custody. 
]t  .should  be  kept  sealed  under  his  private  seal,  and  locked  up,  while  in  his 
possession,  in  a  closet  to  which  no  other  person  has  a  key.  If  he  has  once 
let  the  article  out  of  his  hands,  and  allowed  it  to  pass  through  the  hands 
of  several  other  persons,  then  he  complicates  the  evidence  for  the  prosecu- 
tion, by  rendering  it  indispensable  for  these  persons  to  state  under  what 
circumstances  it  was  placed  while  in  their  possession.  The  exposure  of  a 
suspected  substance  on  a  table  or  in  a  closet  or  room  to  Avhich  many  have 
access,  may  be  fatal  to  its  identity  ;  for  the  chemical  evidence,  so  important 
in  a  criminal  investigation,  will  probably  be  altogether  rejected  by  the 
court.  When  any  article  (e.  g.  a  stomach)  is  reserved  for  analysis,  care 
should  be  taken  to  at  once  attach  immovably  to  it,  or  to  the  vessel  con- 
taining it,  a  label,  upon  which  is  plainly  written  the  name  of  the  deceased 
and  the  date  of  removal*.  This  is  especially  necessary  when  there  are  two 
or  more  articles  for  analysis.  The  greatest  inconvenience  has  resulted 
from  the  neglect  of  this  simple  precaution. 

[A  striking  illustration  of  the  importance  of  this  rule  is  afforded  by  the 
case  of  State  of  Ya.  v.  Mrs.  E.  E.  Lloyd,  charged  with  poisoning  her 
daughter  with  arsenic.  On  the  trial  it  transpired  that  the  person  who 
conveyed  the  article  to  the  analyst  had  died.  Although  several  grains  of 
arsenic  were  said  to  have  l)een  detected,  the  identity  of  the  stomach  could 
not  be  positively  established,  and  the  court  excluded  the  medical  evidence 
for  w^ant  of  this  single  link  in  the  chain  of  identity.'] 

Preserving  articles  for  Analysis. — In  removing  viscera  or  liquids  from 
the  body  and  reserving  them  for  analysis,  it  is  necessary  to  observe 
certain  precautions.  A  clean  vessel  with  a  wide  mouth  should  be  selected  ; 
it  should  be  only  sufBciently  large  to  hold  the  organ  or  liquid  (the  less  air 
remaining  in  it  the  better) ;  and  it  should  be  secured  by  a  closely  fitting 
cork,  covered  with  gutta-percha  tissue  or  bladder.  Another  piece  of  sheet 
caoutchouc  or  gutta-percha  should  then  be  tied  over  the  mouth.  In  this 
way  any  loss  by  evaporation  or  decomposition  is  prevented,  and  the 
viscera  may  be  preserved  in  a  cool  place  for  some  time.  If  the  mouth  of 
the  vessel  be  too  wide  for  a  cork,  the  other  articles  cannot  be  dispensed  with. 
Paper  only  should  not  be  used,  as  the  appearances  after  death  in  the 
viscera  may  be  entirely  destroyed  by  the  evaporation  which  takes  place 
through  the  layers  of  paper  wath  which  the  vessel  containing  them  is 
covered.  The  practitioner  should  bear  in  mind  that  all  these  matters  are 
likely  to  come  out  in  evidence.  For  reasons  already  stated,  antiseptic 
chemical  compounds  should  not  be  used. 

The  articles  used  for  the  preservation  of  viscera  should  be  in  all  cases 
scrupulously  examined.  Some  kinds  of  calico  are  dressed  with  arsenic 
and  starch  paste,  and  many  kinds  of  wrapping-paper  as  well  as  wall-papers 
are  strongl}''  impregnated  with  this  poison.  One  observation  shows  that 
this  is  not  an  unnecessary  caution.  A  medical  man  was  engaged  in 
examining  the  body  of  a  child,  in  order  to  determine  the  cause  of  death. 
The  organs  were  healthy,  and  as  no  sufficient  cause  presented  itself,  he 
'  removed  the  stomach  with  a  view  of  making  an  analysis  of  its  contents. 
He  was  suddenly  called  away ;  and,  to  preserve  the  stomach,  he  wrapped 


26  USE    OF    NOTES. 

it  in  a  piece  of  paper  (used  for  papering-  rooms),  placing  it  on  the  uncolored 
side,  and  he  locked  it  in  a  closet  until  the  following-  day.  Assisted  by  a 
friend,  he  then  analyzed  the  contents,  and  found  a  trace  of  morphine  with 
a  pretty  large  quantit}^  of  arsenic.  As  the  symptoms  from  which  the 
child  had  died  were  not  those  of  poisoning  with  arsenic,  and  there  were 
no  appearances  of  the  action  of  this  substance  on  the  body,  he  came  to  the 
conclusion  that  its  presence  must  have  been  owing  to  some  extraneous 
cause.  He  examined  a  portion  of  the  wall-paper  in  which  the  stomach 
had  been  wrapped,  and  then  found  that  that  part  of  it  which  was  colored 
yellow  was  tinted  with  sulphide  of  arsenic,  or  orpiment.  It  was  therefore 
evident,  as  commercial  orpiment  contains  white  arsenic,  that  the  stomach 
and  its  contents  had  imbibed  a  portion  of  the  poison  during-  the  night. 
(Lancet,  1855,  i.  p.  632.)  This  satisfactorily  accounted  for  the  presence 
of  arsenic,  under  circumstances  which  might  have  given  rise  to  a  false 
charge  of  murder.  Many  wall-papers  contain  arsenic,  and  this  arsenic 
spreads  by  imbibition  to  other  parts  of  the  paper  not  so  tinted.  It  would, 
of  course,  be  proper  to  avoid  in  all  cases  the  use  of  any  wrapper  having 
upon  it  mineral  colors  of  an}^  description.  The  above  case  shows  in  a 
striking  point  of  view  the  danger  of  trusting  to  chemical  analysis  alone. 
Unless  we  look  to  physiology  and  pathology,  an  erroneous  opinion  may 
be  expressed. 

The  products  of  an  analysis,  in  the  shape  of  sublimates  or  precipitates, 
should  be  preserved  as  evidence,  distinctly  labelled  in  small  glass-tubes 
hermeticalh^  sealed.  They  can  then,  if  asked  for,  be  produced  for  exami- 
nation at  the  inquest  or  trial. 

On  the  use  of  Notes. — As  a  rule  in  medico-legal  investigations,  a  medi- 
cal practitioner  should  make  notes  of  what  he  observes  in  regard  to  symp- 
toms, appearances  after  death,  and  the  results  of  analysis.  His  own 
observations  should  be  kept  distinct  from  information  given  to  him  by 
others.  He  may  base  his  conclusions  on  the  former,  but  not  on  the  latter 
until  given  in  evidence.  From  the  common  forms  of  law  in  this  country, 
a  person  charged  with  a  crime  may  remain  imprisoned,  if  at  a  distance 
from  the  metropolis,  for  some  months  before  he  is  brought  to  trial.  It  is 
obvious,  however  clear  the  circumstances  may  at  the  time  appear  to  a 
practitioner,  that  it  will  require  more  than  ordinary  powers  of  memory  to 
retain,  for  so  long  a  period,  a  distinct  recollection  of  all  the  facts  of  the 
case.  If  he  is  unprovided  with  notes,  and  his  memory  is  defective,  then 
the  case  wnll  turn  in  favor  of  the  prisoner,  Avho  will  be  the  person  to 
benefit  by  the  neglect  of  the  witness.  In  adopting  the  plan  here  recom- 
mended, such  a  result  may  be  easily  prevented.  It  may  be  remarked  that 
the  law  relative  to  the  admissibility  of  notes  or  memoranda  in  evidence  is 
very  strict;  and  in  trials  for  murder  is  rigorously  enforced  by  the  juderes. 
In  order  to  render  such  notes  or  memoranda  admissible,  it  is  indispensably 
necessary  that  they  should  have  been  taken  on  the  spot  at  the  time  the 
observations  were  made,  or  as  soon  afterwards  as  practicable  ;  and  further, 
it  must  be  remembered  that  a  witness  can  refer  to  them  only  for  the  pur- 
pose of  refreshing  his  memory.  If  from  indistinctness  of  writing  or  other 
causes  a  copy  of  the  notes  has  been  subsequently  made,  a  witness  should 
not  destroy  the  original  notes,  but  have  them  ready  for  production. 

[The  rule  of  law  governing  a  memorandum  thus  made,  may  be  stated 
as  follows : — 

A  memorandum  is  admitted  in  evidence  only  for  the  purpose  of  showing 
the  existence  of  such  facts  or  circumstances  as  it  contains,  and  for  no 
other  purpose.  And  it  is  open  to  explanation  to  the  same  extent  that  it 
would  be  if  the  words  had  been  spoken  instead  of  being  written. 


MEDICO-LEGAL    REPORTS.  27 

A  memorandum  thus  made  in  the  usual  course  of  business  may  be 
received  in  evidence,  even  though  the  witness  is  unable  after  its  examina- 
tion to  state  the  particulars  from  recollection  :  Russell  v.  Hudson  River 
R.  R.  Co.,  17  N.  Y.  }-6i;  Halsey  v.  Sinsebaugh,  15  N.  Y.  485;  Guv  v. 
Mead,  22  N.  Y.  462;  Howard  v.  McDonough,  11  N.  Y.  592;  Mayor  of 
N.  Y.  V.  2d  Av.  R.  R.,  102  N.  Y.  572. 

But  the  witness  must  be  able  to  state  that  he  once  knew  the  facts  con- 
tained in  the  memorandum  to  he  true  ;  that  he  made  it  at,  or  shortly  after, 
the  time  they  transpired,  which  he  then  intended  to  make  correctly;  and 
that  he  believes  it  to  be  correct;  and  he  must  also  be  able  to  verify  the 
handwriting  as  his  own,  and  the  facts  stated  must  be  facts  of  his  own 
knowledge  and  not  on  information  derived  from  others  :  Haven  v.  Wen- 
dell, 11  K  H.  112;  Sherr  v.  Wiley,  18  Pick.  558;  Smith  v.  Johns, 
3  Gray  (Mass.),  517;  Crittenden  v.  Rogers,  8  Gray,  452;  Stickney  v. 
Bronson,  5  xMinn.  215;  Marely  v.  Schultz,  29  N.  Y.  346;  is^'icoll  v.  Webb, 
8  Wheaton  (U.  S.),  326  ;  Ocean  Nat.  Bk.  v.  Caryle,  9  Hun  (N.  Y.),  239.] 

He  must  also  be  prepared  to  give  a  reasonable  explanation  of  any  altera- 
tions or  interlineations  which  may  appear  in  his  original  notes.  So  in 
reference  to  all  other  written  memoranda  connected  with  the  case,  as,  for 
example,  the  medicines  prescribed  for  the  deceased,  the  visits  made  to  him, 
etc.,  the  witness  should  be  prepared  to  produce  them  and  explain  any 
remarks  which  may  be  found  in  his  books.  Counsel  are  entitled  to  look 
at  and  examine  all  documents  of  this  kind  which  are  produced  or  used  by 
the  witness  in  giving  his  evidence  in  the  courts. 

Medico-legal  Reports. — One  of  the  duties  of  a  medical  jurLst  is  to  draw 
up  a  report  of  the  results  of  his  examination  :  1,  in  regard  to  symptoms  ; 
2,  in  regard  to  appearances  after  death ;  and  3,  in  regard  to  the  results  of 
an  analysis.  With  respect  to  the  first  two  divisions  of  the  report,  the 
reader  is  referred  to  the  rules  for  investigating  cases  of  poisoning 
(pp.  0,  0,  0).  It  need  hardly  be  observed  that  the  time  at  which  the 
person  was  first  seen,  and  the  circumstances  under  which  the  attendance 
of  the  practitioner  was  first  required,  as  well  as  the  time  of  death,  should 
be  particularly  stated.  The  hour,  the  day  of  the  week,  and  the  month, 
should  be  invariably  mentioned.  Some  medical  witnesses  merely  state  the 
day  of  the  week,  without  that  of  the  month,  or  vice  versa.  At  a  trial 
this  sometimes  creates  great  confusion,  by  rendering  a  reference  to  an 
almanac  necessary.  The  words  yesterday,  next  day,  etc.,  should  never  be 
used.  The  facts  which  it  will  be  necessary  to  enter  in  the  report  are 
specially  stated  under  the  heads  of  investigation  (see  pp. 21-2).  If  these 
facts  are  not  observed  in  the  order  there  set  down,  their  value  as  evidence 
of  the  cause  of  death,  or  of  the  criminality  or  innocence  of  particular  per- 
sons, will  be- lost 

In  drawing  up  a  report  of  symptoms  and  appearances  after  death,  the 
facts  should  be  first  plainly  and  concisely  .'Stated  seriatim.,  in  language 
easily  intelligible  to  non-professional  men.  A  reporter  is  not  called  upon 
to  display  his  erudition,  but  to  make  himself  understood.  If  technical 
terms  are  employed,  their  meaning  should  also  be  stated.  When  a  subject 
is  thoroughly  understood,  there  can  be  no  difficulty  in  rendering  it  in  sim- 
ple language  ;  and  when  it  is  not  well  understood,  the  practitioner  is  not 
in  a  position  to  make  any  report.  Magistrates,  coroners,  and  barristers 
easily  detect  ignorance,  even  when  it  appears  under  the  mask  of  erudition. 

In  recording  facts  the  reporter  should  not  encumber  his  statements  with 
opinions,  inferences,  or  comments.  The  facts  should  be  first  stated  and 
the  conclusion  should  be  reserved  until  the  end  of  the  report.  The  lan- 
guage in  which  conclusions  are  expressed,  should  be  precise  and  clear.     It 


28  MEDICO-LEGAL    REPORTS CHEMICAL    ANALYSIS. 

must  be  remembered  that  these  are  intended  to  form  a  concise  summary 
of  the  whole  report,  upon  which  the  judi^raent  of  a  ma^-istrate,  or  the 
decision  of  a  coroner's  jury,  will  be  ultimately  based.  They  should  be 
most  strictly  confined  to  the  matters  which  are  the  subject  of  inquiry,  and 
which  have  actually  fallen  under  the  observation  of  the  witness.  Thus, 
the}^  commonly  refer  to  the  following  questions: — What  was  the  cause  of 
death  ?  What  are  the  medical  circumstances  which  lead  you  to  suppose 
that  death  was  caused  by  violence  ?  What  are  the  circumstances  which 
lead  you  to  suppose  that  death  was  not  caused  by  natural  disease? 
Answers  to  one  or  all  of  these  questions  comprise,  in  genei'al,  all  that  the 
reporter  is  required  to  introduce  into  the  conclusions  of  his  report. 

The  reporter  should  remember  that  his  conclusions  are  to  be  based  only 
upon  medical  facts, — not  upon  moral  circumstances,  unless  he  is  specially 
required  to  express  his  opinion  with  regard  to  them.  Further,  they  must 
be  founded  only  on  what  he  has  himself  seen  or  observed.  Any  informa- 
tion derived  from  others,  should  not  be  made  the  basis  of  an  opinion, 
either  in  evidence  or  in  a  medico-legal  report.  It  is  scarcely  necessary  to 
remark  that  a  conclusion  based  upon  mere  j^'^'obabilities  is  of  no  value  as 
evidence. 

In  drawing  up  a  report  on  the  results  of  a  chemical  analysis,  the 
following  points  should  be  borne  in  mind.  A  liquid  or  solid  is  received 
for  analysis.  1.  When,  from  whom,  and  how  received?  2.  In  what 
state  was  it  received — secured  in  any  M^ay,  or  exposed  ?  3.  If  more  than 
one  substance  received,  was  each  separately  and  distinctly  labelled?  The 
appearance  of  the  vessel,  its  capacity,  and  the  quantity  of  liquid  (by 
measure)  or  solid  (by  weight)  contained  therein,  noted.  4.  Physical 
characters  of  the  substance.  5.  As  to  processes  and  tests  employed  for 
determining  whether  it  contained  poison.  These  processes  need  not  be 
described  ; — a  general  outline  of  the  analysis  will  suffice.  6.  Supposing 
the  substance  to  contain  poison — was  this  in  a  pure  state  or  mixed  with 
some  other  substance  ?  T.  The  strength  of  the  poison,  if  an  acid,  or  if  it 
be  in  solution:  in  oil  cases,  the  qvontity  of  poison  found.  8.  Supposing 
no  poison  to  be  contained  in  it,  what  was  the  nature  of  the  substance? 
Did  it  contain  anything  of  a  noxious  nature,  i.  e.,  likely  to  injure  heallh 
or  destroy  life?  9.  Could  the  supposed  poisonous  substance  exist 
naturally  or  be  produced  within  the  body  ?  10.  Was  it  present  in  any  of 
the  liquids  or  solids  employed  in  the  chemical  analysis?  11.  Was  it  con- 
tained in  any  of  the  articles  of  food  or  medicine  taken  by  the  deceased  ? 
12.  Is  its  presence  to  be  ascribed  to  the  use  of  any  mineral  matter  em- 
ployed by  injection  after  death  for  the  preservation  of  the  body  of  the 
deceased?  13.  What  quantity  of  poison  was  actually  separated  in  the 
free  or  absorbed  state?  14.  How  much  of  the  substance  found  would, 
under  the  circumstances,  be  likely  to  destroy  life  ?  There  are  few  reports 
in  which  answers  to  some  of  these  questions,  although  not  formally  put, 
will  not  be  required  ;  and  unless  they  are  borne  in  mind  by  the  operator 
at  the  time  an  analysis  is  undertaken,  those  which  are  omitted  can  never 
receive  an  answer,  however  important  to  the  ends  of  justice  that  answer 
may  ultimately  become. 

There  are  frequently  defects  in  these  reports  which  it  is  desirable  to 
point  out.  The  statements  are  sometimes  drawn  up  in  exaggerated 
language  ;  at  others  they  are  overloaded  with  technical,  and  therefore  un- 
intelligible terms,  and  the  writer  is  not  careful  enough  to  keep  his  facts 
distinct  from  his  comments.  The  former  may  be  useful  as  evidence  ;  the 
latter  are  inadmissible.  With  respect  to  the  first  of  these  defects,  it  is 
too  much  the  practice  of  medical  men,  in  drawing  up  reports  of  medical 


MEDICO-LEGAL    REPORTS TECHNICAL    TERMS.  29 

cases  for  professional  purposes,  to  use  exap:gerated  language.  Thus  it 
may  be  observed  in  the  description  of  an  ordinary  post-mortem  examina- 
tion, the  lining  membrane  of  the  stomach  is  described  as  being  "intensely" 
inflamed,  or  some  part  is  "considerably"  injected,  or  a  cavity  is 
"enormously"  distended.  Expressions  thus  loosely  employed,  convey  to 
the  legal  mind  a  widely  different  meaning  from  that  intended  by  the 
reporter.  They  create  also,  if  withdrawn  or  modified,  great  difficulty  in 
evidence,  and  at  the  same  time  they  place  the  witness  in  an  undesirable 
position  before  the  court.  On  the  other  hand,  if  retained,  they  may 
render  the  facts  insusceptible  of  explanation  upon  any  theory  of  naturiil 
disease.  Such  descriptions  obviously  imply  a  comparison  with  similar 
conditions  in  numerous  other  dead  bodies ;  but  what  is  the  standard  by 
which  they  are  really  measured,  and  what  opportunity  has  the  witness 
had  of  creating  such  a  standard  from  his  own  experience  ?  In  general  it 
will  be  found  that  such  expressions  have  been  used,  without  proper  con- 
sideration, from  a  habit  acquired  by  the  writer  in  reporting  cases  for  the 
information  of  medical  men  only.  Let  him  who  is  inclined  to  use  them, 
bear  in  mind  that  barristers  look  much  more  closely  to  the  strict  meaning 
of  words  than  medical  men,  and  that  they  are  always  disposed  to  distrust 
the  judgment  of  one  who  cannot  speak  or  write  without  resorting  to  the 
use  of  the  superlative  degree. 

The  free  use  of  technical  terms  in  drawing  up  reports  should  be 
avoided.  Putting  aside  those  cases  in  which  a  medical  man  believes  that 
he  is  displaying  his  erudition  by  the  selection  and  use  of  such  terms,  there 
can  be  no  doubt  that  the  greater  number  of  medical  practitioners  fall  into 
this  practice  from  mere  habit.  They  write  as  if  they  were  addressing  the 
report  to  some  medical  society,  instead  of  a  coroner  and  jury  who  have 
never  in  their  reading  or  experience  met  with  such  terms,  and  to  whom 
therefore  they  are  unintelligible.  In  a  report,  which  was  submitted  to 
the  author  for  explanation,  on  the  appearances  in  the  body  of  a  man  who 
had  suffered  from  chronic  insanity,  the  following  passage  occurred  : — "  The 
only  morbid  appearance  in  the  brain  was  an  atheromatous  deposit  in  the 
Pons  Varolii,  near  the  situation  of  the  locus  niger."  In  another  docu- 
ment the  reporter  stated,  for  the  information  of  a  coroner's  jury,  that 
the  "  integuments  of  the  cranium  were  reflected,  and  the  calvarium  was 
exposed."  If  a  reporter  will  use  such  terms  as  these  or  others  of  a 
similar  kind,  such  as  "  parietes  of  the  abdomen,"  "  epigastrium,"  "  hyper- 
trophy of  the  liver,"  when  it  would  require  no  more  trouble  to  put  what 
he  means  in  plain  English,  he  must  be  prepared  to  have  his  meaning  per- 
verted or  wholly  misunderstood.  Setting  aside  the  jurors,  it  may  be 
observed  that  educated  persons,  such  as  coroners  and  magistrates,  do  not 
commonly  include  professional  terms  within  the  range  of  their  studies. 
There  are  but  few  of  them  who  understand  the  difference  between  perineum 
and  peritoneum,  or  the  meaning  of  the  words  hemispheres  of  the  brain,  pia 
mater,  puncta  cruenta,  corpora  quadrigemina,  centrum  ovale,  etc.  Thev 
are  not  likely  to  know  the  difference  between  the  cardia  and  pylorus,  noV 
the  nature  or  situation  of  the  duodenum,  jejunum,  ileum,  or  caecum,  and 
are  as  ready  to  consider  them  to  be  parts  of  the  liver  or  urinary  bladder  as 
of  the  intestines.  On  one  occasion,  a  judge  asked  for  an  explanation  of 
the  meaning  of  the  term  "alimentary  canal ;"  on  another  he  was  entirely 
ignorant  as  to  the  meaning  of  "verdigris."  A  slight  consideration  will 
show  to  any  medical  practitioner,  that  refined  professional  languaii'e  is 
wholly  misplaced  in  a  report  which  is  intended  to  inform  and  convince 
the  minds  of  ordinary  men  upon  plain  matters  of  fact. 

The  last  point  which  calls  for  comment  in  reference  to  medical  reports, 


30  MEDICO-LEGAL    REPORTS. 

is  the  loose  manner  in  which  facts,  comments  on  facts,  and  hearsay  state- 
ments are  sometimes  found  blended.  If  a  reporter  takes  care  to  separate 
facts  from  comment,  his  report  is  admissible,  and  may  be  read  at  the  in- 
quest or  trial  as  evidence.  The  facts  are  for  the  jur\' — the  comments  upon 
the  facts,  introduced  by  the  reporter,  may  or  may  not  be  correct  and  are 
not  evidence.  Their  correctness  or  relevancy  to  the  case  will  be  elicited  in 
the  cross-examination.  As  a  rule,  nothing  should  be  entered  in  a  report 
which  is  not  connected  with  the  subject  of  inquiry,  nor  except  it  has 
actually  fallen  under  the  observation  of  the  reporter.  The  introduction  of 
statements  made  by  others,  or  of  circumstances  which  have  come  to  his 
knowledge  through  public  rumor,  should  be  carefully  avoided. 

Upon  the  medical  report,  and  such  evidence  as  may  be  required  to  explain 
it,  an  accused  person  may  be  committed,  either  by  a  coroner  or  magistrate, 
for  trial  at  the  Assizes.  In  the  lirst  stage  of  the  proceedings,  under  these 
circumstances,  the  medical  witness  goes  before  the  grand  jury,  and  there, 
after  the  administration  of  an  oath,  he  is  required  to  make  a  general  state- 
ment of  what  he  knows  of  the  matter.  Such  questions  are  put  as  may  be 
necessary  to  elucidate  the  cause  of  death  ;  and  on  the  finding  of  a  true  bill, 
the  accused  is  placed  upon  his  trial  before  one  of  the  judges  of  asi-ize. 
According  to  the  variable  circumstances  attending  such  cases,  the  medical 
evidence  is  called  for  at  an  early  or  late  stage  of  the  proceedings.  "\\'hen 
it  is  at  all  doubtful  whether  the  cause  of  death  was  owing  to  any  criminal 
act,  it  is  called  for  at  the  commencement  of  the  case  in  order  to  lay  a  foun- 
dation for  further  inquiry. 

It  is  necessarv  that  a  medical  witness  should  remember  that  copies  of 
his  report  and  depositions,  either  before  a  coroner  or  magistrate,  are  usually 
placed  in  the  hands  of  counsel  as  well  as  of  the  judge,  and  that  his  evidence 
as  it  is  given  at  the  trial,  is  compared  word  for  word  with  that  which  has 
already  been  put  on  record.  There  is  reason  to  believe  that  this  is  not 
generally  known  to  members  of  the  medical  profession,  and  thus  it  happens 
that  either  from  failure  of  memory,  want  of  accurate  observation,  or  care- 
lessness in  giving  preliminary  evidence,  medical  witnesses  have  laid  them- 
selves open  to  severe  censure,  either  by  stating  matters  differenth'  at  the 
trial,  or  by  giving  a  different  complexion  to  the  facts.  Any  serious  devia- 
tions from  what  is  on  record  will  of  course  tell  unfavorably  for  the  wit- 
ness, supplv  ample  materials  for  a  severe  cross-examination,  and  form  an 
excellent  ground  of  defence  for  the  prisoner.  The  witness's  weakness  is 
the  prisoner's  opportunity,  and  of  course  counsel  for  the  defence  will  not 
lo.se  the  occasion  of  impressing  upon  the  jury  that  a  man  who  can  on  oath 
give  two  different  accounts  of  the  same  transaction,  is  not  to  be  believed 
on  either. 

[Dying  declarations  may  be  defined  as  statem.rnts  of  material  facts  con- 
cerning the  cause  and  circumstances  of  homicide,  made  by  the  victim 
under  the  solemn  belief  of  impending  death,  the  effect  of  which  on  the 
mind  is  regarded  as  equivalent  to  the  sanctity  of  an  oath. 

They  are  substitutes  for  sworn  testimony,  and  must  be  such  narrative 
statements  as  a  witness  mie-ht  give  on  the  stand,  if  living:  3  Kussell  on 
Crimes  (9th  Am.  Ed.).  2.50;  Wharton.  Criminal  Evidence  (9th  Ed.), 
S  276;  Roscoe,  Crim.  Ev.  (10th  Ed.),  34;  Greenleaf  on  Evidence  (14th 
Ed.),  §  158. 

1.  Dying  declarations  are  admi.ssible  only  in  ca.ses  of  homicide,  where 
the  death  "of  the  deceased  is  the  subject  of  the  charge,  and  the  circum- 
stances of  the  death  are  the  subject  of  such  declarations:  Reynolds  v. 
State,  fi8  Ala.  502;  Hill  v.  State.  41  Ga.  484;  Montgomery  v  State,  80 
Ind.   281 ;   Wright  v.  State,  41  Texas,  246  ;    Hackett  v.  People,  54  Bar. 


DYING    DECLARATIONS.  31 

(N.  Y.)   370;    Hudson   t;.  State,  3  Coldw.  (Tenii.)  355;    3  Russell  on 
Crimes  (5th  Ed.),  354. 

2.  The  declarations  must  be  made  not  merely  in  articulo  mortis,  but 
under  the  sense  of  impending:  death,  without  expectation  or  hope  of 
recovery  :  Reynolds  v.  State,  68  Ala.  502  ;  People  v.  Hodyson,  55  Cnl.  72  ; 
State  V.  Darraud,  5  Oregon,  216;  Dunn  v.  State,  2  Ark  229;  Hay  t;. 
State,  40  Maryland,  633;  State  v.  Blackburn,  80  N.  C.  474;  1  Greenleaf 
on  Evidence  '(14th  Ed.),  158;  Tracy  v.  People,  97  111.  lOl  ;  People  v. 
dray,  &1  Cal.  164. 

3.  Dyin.i?  declarations  are  admissible,  even  thoufjh  others  may  not  have 
thought  the  person  making  them  would  die:  People  v.  Simpson,  48  Mich. 
474  ;  R.  V.  Mosly,   1  Mood  C.  C.  97  ;  R.  v.  Peel,  2  F.  &  F.  21  . 

But  not  if  the  victim  has  any  hope  of  recovery,  however  slight:  3 
Russell  on  Crimes  (9th  Am.  Ed.),  252. 

Hope  of  recovery  afterwards  abandoHed  makes  the  dying  declarations 
admis.<ible:  Swall  o.  Com.  of  Pa.,  91  Pa.  State,  304;   Yong  u.  Com.  (Kv.),_ 
6  Bush,  317  ;    State   v.  McEvoy,  9  S.  C.  208  ;   Mockabee  v.  Com.,  75  Kv. 
380;    R.  V.   State,  12  Cox  C.  C.  108;  State  v.  Kilgore,  70  Mo.  546;   R. 
V.  Hubbard,  14  Cox  C.  C.  505. 

It  is  not  essential,  however,  that  the  consciousness  of  impending  death 
should  be  expressed  i)y  the  dying  man  himself;  it  may  be  collected  from 
the  circumstances  of  the  case,  the  nature  of  the  w^ounds,  or  from  expres- 
sions used  bv  the  victim  :  Com.  v.  Murray,  2  Ark.  41  ;  Com.  v.  Williams, 
lb.  69;  State  v.  Gallick,  7  Clark  (Iowa),  287;  State  v.  Nash,  lb.  347; 
People  V.  Lee,  17  Cal.  76;  People  v.  Ybarra,  lb.  166  ;  Kilpatrick  v.  Com- 
monwealth, 7  Casey,  198. 

4.  The  dying  declarations  may  be  made  by  signs,  by  writing,  or  in  any 
other  manner  of  communication  :  Com.  v.  Casey,  11  Cush.  417  ;  Jones  v. 
State,  71  Ind.  66;  R.  v.  Reddingfield,  14  Cox  C.  C.  341. 

It  is  not  necessary  that  the  examination  of  the  deceased  should  be  con- 
ducted after  any  formal  manner. 

It  is  no  objection  that  the  declarations  were  obtained  by  pressing  and 
earnest  solicitations,  or  in  answer  to  leading  questions. 

The  jury  pass  upon  the  effect  of  the  statemeiats  and  their  real  value:  1 
Russell  on  Crimes  (5th  Ed.),  360  ;  Com.  v.  Casey,  11  Cushing,  417  ;  R.  v. 
Osman,  15  Cox  C.  C.  1 ;  R.  v.  Woodcock,  2  Leach,  561 ;  State  v.  Wilson, 
24  Kansas,  189. 

0.  It  does  not  matter  if  considerable  time  elapses  after  the  declarations 
w^ere  made,  if  they  were  uttered  under  a  sense  of  impending  death,  and 
without  hope  of  recoverv  :  3  Russell  on  Crimes  (5th  Ed.),  355,  556; 
1  Phillips's  Ev.  (10th  Ed.),  245;  Roscoe's  Crim.  Ev.  (10th  Ed.),  57; 
R.  V.  Bernadotti,  11  Cox  C.  C.  316. 

6.  Dying  declarations  must  be  confined  strictly  to  the  act  of  killing, 
and  to  the  facts  and  circumstances  relating  to  and  attending  it,  which 
form  a  part  of  the  r^.s  gestae. 

They  are  inadmissible  in  relation  to  former  or  other  transactions,  not 
relating  to  the  killing,  or  disconnected  with  the  death  of  the  victim  : 
Reynolds  v.  State,  68  Ala.  502;  Ume  v.  State,  20  Ohio  St.*  460  ;  West 
I'.  State,  7  Texas  Appeals,  150  ;  State  v.  Wood,  53  Vt.  560  ;  State  v. 
Draper,  65  Mo.  335. 

The  true  test  of  the  relevancy  of  the  declarations  is,  as  to  whether  the 
deceased  could  have  testified  to  them  as  a  witness  in  the  cause,  if  living. 

They  must  be  statements  of  actual  facts,  and  not  be  mere  expressions 
of  opinion,  or  matters  of  belief:  Shaw  v.  People,  3  Hiin  (N.  Y.), 
272  ;   State  v.  Williamson,  67  N.  C.  12  ;  Reynolds  v.  State,  68  Ala.  502; 


82  DYING    DECLARATIONS. 

McPherson  v.  State,  22  Ga.  4  78;  People  v.  Wasson,  66  Cal.  538  :  People 
V.  Taylor,  59  Cal.  640. 

7.  JBefore  dying  declarations  are  received  in  evidence  it  should  be 
proved  that,  they  were  actually  made  in  expectation  of  impending  death, 
and  without  hope  of  recovery.  This  may  be  shown  by  the  nature  of  the 
injury,  by  what  the  injured  person  said,  or  by  what  the  physicians  and 
attendants  said  in  his  hearing,  by  the  state  of  his  mind,  and  by  the  facts 
surrounding  the  act. 

It  is  not  essential  that  the  injured  person  should  have  stated,  that  the 
declarations  were  made  in  expectation  of  death,  or  that  any  one  in  his 
presence  should  have  stated  that  his  death  was  impending,  or  must  follow  : 
People  V.  Simpson,  48  Mich.  474  ;  Ward  v.  State,  78  Ala.  441  ;  State  v. 
Patterson,  48  Vt.  308. 

8.  The  question  of  the  admissibility  of  the  declarations  is  a  judicial  one, 
and  is  to  be  determined  by  the  court  from  all  the  circumstances  of  the 
case. 

The  province  of  the  court  is  to  pass  upon  the  admissibility  of  the 
declarations.  Their  weight  and  effect  are  to  be  determined  by  the  jury 
alone:  Campbell  v.  State,  38  Ark.  509;  Walker  v.  State,  37  Texas,  366; 
People  V.  Maine,  16  N.  Y.  113. 

9.  Dying  declarations  may  be  given  in  evidence  as  well  in  favor  of  the 
prisoner  on  the  trial  as  against  him:  Moon  v.  State,  11  Ala.  764;  R.  v. 
Scaife,  1  M.  &  Rob.  551  ;  3  Russell  on  Crimes  (5th  Ed.),  361,  ??. 

10.  Where  a  child  is  of  intelligent  mind,  and  fully  comprehends  the 
nature  and  effect  of  an  oath,  his  declarations  made  under  a  belief  of  im- 
pending death  are  admissible  :  R.  v.  Pike,  3  C.  &  P.  598  ;  R.  v.  Perkins, 
2  Moo.  C.  &  C.  135  ;  9  C.  &  P   395  ;  Wharton,  Cr.  Ev.  (9th  Ed.),  §  290. 

11.  The  deceased  must  be  shown  to  have  been  in  such  a  state  of  mind, 
at  the  time  the  declarations  were  made  or  signed,  as  to  have  had  a  full 
and  clear  understanding  of  the  document  he  signed  or  of  the  declaration 
made:  Winfield  v.  State,  15  Neb.  484;  Mitchdl  v.  State,  71  Ga.  128; 
McHugh  V.  State.  31  Ala.  317. 

12.  The  general  rule  of  evidence  applies  to  all  cases  alike,  whether  the 
defence  be  insanity,  self-defence,  or  an  alibi,  as  to  dying  declarations. 

Dying  declarations  are  regarded  by  the  law  as  secondary  evidence,  and 
will  be  received  and  treated  bv  the  judges  as  such:  Boyle  v.  State,  105 
Ind.  469;  s.  c.  55  Am.  Rep.  218;  State  v.  Yansent,  80  Mo.  67  ;  Lambert 
V.  State,  23  Miss.  322 ;  Peo])le  v.  Knapp,  1  Edm.  Select  Cases  (N.  Y.),  177. 

13.  If  the  deceased  would  be  incompetent  as  a  witness,  if  living,  for 
any  cause,  his  declarations  could  not  be  received — 

a.  If  convicted  of  an  infamous  crime: 

b.  If  an  insane  person: 

c.  If  incompetent  for  an V  reason  :  1  Greenleaf  oji  Ev.  (Hth  Ed.),  §  157; 
Nesbit  V.  State.  43  Ga.  238;  Walker  v.  State.  39  Ark.  220. 

As  to  insanity:  Bolin  v  State,  9  Lea  (Tenn.),  516  ;  Donelly  v.  State, 
2  Putch.  (N.  J.),  463;  State  v.  Ah  Lee,  8  Oregon,  314.] 


coroners'  inquests.  33 


CHAPTER    II. 

COROXEKS'    IXQITESTS. TRIALS. SUBPCENAS. MEDICAL    FEES. DUTIES     OF    MEDICAL     -^TIT- 

ri'ESSES. — MEDICAL  SECRETS. QU0TAT10>S  FROM  BOOKS. PRESENCE    IN  COURT. TECHNI- 
CAL TERMS. LICENSE  OF  COUNSEL  RULES  FOR  THE    DELIVERY  OF  EVIDENCE. EXPERTS, 

EXPERT  TESTIMONY  AND  OPINION   EVIDENCE. 

Coroners''  Inqueds. — The  proceedings  at  coroners'  inquests  are  treated 
too  lightly  by  medical  men.  The  ignorant  and  uneducated  class  of  persons 
who  often  constitute  the  jury,  as  well  as  ihe  circumstances  under  which  the 
inquiry  takes  place,  are  not  calculated  to  inspire  great  respect  for  these 
initiatory  proceedings  ;  but  still  by  law  and  custom  coroners'  inquisitions 
are,  and  have  been  for  ages  in  this  country,  the  only  tribunals  for  inquir- 
ing into  and  determining  the  cause  of  death  in  cases  of  suspected  violence  ; 
and  they  are  therefore  deserving  of  more  attention  than  is  usually  shown 
to  them  by  medical  witnesses.  As  a  rule,  in  all  inquests  which  are  likely 
to  end  in  a  committal  of  the  accused  person,  a  medical  man  who  is  giving 
his  evidence  before  a  coroner  in  the  room  of  a  small  country  inn  or  in  a 
village  school-room,  is  virtually  delivering  it  before  a  judge  of  assize  ;  and 
this  fact  alone,  if  not  a  respect  for  the  court,  should  induce  him  to  give  his 
evidence  guardedly,  and  with  a  due  consideration  to  the  serious  results  to 
which  it  may  ultimately  lead.  The  Coroners'  Act,  1887  (50  and  51  Yict, 
c.  71,  s.  1),  directs  that  "  where  a  coroner  is  informed  that  the  dead  body 
of  a  person  is  lying  wnthin  his  jurisdiction,  and  there  is  reasonable  cause 
to  suspect  that  such  person  has  died  either  a  violent  or  unnatural  death, 
or  has  died  a  sudden  death  of  which  the  cause  is  unknown,  or  that  such 
person  has  died  in  prison,  or  in  such  place  or  under  such  circumstances  as 
to  require  an  inquest  in  pursuance  of  any  Act,  the  coroner,  whether  the 
cause  of  death  arose  within  his  jurisdiction  or  not,  shall,  as  soon  as  prac- 
ticable, issue  his  Avarrrant"  for  an  inquest;  and  the  Lunacy  Act,  1890 
(53  Vict.  c.  5,  s.  84),  directs  that  "  every  coroner  shall,,  upon  receiving- 
notice  of  the  death  of  a  lunatic  within  his  district,  if  he  considers  that  any 
reasonable  suspicion  attends  the  cause  and  circumstances  of  the  death,  sum- 
mon a  jury  to  inquire  into  the  same."  The  information  upon  which 
a  coroner  generally  acts  is — 1.  Notice  from  a  beadle,  or  other  officer 
of  the  parish  (whose  zeal  is  sometimes  stimulated  by  a  fee  or  salarv), 
of  any  death  from  sudden  or  supposed  unusual  causes.  2.  JN'otice 
from  a  medical  man  who  may  have  attended  the  deceased,  and  who  com- 
municates his  suspicion  that  the  cause  of  death  was  not  natural.  3.  Notice 
from  a  registrar  of  deaths  that  no  cause  has  been  assigned  in  a  particular 
case,  or  that  there  had  been  a  rapid  death  after  a  short  illness.  The  con- 
clusion to  which  experience  leads  in  reference  to  these  inquiries  is,  that 
the  system  affords  no  certainty  for  the  detection  of  crime;  that  it 
afl'ords  no  protection  to  those  who  are  wrongly  charged  with  crime ; 
and,  lastly,  that  in  some  cases  it  screens  a  criminal  by  a  verdict 
based  upon  an  imperfect  inquiry,  in  which  the  important  medical  facts  are 
either  not  understood  or  are  misinterpreted  by  the  jury.  Xo  preliminary 
test  of  ability  or  capacity  is  required  of  the  coroner,  although  the  Coroners' 
Act,  1887,  states  that  he  shall  be  a  "fit  person." 

[The  office  of  coroner,  originallv  one  of  great  dignity  and  closely  allied 
8 


O-i  OFFICE    OF    CORONER. 

to  the  Crown  of  England,  was  brought  to  America  by  the  Colonists,  as  a 
part  of  the  inheritance  of  the  common  law,  and  may  be  said  to  exist  in 
most  of  the  American  States,  with  common  law  incidents,  except  as  modi- 
tied  by  special  statutes.  Originally  a  coroner  must  needs  be  a  knight,  but 
the  office  has  greatly  deteriorated  in  England  and  America.  It  has  been 
abolished  in  Massachusetts,  and  we  think  Rhode  Is-land,  but  the  powers 
and  duties  are  very  similar  in  America  to  those  of  that  oflBcial  in  England.] 
In  Scotland  the  office  of  coroner  does  not  exist;  but  in  place  of  this, 
there  is  an  officer  named  Procurator  Fiscal,  generally  a  skilled  solicitor, 
nominated  by  competent  authority,  and  not  elected  by  scot  and  lot  voters. 
The  general  order  issued  to  these  officers  by  the  Lord  Advocate,  enjoins 
that  in  cases  wbere  a  dead  body  is  discovered,  the  Procurator  Fiscal  shall 
obtain  a  medical  report  of  the  cause  of  death  ;  and  in  cases  of  persons 
found  dead,  the  body  is  generally  inspected  for  this  purpose.  This,  how- 
ever, is  at  the  option  of'the  appointed  officer,  the  instruction  being  in  these 
words: — "  Wherever,  in  his  opinion,  a  written  medical  report  is  necessary 
for  the  due  consideration  of  the  case,  he,  the  Procurator,  shall  obtain  such 
a  report  from  a  duly  qualified  medical  practitioner."  The  usual  practice 
in  England  is  to  select  the  nearest  medical  practitioner,  whether  he  has 
had  any  experience  or  not,  and  often  to  trust  an  important  and  delicate 
pathological  inquiry  in  the  hands  of  one  who  probably  has  never  before 
made  an  inspection. 

Under  the  present  system  coroners  are  empowered  by  the  Coroners' 
Act  (50  and  51  Vict.  c.  71,  s.  21)  to  issue  an  order  for  the  attendance  of 
any  legally  qualified  practitioner,  "at  the  time  in  actual  practice  in  or  near 
the  place  Avhere  the  death  happened."  A  fee  of  two  guineas  is  the  maxi- 
mum allowed  for  making  a  post-mortem  examination,  and,  if  considered 
necessary  by  the  jury,  a  chemical  analysis  of  the  stomach  and  intestines. 
A  penalty  of  five  pounds  is  attached  to  disobedience  of  this  order,  except 
for  reasonable  cause.  It  is  further  enacted  (50  and  51  Yict.  c.  *7l,  s.  21) 
that  "if  a  majority  of  the  jury  sitting  at  an  inquest  are  of  opinion  that 
the  cause  of  death  has  not  been  satisfactorily  explained  by  the  evidence  of 
the  medical  practitioner  or  other  witnesses  brought  before  them,  they  may 
require  the  coroner  in  writing  to  summon  as  a  witness  som.e  other  legally 
qualified  medical  practitioner  named  by  them,  and  further  to  direct  a  post- 
niortera  examination  of  the  deceased,  with  or  without  an  analysis  of  the 
contents  of  the"  stomach  or  intestines,  to  be  made  by  such  last-mentioned 
practitioner,  and  that  whether  such  examination  has  been  previously 
made  or  not,  and  the  coroner  shall  comply  with  such  requisition,  and  in 
default  shall  be  guilty  of  a  misdemeanor." 

Ko  medical  man  can  be  compelled  to  undertake  that  which  he  feels 
incompetent  to  perform  ;  and  some  medical  practitioners  who  have  felt 
this  want  of  experience  have  properly  declined  to  make  chemical  analyses 
involving  so  serious  a  responsibility.  It  is  thus  that,  in  cases  of  import- 
ance, analyses  for  coroners'  inquests  are  now  referred  to  experts  appointed 
by  the  Home  Secretary,  and  the  practitioner  discharges  himself  of  that 
responsibility  which  the  Coroners'  Act  imposes  upon  him  without  any 
adequate  remuneration.  A  coroner  can  obtain  this  assistance  free  of  cost 
on  application  to  the  Home  Secretary. 

Medical  men  are  too  ready  to  give  their  opinions  of  the  cause  of  death 
for  a  coroner's  inquest  without  making  a  post-mortem  examination  of  the 
body.  No  man  is  compelled  to  give  an  opinion  upon  insufficient  data,  and 
if  by  the  institution  of  a  judicial  inquiry  there  are  grounds  for  believing 
that  a  death  has  not  been  natural,  no  medical  opinion  of  the  cause  should 
be  given  in  the  absence  of  an  autopsy.     Such  an  opinion  must  always  be 


TRIAL    AT    THE    ASSIZES.  35 

conjectural,  and  may  involve  the  medical  man  in  an  unpleasant  responsi- 
bility. 

Ti'ial  at  the  Assizes. — The  next  sta>re  of  the  proceedin,2'S  in  a  criminal 
case  brings  a  medical  witness  before  a  trial  court.  For  this  purpose  the 
witness  is  bound  over  by  the  coroner  or  magistrate,  or  a  subpoena  is 
issued.  Every  witness  is  bound  to  obey  a  subpoena,  when  with  it  his 
reasonable  expenses  for  the  journey,  etc.,  are  tendered  to  him;  but  he  is 
not  bound  to  attend  the  trial  except  upon  a  subpoena,  or  when  bound  over. 
[In  the  United  States  no  payment  of  fees  is  required  in  criminal  cases. 
Every  citizen  is  bound  to  obey  such  calls,  as  to  facts  within  his  knowledge, 
and  the  accused  is  entitled  to  compi^lsory  process  to  obtain  the  presence 
of  witnesses  in  his  favor,  without  prepayment  of  fees.]  There  are  some 
questions  connected  with  this  subject  which  it  will  be  proper  to  consider 
in  this  place.  If  a  subpoena  is  served  on  an  ordinarip  or  skilled  medical 
loitness,  is  he  bound  to  obey  it '^  In  Betts  v.  Clifford  (Warwick  Lent 
Ass.,  1858)  Lord  Campbell  stated,  in  answer  to  a  question,  that  a  scientific 
witness  was  not  bound  to  attend  upon  being  served  with  a  subpoena,  and 
that  he  ought  not  to  be  subpoenaed.  If  the  witness  knew  any  question 
of  fact,  he  might  be  compelled  to  attend,  but  he  could  not  be  compelled  to 
give  his  attendance  to  speak  to  matters  of  opinion. 

In  Rich  u.  Pierpoint,  an  action  for  malapraxis,  Lee  was  summoned 
against  his  will  to  give  evidence  on  the  part  of  the  plaintiff.  He  stated 
that  on  the  evening  before  the  trial  a  solisitor  called  on  him  and  left  a 
subpoena  with  him.  Lee  w^ould  not  hear  any  account  of  the  case  which 
the  solicitor  proposed  to  give,  and  expressed  his  resolution  to  have  nothing 
to  do  with  the  trial.  The  solicitor  informed  him  that  he  would  be  required 
to  pay  the  usual  penalty  if  he  did  not  attend.  He  went  to  Kingston,  and 
was  warned  not  to  leave  the  Court  until  the  trial  was  over.  He  heard 
the  evidence  on  the  part  of  the  plaintiff,  and  upon  this  and  the  medical 
evidence  he  gave  his  opinion — not  much  in  favor  of  the  party  who  sum- 
moned him,  and  not  much  against  him.  Lee  considered  that  he  could  not 
avoid  attending  the  trial  under  these  circumstaaces.  (Med.  Times  and 
Gaz.,  1862,  i.  p.  389.) 

In  the  case  of  Webb  v.  Page  (Carrington  and  Kirwan's  Reports,  p.  23) 
the  late  Maule,  J.,  ruled  as  follows: — "There  is  a  distinction,"  said  his 
Lordship,  "between  the  case  of  a  man  who  sees  a  fact  and  is  called  to 
prove  it  in  a  court  of  justice,  and  that  of  a  man  who  is  selected  by  a  party 
to  give  his  opinion  on  a  matter  on  which  he  is  peculiarly  conversant  from 
the  nature  of  his  employment  in  life.  The  former  is  bound,  as  a  matter 
of  public  duty,  to  speak  to  a  fact  which  happens  to  have  fallen  within  his 
own  knowledge,  for  without  such  testimony  the  course  of  justice  must  be 
stopped.  The  latter  is  wider  no  such  obligation ;  there  is  no  such  neces- 
sity for  his  evidence,  and  the  party  who  selects  him  must  pay  him."  In 
the  case  referred  to,  a  skilled  witness  had  been  subpoenaed,  but  he  .refused 
to  give  evidence  unless  first  paid  for  his  services  and  loss  of  time  (Med. 
Times  and  Gaz.,  18fi2,  i.  p.  432).  A  barrister,  who  quotes  this  ruling, 
goes  on  to  say:  "There  is  one  reason  why  I  should  not  advise  any 
person  in  the  position  of  a  skilled  witness  totally  to  disregard  a  subpoena. 
It  is  quite  clear  that  should  such  a  person  fail  to  attend  a  trial  no  attach- 
ment could  issue,  even  if  he  were  called  as  is  usual  upon  the  subpoena, 
because  the  party  subpoenaing  him  could  not  make  the  requisite  affidavits 
that  he  was  damnified  by  the  witness's  absence,  and  in  what  respect.  But 
such  party  might  bring  an  action  for  damages;  and,  although  he  would 
recover  none,  he  might  not  only  worrv,  but  might  even  put  the  defendant 
to  a  considerable  expense,  as  taxed  costs  by  no  means  include  the  entire 


86  '    OBEDIENCE    TO    SUBPCENAS. 

costs  in  such  cases.  Althons>:h,  therefore,  I  could  not  advise  a  total 
neglect  of  the  subpoena,  the  saleht  course  would  be  to  obey  it,  and  demand 
expenses  before  giving  evidence.  Such  expenses  would  be  only  those 
allowed  for  a  professional  witness  (not  special  fees),  but  if  the  person  so 
subpoenaed  were  willing  to  run  the  risk  of  an  action,  he  might  safely 
absent  himself  without  any  fear  of  an  attachment  from  the  court  for  con- 
tempt." With  regard  to  the  question  whether  a  skilled  witness  would 
be  permitted  to  demand  a  high  fee  for  his  attendance  under  such  circum- 
stances, the  writer  adds:  "To  permit  him  legally  to  demand  a  high  fee 
would  perhaps  look  somewhat  like  legally  countenancing  a  bribe."  At 
all  events  there  is  no  such  legal  recognition. 

In  a  case  which  came  before  the  Court  of  Exch.  (Maxted  v.  Morris, 
May,  1868),  a  witness  wilfully  disobeyed  a  subpoena.  In  consequence 
of  this  the  trial  w^  postponed,  and  the  parties  were  put  to  great  expense. 
An  arrangement  was  made  by  which  the  witness  bound  himself  to  pay  a 
part  of  the  expenses.  The  Chief  Baron  said :  It  must  be  distinctly 
understood  that  in  all  cases  where  it  appeared  lo  the  court  that  there  had 
been  a  wilful  disobedience  of  a  subpoena  after  proper  service,  such  a  con- 
tempt of  court  would  be  visited  with  the  punishment  it  deserved.  Martiv, 
B. :  It  was  not  to  be  tolerated  that  a  man  should  exercise  any  discretion 
as  to  whether  he  would  or  would  not  attend  a  court  in  pursuance  of  sub- 
poena. Enormous  costs  were  incurred  in  preparing  a  case  and  bringing  it 
down  to  trial,  the  Avhole  of  w^hich  were  to  be  thrown  away  and  wasted, 
because  a  man  refused  to  obey  a  lawful  summons  to  attend  as  a  witness. 
Figott,  B. :  A  subpoena  was  not  to  be  treated  as  mere  waste  paper. 
Public  justice  required  that  persons  wilfully  committing  contempt  of  court 
should  be  dealt  with  in  such  a  manner  as  to  teach  them  that  they  could 
not  commit  a  contempt  of  court  with  impunity. 

Lord  Campbell's  dictum  in  reference  to  the  distinction  between  fact  and 
opinion  confers  no  practical  benefit  on  wn'tnesses.  It  is  at  all  times  diffi- 
cult in  science,  and  in  the  medical  sciences  particularly,  to  separate  them  ; 
and  if  a  man  appears  to  testify  to  a  medical  or  scientific  fact,  he  cannot 
avoid  giving  an  opinion  arising  out  of  the  fact.  In  -an  action  against  a 
druggist  for  a  mistake  in  compounding  medicine,  an  attempt  was  made  to 
procure  the  author's  opivion  as  a  skilled  witness  at  the  trial,  by  reason  of 
facts  obtained  from  the  report  of  a  chemical  anal3^sis,  the  real  object  of 
which  was  at  the  time  entirely  concealed.  The  suit  was  fortunately  com- 
promised, and  attendance  was  not  necessar}^,  but  such  a  case  should  con- 
vey a  caution  to  chemical  experts.  They  may  be  employed  under  untrue 
statements  to  make  analyses  ;  these  become  facts  on  which  they  may  be 
summoned  like  ordinary  witnesses  to  give  opinions  as  skilled  witnesses, 
while  the  payment  of  the  usual  fee  for  a  skilled  witness  is  evaded. 

It  would  appear  from  the  following  case  (Maskerry  v.  O'Connor,  Q.B., 
June,  18'73),  that  medical  men  residing  w-ithin  the  "Bills  of  Mortality" 
are  placed  under  exceptional  circumstances.  The  plaintiff,  a  girl  seven 
years  old,  appeared  by  her  father,  claiming  damages  of  the  defendant  by 
reason  of  personal  injuries  sustained  from  careless  driving.  Leslie  was 
called  to  prove  the  nature  of  the  injuries,  but  he  declined  to  give  evidence 
unless  his  medical  fees  ^vere  first  paid.  It  appeared  that  he  had  been 
served  with  a  subpoena  without  any  fee.  A  shilling  was  then  tendered 
him,  but  he  still  declined  to  give  evidence  until  either  his  expenses  were 
paid  or  there  was  an  undertaking  to  pay  them.  Quain,  J.,  ruled  that  as 
Leslie  resided  within  the  "  Bills  of  Mortality,"  all  that  he  was  entitled  to 
was  one  shilling  on  his  subpoena.  The  witness  then  produced  a  report  of 
a  case  in  which  a  medical  man  had  successfully  insisted  on  his  fees  being 


MEDICAL    WITNESSES.  37 

paid  before  giving  evidence,  but  it  appeared  that  he  did  not  reside  within 
the  "Bills  of  Mortalit^^"  Leslie  was  accordingly  sworn.  The  juiw  re- 
turned a  verdict  of  damages  against  the  defendant,  and  the  judge  refused 
to  certify.  It  may  be  remarked  of  these  Bills,  which  ^vere  commenced  in 
1592,  that  since  1S4U  they  have  been  superseded  in  fact  but  not  in  law  by 
the  Registrar-General's  weekly  returns.  They  included  latterly  148 
parishes  in  Middlesex  and  Surrey,  but  excluded  the  large  parishes  of 
Marylcbone  and  St.  Pancras.  The  payment  of  medical  fees  should  not 
depend  upon  the  witness  living  within  or  without  an  antic|uated  boundary 
of  this  kind. 

In  a  case  tried  at  the  Carnarvon  Assizes,  Aug.  18T2,  a  medical  man 
bad  refused  to  sign  the  depositions  which  had  been  taken  before  the 
magistrates  without  being  guaranteed  a  higher  fee  than  that  allowed  by 
the  county  tariff.  Bovil,  C.J.,  told  the-  witness  that  the  Act  of  Parlia- 
ment imposed  an  obligation  upon  him,  and  he  had  no  power  to  refuse, 
and  if  he  did  so  on  another  occasion  he  would  be  liable  to  be  indicted  for 
disobedience.  The  judge  held  that  a  medical  man  has  no  right  to  fix  the 
amount  of  his  expenses,  but  must  always  take  the  allowance  the  law 
gives  him.  (Lancet,  18T2,  ii.  p.  204.)  [In  the  United  States,  this  rule 
would  apply  to  a  medical  man  called  as  a  witness  to  facts  within  his 
knowledge;  bat  not  to  experts  who  are  called  to  give  their  opinions  as 
such  ;  as  the  law  does  not  as  a  rule  fix  the  amount  of  compensation  ; 
that  is  left  to  arrangement  between  counsel  and  witness.] 

Medical  Wityiesses. — Assuming  that  the  medical  man  has  obeyed  a 
subpoena,  he  will  now  be  required  to  attend  before  the  court,  and  to  state, 
in  the  face  of  adverse  counsel,  the  opinions  which  he  has  formed  from  the 
medical  facts  of  the  case,  as  well  as  the  grounds  for  these  opinions.  He 
will  then,  for  the  first  time,  undergo  the  ordeal  of  a  public  examination. 
Some  medico-legal  writers  have  considered  it  necessary  to  lay  down  rules 
respecting  the  manner  in  which  a  medical  witness  should  give  his  evidence; 
how  he  is  to  act  on  cross-examination,  and  in  what  way  he  is  to  recover 
himself  on  re-examination.  Any  advice  upon  this  head  appears  to  be 
superfluous  ;  since  experience  shows  that  these  rules  are  invariably  for- 
gotten at  the  very  moment  w^hen  a  person  is  most  in  need  of  them.  A 
man  Avho  goes  to  testify  to  the  truth  to  the  best  of  his  ability  should  bear 
in  mind  two  points :  1.  That  he  should  be  well  prepared  on  all  parts  of  the 
subject  on  which  he  is  about  to  give  evidence.  He  should  act  on  these 
occasions  upon  the  advice  contained  in  the  Latin  motto,  ne  tentea  aut 
perfice.  2.  That  his  demeanor  should  be  that  of  an  educated  man,  and 
suited  to  the  serious  occasion  on  which  he  appears,  even  although  he  mav 
feel  himself  provoked  or  irritated  by  the  course  of  examination  adopted. 
A  medical  witness  must  not  show  a  testy  disposition  in  having  his  pro- 
fessional qualifications,  his  experience,  his  means  of  knowledge,  or  the 
grounds  for  his  opinions  very  closely  investigated  :  he  should  rather  pre- 
pare himself  to  meet  with  good  humor  the  attempts  of  an  adverse  coun- 
sel to  involve  him  in  contradiction,  and  show  by  his  answers  that  he  has 
only  a  desire  to  state  the  truth.  Law  and  custom  have  long  established 
that  a  bai-rister,  in  defending  a  prisoner,  has  a  right  to  make  use  of  all 
fair,  and  even  what  may  appear  to  the  witness  unfair,  means  for  the 
defence.  Nothing  can  tend  more  to  lovVer  a  witness  in  the  opinion  of  the 
court  and  jury,  and  to  diminish  the  value  of  his  evidence,  than  the  mani- 
festation of  a  disposition  to  deal  with  his  examiner  as  if  he  were  a  per- 
sonal enemy,  to  evade  the  questions  put,  or  to  answer  them  with  flippancy 
or  anger.  All  such  exhibitions  invariably  end  in  the  discomfiture  of  the 
witness.     It  has  been  suggested  that  medical  men  on  these  occasions  might 


38  LICENSE    OF    COUNSEL. 

take  a  lesson  from  lawyers,  and  observe  how  little  they  allow  forensic 
differences,  which  they  put  on  with  their  professional  costume,  to  influence 
them  in  their  intercourse  with  each  other  or  with  an  adverse  judge  or 

Scientific  experts  sometimes  lay  themselves  open  to  rebuke  by  setting- 
up  a  claim  of  infallibility.  In  the  English  courts  this  is  unusual,  but  in 
France  and  Italy,  where  argument  is  allowed,  it  is  i'requently  witnessed. 
In  a  trial  at  Florence,  involving  a  medico-legal  question,  the  medical  ex- 
pert exclaimed  in  full  court,  "Be  abaglio  io,  sbaglia  la  scienza.  If  I  err, 
science  errs." 

Medical  men  have  complained,  and  on  many  occasions  justly,  of  the 
license  of  counsel.  On  this  subject  it  may  be  well  to  consider  what  has 
been  said  by  a  late  high  authority  on  the  Bench,  Erie,  C.J.: — "  The  law 
trusts  the  advocate  with  a  privilege  in  respect  to  the  liberty  of  speech 
w4iich  is  in  practice  bounded  only  by  his  own  sense  of  duty  ;  and  he  may 
have  to  speak  upon  subjects  concerning  the  deepest  interests  of  social  life, 
and  the  innermost  feelings  of  the  soul.  The  law  also  trusts  him  with  a 
power  of  insisting  upon  answers  to  the  most  painful  questioning,  and  this 
power  again  is  in  practice  only  controlled  by  his  own  view  of  the  interests 
of  truth."  (Judgment  in  Kennedy  v.  Brown,  1862.)  Thus  it  will  be  seen 
that  almost  unlimited  powers  of  interrogation  are  intrusted  to  counsel  by 
the  law,  and  it  is  a  serious  question  whether  the  unrestricted  use  of  these 
enormous  powers  is  necessary  to  the  administration  of  justice.  One  of 
the  most  severe  reprimands  on  this  abuse  came  from  the  same  judge  in  a 
case  which  was  before  him  in  1857  ;  and  was  to  this  efCect :  A  question 
had  been  put  throwing  on  the  witness  an  imputation  for  Avhich  there  was 
really  no  foundation.  The  judge  then  said :  "  The  freedom  of  question 
allowed  to  the  bar  was  a  public  nuisance,  and  the  barrister  who  made  such 
an  imputation  ought  to  be  prosecuted.  If  a  question  had  relation  to  the 
truth,  he  was  most  anxious  it  should  be  put,  but  to  cast  haphazard  impu- 
tations at  the  suggestion  of  a  person  (an  attorney)  who  might  have  no 
scruples  as  to  what  he  did,  was  a  degree  of  mischief  that  made  him  Avish 
that  a  party  should  be  prosecuted.  He  begged  leave  to  say  that  in  his 
experience  he  had  seen  counsel  so  abuse  their  privilege,  that  he  had  cor- 
dially wished  a  power  could  be  instituted  that  they  might  be  prosecuted 
for  a  misdemeanor." 

Some  medical  men  have  claimed  a  privilege  not  to  ansAver  certain  ques- 
tions which  are  put  to  them,  on  the  ground  that  the  matters  have  come  to 
their  knowledge  through  private  and  confidential  communications  with 
their  patients;  but  the  law  concedes  no  special  privilege  of  this  nature  to 
members  of  the  medical  profession.  No  man  is  bound  to  reply  to  any 
question  if  the  answer  would  tend  in  any  way  to  incriminate  himself — 
for  no  man  is  compelled  to  be  a  witness  against  himself.  With  this  ex- 
ception, all  questions  must  be  answered,  provided  they  are  relevant  to  the 
case;  and  their  relevancy  is  a  matter  for  the  consideration  of  the  judge. 

Sometimes  a  witness  makes  a  frivolous  objection  and  refuses  to  answer 
an  ordinary  question,  thus  bringing  only  ridicule  upon  himself.  A  skilled 
expert,  at  an  important  trial,  was  asked  his  age.  Instead  of  answering  so 
simple  a  question  at  once,  he  angrily  appealed  to  the  judge  to  know 
whether  he  was  bound  to  give  an  answer  on  a  matter  Avhich,  as  he  said, 
could  have  nothing  to  do  with  the  case.  The  judge  informed  him  that 
unless  he  had  some  very  strong  reasons  for  concealing  it,'  he  had  better 
state  it.  At  a  trial  for  murder  by  poison,  in  the  course  of  a  cross- 
examination,  counsel  for  the  prisoner  asked  the  medical  witness  what 
remedy  or  antidote  he  had  employed  when  he  was  first  called  to  attend  the 


MEDICAL    SECRETS.  39 

deceased.  He  appealed  to  the  judge  to  know  whether  he  was  bound  to 
answer  such  a  question  as  that.  Juchje:  "Yes,  unless  you  have  reason 
to  believe  that  your  antidote  killed  the  deceased.  In  that  case  vou  are 
not  bound  to  answer  ii!"     The  question  was  immediately  answered. 

As  there  is  no  special  privilege  granted  to  members  of  the  profession, 
a  witness  must  remember  that  there  are  i}0  viedi.cal  aecreta.  ]n  the  case 
of  the  Duchess  of  Kingston  this  privilege  of  withholding  statements  was 
claimed  by  a  medical  witness,  but  rejected.  In  the  case  in  which  a  woman 
was  indicted  for  the  murder  of  her  infant,  a  surgeon  was  called  to  prove 
certain  confessions  made  to  him  by  her  during  his  attendance  on  her.  He 
objected,  on  the  ground  that  he  was  then  attending  her  as  a  private  patient. 
Park,  J.,  said  that  this  was  not  a  sufficient  reason  to  prevent  a  disclosure 
for  the  purpose  of  justice,  and  he  was  ordered  to  answer  the  question. 
Any  statements,  therefore,  which  are  made  to  physicians  or  surgeons 
while  attending  persons  in  a  private  capacity,  although  they  are  not  to 
be  volunteered  in  evidence,  must  be  given  in  answer  to  questions,  what- 
ever consequences  may  ensue.  Cases  of  poisoning,  wounding,  and  child- 
murder,  as  well  as  cases  which  involve  questions  of  life-insurance,  divorce, 
or  the  legitimacy  of  offspring,  may  be  materiallv  affected  by  the  answers 
of  a  medical  man  on  matters  which  have  been  the  subject  of  private  com- 
munications. A  professional  man  who  claims  a  privilege  where  none  is 
allowed,  is  endeavoring  to  set  himself  above  the  law.  There  is  no  real 
breach  of  confidence  under  the.se  circumstances,  because,  as  Gordon  Smith 
justly  observes,  "  Society  in  general  receives  the  authority  of  courts  as 
paramount  to  all  obstacles  and  private  considerations,  so  that,  in  vielding' 
to  such  an  authority,  a  professional  man  will  be  fully  acquitted  even  in 
the  opinion  of  those  who  may  be  the  sufferers  by  his  evidence  The  ex- 
pressed opinion  of  the  judge  will  be  a  full  indemnity  for  the  witness." 
(Analysis  of  Med.  Evid.,  p.  98.)  Any  medical  man,  however,  who  vol- 
untarily violated  the  confidence  reposed  in  him  by  a  patient,  or  who  com- 
municated professional  secrets  to  counsel,  apart  from  a  public  necessitv  in 
court,  would  justly  lay  himself  open  to  censure. 

[There  is  a  wide  divergence  of  opinion  between  the  views  of  English 
common  law  jurists,  and  the  legal  and  medical  profession  in  many  States 
of  the  American  Union  upon  this  subject. 

The  statute  of  the  State  of  New  York  provides  as  follows:  "  No  per- 
son duly  authorized  to  practise  physic  and  surgery  shall  be  allowed  to  dis- 
close any  information  which  he  may  have  acquired  in  attending  any 
patient  in  a  professional  character,  and  which  information  was  necessary 
to  enable  him  to  prescribe  for  such  patient  as  a  phj'sician  or  to  do  anv  act 
for  him  as  a  surgeon."  (2  Rev.  Statutes  406,  part  3,  chap.  7,  title  3, 
sec.  73.) 

By  section  834  of  the  Code  of  Civil  Procedure  of  the  State  of  New 
Y'"ork,  it  is  enacted  as  follows:  "A  person  duly  authorized  to  practise 
physic  or  surgery  shall  not  be  allowed  to  disclose  any  information  which 
he  acquired  in  attending  a  patient  in  a  professional  capacity,  and  which 
was  necessary  to  enable  him  to  act  in  that  capacity." 
,    The  Code  of  Civil  Procedure  of  New  York  provides  as  follows  : — 

Section  833:  "A  clergyman  or  other  minister  of  anv  religion  shall 
not  be  allowed  to  disclose  a  confession  made  to  him  in  his  professional 
character,  in  the  course  of  discipline  enjoined  by  the  rules  or  practice  of 
the  religious  body  to  which  he  belontrs."  This  provision  mav  be  also 
found  in  the  Revised  Statutes  of  New  York,  at  2  R.  S.,  406,  part  3,  ch.  7, 
tit.  3,  sec.  72. 

Section  835  :    "  An  attornev  or  counsellor-at-law  shall  not  be  allowed 


40  MEDICAL    PRIVILEGE. 

to  disclose  a  communication  made  by  his  client  to  him,  or  his  advice  given 
thereon,  in  the  course  of  his  professional  employment." 

Section  836  :  "  The  last  three  sections  (833,  834,  and  885)  apply  to 
every  examination  of  a  person  as  a  witness,  unless  the  provisions  thereof 
are  expressly  waived  by  the  person  confessing,  the  patient,  or  the  client." 

Section  836  was  amended  by  an  enactment  of  the  Legislature  of  the 
State  of  New  York  in  1891,  chap.  381,  by  adding  to  it  the  following  lan- 
guage :  "  But  a  physician  or  a  surgeon  may,  upon  a  trial  or  examination, 
disclose  any  information  as  to  the  mental  or  physical  condition  of  a  patient 
who  is  deceased  which  he  acquired  in  attending  such  patient  professionall}^, 
except  confidential  communications  and  such  facts  as  would  tend  to  dis- 
grace the  memory  of  the  patient,  when  the  provisions  of  section  834  have 
been  expressly  waived  on  such  a  trial  or  examination  by  the  personal  rep- 
resentatives of  the  deceased  patient,  or  if  the  validity  of  the  last  will  and 
testament  of  such  deceased  patient  is  in  question,  by  the  executor  or  exec- 
utors named  in  said  will." 

Tlie  following  amendment  was  passed  by  the  New  York  Legislature 
in  1892  :— 

Section  1.  Section  eight  hundred  and  thirt3'"-six  of  the  Code  of  Civil 
Procedure,  is  hereby  amended  so  as  to  read  as  follows  : — 

§  836.  The  last  three  sections  apply  to  any  examination  of  a  person  as 
a  witness  unless  the  provisions  thereof  are  expressly  waived  upon  the  trial 
or  examination  by  the  person  confessing,  the  patient  or  the  client.  But  a 
physician  or  surgeon  may  upon  a  trial  or  examination  disclose  any  infor- 
mation as  to  the  mental  or  physical  condition  of  a  patient,  who  is  deceased, 
which  he  acquired  in  attending  such  patient  professionally,  except  confiden- 
tial communications  and  such  facts  as  would  tend  to  disgrace  the  memory 
of  the  patient,  when  the  provisions  of  section  eight  hundred  and  thirty- 
four  have  been  expressly  waived  on  such  trial  or  examination  by  the  per- 
sonal representatives  of  the  deceased  patient,  or  if  the  validity  of  the  last 
will  and  testament  of  such  deceased  is  in  question,  b}^  the  executor  or 
executors  named  in  said  will,  or  the  surviving  husband,  widow,  or  an 
heir-at-law  or  any  of  the  next  of  kin  of  such  deceased,  or  any  other  party 
in  interest.  But  nothing  herein  contained  shall  be  construed  to  disqualify 
an  attorney  on  the  probate  of  a  will  heretofore  executed  or  offered  for 
probate  or  hereafter  to  be  executed  or  offered  for  probate,  from  becoming 
a  witness  as  to  its  preparation  and  execution  in  case  such  attorney  is  one 
of  the  subscribing  witnesses  thereto. 

Session  Laws  N.  Y.  1892,  chap.  514,  p.  111.  The  following  American 
States  and  Territories  have,  by  legislative  enactment,  adopted  substantially 
the  provisions  contained  in  the  Eevised  Statutes  of  New  York  :  Arizona 
Territory,  Arkansas,  California,  Idaho,  Indiana,  Iowa,  Kansas,  Missouri, 
Montana,  Nebraska,  Nevada,  New  Y^'ork,  Ohio,  Oregon,  Utah  Territory, 
Washington,  Wisconsin,  Wyoming. 

The  States  and  Territories  which  have  not  legislated  upon  the  subject 
are  :  Alabama,  Colorado,  Connecticut,  Delaware,  Florida,  Georgia,  Maine, 
Massachusetts,  Mississippi,  Minnesota,  North  Carolina,  New  Hampshire, 
yew  Jersey,  New  Mexico  Territory,  Pennsylvania,  Rhode  Island,  South 
Carolina,  Tennessee,  Texas,  Yermont,  Virginia,  West  Virginia. 

The  fundamental  principle  of  law  which  should  control  the  question  may 
be  stated,  and  should  be  considered,  as  follows  : — 

Privileged  communications  may  be  defined  to  relate  to  that  class  of  evi- 
dence which,  on  grounds  of  public  policy,  courts  decline  to  receive  for  the 
reason,  that  its  admission  would  entail  greater  mischief  than  its  rejection, 
because  of  some  collateral  evil  to  third  persons  or  to  society  in  general. 


MEDICAL    SECRETS.  41 

The  following  examples  illastrate  the  reason  of  the  rule  :  secrets  of 
State;  communications  between  a  government  and  its  officials  ;  the  secrets 
of  the  jury-room  ;  judicial  consultations  ;  sources  of  inibrmation  on  which 
criminal  prosecutions  are  based;  communications  of  client  to  counsel; 
patient  to  physician,  penitent  to  priest,  and  between  husband  and  wife. 

The  discrimination  ag-ainst  physicians  in  respect  to  cojifidential  disclo- 
sures under  the  common  law  rule  seems  to  be  contrary  to  the  principle 
of  law  above  stated,  and  the  legislation  in  jXew  York  and  other  States 
extending-  the  privilege  to  physicians  and  surgeons,  has  been  in  response 
to  a  universal  pul)lic  sentiment,  that  public  policy  and  the  best  interests 
of  society  would  be  promoted  and  subserved,  by  interdicting  disclosures  by 
physicians,  which,  from  the  nature  of  their  intimate  relation  to,  and  knowl- 
edge of  the  family  secrets  of  their  patients,  they  must  necessarily  acquire 
as  well  from  observation  as  from  disclosure.  The  language  of  the  statutes 
is  more  in  the  interest  of  the  patient,  of  the  family  relation  and  of  society, 
than  of  the  physician 

"  He  shall  not  be  allowed  to  disclose,"  is  the  language  of  the  statutes. 

The  physician  who  has  taken  the  usual  oath  of  Hippocrates  has 
sworn  to  keep  such  secrets  inviolate,  and  that  physician  in  an  American 
State,  where  the  privilege  has  not  been  extended  by  statute,  who  should 
disclose  the  secrets  of  his  patient  would  encounter  public  odium  and  social 
ostracism,  so  universal  is  the  public  sentiment  against  any  disclosures  by 
a  physician  or  surgeon  of  the  professional  secrets  of  his  patients. 

The  sentiment  of  English  physicians,  where  theconimon  law  rule  is  en- 
forced, is  doubtless  correctly  stated  by  the  eminent  writer.  Prof.  C.  Mey- 
mote  Tidy,  in  his  work  on  Legal  Medicine  : — 

"  The  highest  legal  authorities  in  England  have  decided  that  medical  men 
enjoy  no  special  privilege  with  regard  to  secrets  of  a  professional  nature. 
In  other  words,  no  practitioner  can  claim  exemption  from  answering  a 
question  because  the  answer  may  or  would  involve  a  violation  of  secrecy, 
or  even  implicate  the  character  of  his  patient.  This  is  the  law,  and  how- 
ever it  may  be  defended  upon  legal  grounds,,  we  hope  there  are  not  a  few 
medical  men  who  would  prefer  to  sacrifice  their  personal  liberty  to  their 
honor.  It  seems  a  monstrous  thing  to  require  that  secrets  affecting  the 
honor  of  families  and  perhaps  confided  to  the  medical  adviser  in  a  moment 
of  weakness  should  be  dragged  into  the  garish  light  of  a  law  court,  there  to 
be  discussed  and  made  joke  of  bv  rude  tongues  and  unsympathetic  hearts." 
(1  Tidy's  Legal  Medicine,  20;    Phlla.  ed.) 

Prof.  R.  J.  Kiukead,  Lecturer  on  Medical  Jurisprudence  in  Queen's  Col- 
lege, Galway,  speaks  the  sentiments  of  Irish  medical  men  in  saying: — 

"  In  Great  Britain  and  Ireland  the  medical  practitioner  is  compelled  to 
answer  any  question,  although  it  may  involve  the  violation  of  a  solemn 
obligation  to  secrecy,  and  the  betrayal  of  a  trust  confided  to  him  in  one  of 
the  most  sacred  relationships  that  can  exist  between  men. 

"  Many  men,  it  is  to  be  hoped,  would  prefer  to  sacrifice  their  liberty,  rather 
than  their  honor  and  that  of  their  profession."  (Guide  to  Irish  Medical 
Practitioner,  by  Prof.  Kinkead,  p.  420.) 

Bv  the  Roman  law,  the  privilege  is  extended  to  physicians.  (Weiske, 
Pvechts,  Lexicon  XY.,  259,  ff.) 

By  the  Penal  Code  of  France  it  is  made  a  crime  for  a  physician  to  dis- 
close the  secrets  of  his  patient.     (Boniere,  Traits  des  Preuves,  sec.  1*79.) 

For  an  able  exposition  of  the  law  upon  the  sulyect,  see  paper  by  Mr. 
Albert  Bach,  "  Medico- Legal  Aspect  of  Privileqed  Commuyncations.''^ 
(Medifo-Legal  Journal,  June,  1892,  vol  X.,  p.  32.')] 

In  Wright  v.  Wilkin  (June,  18G5),  a  suit  involving  the  validity  of  the 


42  MEDICAL    PRIVILEGE. 

will  of  a  lady,  the  only  question  before  Kindersley,  Y.-C,  was  as  to  the 
costs,  occasioned  by  the  refusal  of  a  medical  witness  to  answer  a  question 
in  reference  to  the  disease  of  which  the  testatrix  had  died.  The  witness 
had  attended  the  testatrix,  and  on  being  asked  of  what  disease  she  had 
died,  he  refused  to  answer,  on  the  ground  of  professional  privilege,  and 
also  that  the  question  was  irrelevant.  The  Vice-Chancellor  said,  that  he 
could  not  possibly  see  the  relevancy  of  the  question  ;  and,  further,  of  what 
use  it  was  to  examine  witnesses  at  all  in  the  cause.  No  reason  was  given 
for  so  doing.  The  question  of  costs  would,  primd  facie,  have  been  left  till 
the  hearing,  but  that  it  was  a  dangerous  precedent  to  allow  a  witness  to 
decline  answering  on  such  grounds.  He  was  clearly  of  opinion  that  the 
witness  could  not  claim  professional  confidence  or  irrelevancy  as  an  excuse 
for  not  answering  the  question,  and  he  must  pay  the  costs.  From  this 
judgment  it  will  be  perceived  that  even  the  refusal  to  answer  an  irrelevant 
question  may  lead  to  the  infliction  of  a  heavy  penalty  on  a  medical  prac- 
titioner. A  man  M'-ho  refuses  to  answer  a  question  which  the  court  con- 
siders to  be  relevant  and  proper,  may  render  himself  liable  to  imprison- 
ment for  contempt.  In  a  case  in  the  Divorce  Court  (Babbage  v.  Babbage, 
1815),  the  wife  had  petitioned  and  obtained  a  decree  ??m  for  a  dissolution 
of  marriage  on  account  of  her  husband's  adultery.  Subsequently  to  this 
she  wrote  a  letter  to  her  medical  attendant,  admitting  that  she  herself  had 
been  guilty  of  adultery.  He,  when  called  as  a  witness,  declined  to  pro- 
duce the  letter  or  state  its  contents  on  account  of  professional  confidence. 
The  judge  said  he  knew  of  no  such  privilege  as  that  claimed  by  the  wit- 
ness. In  a  court  of  justice  he  was  bound  to  produce  or  state  the  contents 
of  the  letter.     See  also  a  case  by  Braxton  Hicks.   (Lancet,  1885,  ii.  p.  285.) 

The  question  of  medical  privilege  has  presented  itself  on  some  occasions 
in  a  medico-ethical  aspect,  as  where,  for  instance,  during  his  attendance  on 
a  patient,  a  suspicion  arises  in  the  mind  of  a  medical  man  that  the  person 
is  undergoing  slow  poisoning.  It  has  been  supposed  that  when,  under 
these  circumstances,  the  poisoner  was  himself  in  the  medical  profession, 
there  would  be  a  breach  of  etiquette  in  communicating  to  others  the  sus- 
picion entertained.  There  is  no  code  of  medical  etiquette  by  which  any 
member  of  the  profession  is  bound  to  conceal  the  fact  of  poisoning,  which 
he  believes  to  be  going  on  before  his  eyes,  whether  perpetrated  by  a 
medical  man  or  any  other  person  ;  and  at  the  same  time  there  is  a  higher 
code  of  ethics  which  makes  the  prevention  of  secret  murder  and  the  safety 
of  society  paramount  to  all  other  considerations. 

A  medical  man  must  take  care  not  to  charge  another  with  a  crime  upon 
loose  suspicion.  [Professor  Eeese  has  said  concerning  this  subject :  "  tin- 
questionably  it  is  the  first  and  paramount  duty  of  a  medical  man  to  protect 
his  patient  in  a  case  of  suspected  poisoning ;  but  he  should  be  equally 
careful  not  to  raise  suspicion  against  another — very  possibly  an  innocent 
person.  The  practice  of  some  medical  'experts'  in  swearing  to  the 
presence  of  poison,  not  only  \Ahere,  in  the  language  of  Sir  R.  Christison, 
'the  symptoms  deviate  a  little  from  the  ordinary  course,'  but  even  when 
they  are  perfectly  reconcilable  with  those  of  ordinary  disease,  cannot  be 
too  severely  reprobated,  especially  when  such  '  expert'  opinions  are  main- 
tained in  non-fatal  cases  in  the  absence  of  all  chemical  tests  on  the  food 
and  drinks,  and  on  the  urine  and  other  excreta  of  the  patient."]  If,  from 
the  nature  of  the  symptoms,  the  absence  of  any  natural  cause  for  the  ill- 
ness, and  the  inefficiency  of  ordinary  remedies,  he  suspects  that  the  patient 
is  under  the  influence  of  poison,  it  his  duty  to  lose  no  time  in  confirming 
or  removing  that  suspicion  by  a  proper  medical  and  chemical  investigation. 
If  his  suspicion  is  confirmed  by  the  discovery  of  poison  in  the  food  or 


DUTIES    OF    MEDICAL    MEN.  43 

urine,  then  steps  must  be  immediately  taken  to  save  the  life  of  the  patient. 
In  Re<^.  V.  VA-'ooler  (Durham  Wint.  Ass.,  1855),  in  which  the  prisoner  was 
charged  with  the  murder  of  his  wife  by  secretly  adnjinisteriny  to  her 
arsenic,  three  medical  men  weve  in  attendance.  There  was  a  suspicion 
that  arsenic  was  being  administered  to  the  deceased  nineteen  days  before 
her  death  ;  but  the  fact  was  not  made  known  because  these  gentlemen 
Avere  unable  to  satisfy  themselves  conclusively  that  arsenic  was  present  in 
the  urine.  They  appealed  to  high  authority  to  aid  them,  but  the  advice 
reached  them  too  late — the  patient  had  died,  and,  as  it  was  clearly  proved, 
from  the  effects  of  arsenic.  The  judge  who  tried  this  case  said  :  '•  When 
the  idea  of  poisoning-  struck  them  they  ought  to  have  communicated  their 
suspicion  to  the  husband,  if  they  did  not  suspect  him,  and  if  they  did  su.s- 
pect  him  they  ought  to  have  gone  before  a  magistrate,  and  not  have  gone 
on  from  the  8th  to  the  2Tth  June  seeing  the  woman  murdered  before  their 
eyes."  Christison,  in  commenting  upon  this  case,  very  properly  takes  " 
exception  to  this  advice,  and  any  man  acting  upon  it  would  expose  him- 
self to  an  action  for  slander.  "Ideas"  of  poisoning"  often  arise  in  cases 
of  disease  where  the  symptoms  deviate  a  little  from  the  ordinary  cour.se, 
but  they  are  dismissed  on  further  observation.  If,  in  the  absence  of  the 
means  or  knowledge  of  applying  chemical  tests,  or  of  taking  the  opinions 
of  others  experienced  in  toxicology,  a  medical  man  charged  the  husband 
of  a  woman  with  secret  poisoning,  or  went  before  a  magistrate  and 
charged  him  publicly,  he  would  be  acting  with  rashness,  ruin  his  own 
practice  and  reputation,  and  be  mulcted  in  heavy  damages  for  the  irre- 
parable injury  done  by  a  false  accusation.  Such  a  step  should  be  taken 
upon  something  more  than  a  suspicion.  A  prudent  and  conscientious 
man  will  always  await  the  result  of  a  chemical  analysis  before  giving  pub- 
licity to  a  suspicion  which  may  after  all  turn  out  to  be  unfounded  ;  and 
he  will  lose  no  time  in  obtaining  this  necessary  confirmation  or  a  removal 
of  his  doubts. 

When  the  suspicion  is  confirmed,  there  is  some  difference  of  opinion  as 
to  the  course  to  be  pursued.  Christison  advises  that  when  a  medical  man 
is  satisfied  of  the  fact  of  poisoning,  he  should  communicate  his  conviction 
to  the  patient  himself,  and  that  he  ought  not  to  be  deterred  by  the  chance 
of  injury  to  his  patient  from  making  even  so  dreadful  a  disclosure.  He 
will  have  thus  taken  the  surest  preparative  step  to  prevent  a  repetition  of 
the  poisoning.  Whether  this  communication  be  made  to  the  patient  or 
not,  the  proper  course  will  be  to  place  the  matter  immediately  in  the 
hands  of  a  magistrate  for  investigation.  The  author  was  consulted  in  a 
case  of  supposed  slow  poisoning.  The  symptoms  suffered  by  a  lady, 
taken  as  a  whole,  were  not  reconcilable  with  any  disease.  The  medical 
man  had  an  "idea"  that  poisoning  might  possibly  be  the  cause,  but  before 
acting  upon  this  idea  he  sent  to  the  author  a  portion  of  urine  for  examina- 
tion. Antimony  was  found  in  it,  and  the  cause  of  the  symptoms  was  at 
once  explained.  The  medical  attendant  communicated  the  result  of  the 
analysis  to  the  members  of  the  family,  and  the  symptoms  of  poisoning 
ceased  from  that  time.  In  one  instance  within  the  editor's  knowledge, 
the  suspicion  of  poisoning  was  communicated  to  the  husband  of  the 
patient.  He  at  once  committed  suicide;  and  chemical  anal_vsis  proved  the 
secret  administration  of  arsenic.  In  another  case,  strychnine  was  found 
in  some  cocoa  of  which  a  lady  had  partaken.  The  fact  Avas  communicated 
by  the  medical  attendant  to  a  magistrate ;  and  thus  the  medical  man  was 
relieved  of  further  responsibility.  In  a  third  case  a  Avoman  was  seen  by 
three  medical  men  in  consultation;  and  two  of  them  Avere  of  opinion  that 
she  was  being  sloAvly  poisoned  by  antimony.     The  third  was  of  a  contrary 


4-1  EX  AMI  NATION- IN- CHIEF CROSS-EXAMINATION. 

opinion.  Some  urine  from  the  patient  was  forthwith  sent  for  anal3''sis. 
!Xo  antimony  was  found  ;  and  the  patient  died  very  shortly  afterwards 
from  cancer  of  the  abdominal  viscera.  Each  case  must  be  treated  on  its 
own  merits.  The  error  committed  by  medical  men  is,  on  these  occasions, 
not  in  claiming-  a  privilege  of  concealment,  but  in  allowing  a  doubt  upon 
so  serious  a  question  to  remain  in  their  minds  for  days  or  weeks. 

This  question  was  brought  into  prominence  at  the  trial  of  Dr.  Pritchard 
at  Edinburgh  (July,  1865),  on  the  charge  of  poisoning  his  wife  with  anti- 
mony. One  of  the  medical  witnesses,  who  saw  the  deceased  a  fortnight 
before  her  death,  and  at  other  times,  stated  in  his  evidence  at  the  trial 
that  he  suspected  she  was  suffering-  from  the  effects  of  antimony  when  he 
ffrst  saw  her,  but  it  seems  that  there  the  matter  was  allowed  to  remain.  No 
one  was  accused,  but  no  step  was  taken  to  prevent  the  continuance  of  the 
poisoning-,  the  suspicion  of  which  turned  out  to  be  well-founded.  Lord 
Justice  Clerk,  who  tried  this  case,  is  reported  to  have  said  that  no  notions 
of  medical  etiquette  should  be  permitted  to  interfere  with  those  higher 
duties  which  every  right-minded  man  owes  to  his  neighbor,  and  which 
are  to  be  expected  in  a  tenfold  degree  from  every  medical  man,  because 
his  life  is  solemnly  devoted  to  the  preservation  of  life  and  the  prevention 
of  its  destruction. 

Examinotion-in-cliief. — The  ordinary  course  of  proceeding  in  a  criminal 
case  is  thus  concisely  stated  by  Stephen,  J.: — After  opening  the  case,  the 
counsel  for  the  Crown  calls  the  witnesses,  and  examines  them  according 
to  the  rules  of  evidence — that  is,  he  brings  out,  by  questions  which  do  not 
suggest  their  answerfi,  the  facts  relevant  to  the  issue  to  be  tried  which  are 
within  his  personal  knowledge.  Those  questions  which  do  suggest  the 
answers  are  called  "leading"  questions.  With  one  exception  it  is  not 
the  practice  to  allow  these  to  be  put  in  this  part  of  the  examination.  The 
exception  is:  "When  the  judge  is  satisfied,  either  by  a  Mntness's  de- 
meanour or  by  contradictions  between  the  evidence  and  the  depositions, 
that  he  is  trying  to  keep  back  the  truth  and  favor  the  prisoner,  he  may, 
in  his  discretion,  allow  the  counsel  for  the  Crown  to  ask  leading  questions, 
and,  as  the  phrase  is,  to  treat  the  witness  as  hostile."  When  the  ex- 
amination-in-chief is  closed,  the  next  step  is  the  cross-examination. 

Cross-examination. — In  this,  the  second  stage,  the  counsel  for  the 
prisoner  extracts  from  the  medical  witness,  by  questions  which  may  sug- 
gest the  answers  in  the  strongest  form,  any  facts  that  may  appear  to  be 
favorable  to  his  client,  and  which  he  believes  to  be  within  the  witness's 
knowledge.  Leading  questions  are  not  only  allowable  in  this  part  of  the 
examination,  but,  according  to  good  authority,  a  counsel  for  the  defence 
can  hardly  lead  too  ranch.  The  theory  of  the  law  is  that  the  witness  is 
unfavorable  to  the  prisoner  and  has  come  to  bear  evidence  against  him. 
The  more  he  has  shown  himself  by  conduct  or  conversation  a  partisan  in 
the  case,  the  more  severely  will  he  be  treated.  Anything  which  he  may 
have  .said  in  the  hearing  of  others,  or  published  in  journals,  or  even 
written  in  private  letters  (if  the  contents  transpire),  in  reference  to  the 
case,  or  the  guilt  of  the  prisoner,  is  now  brought  to  light,  although  he  may 
have  supposed  that  what  he  did  say  was  in  pei-fect  confidence.  It  is  at 
this  stage  of  the  case  that  any  exaggerations  which  may  have  been  most 
favorably  received  Ijy  the  counsel  for  the  prosecution  are  reduced  to 
their  true  proportions.  Any  bias  by  which  the  mind  of  a  witness  may 
have  been  influenced,  or  any  imperfection  or  confusion  of  memory  as  to 
facts,  is  here  brought  out.  It  is  in  this  part  of  his  examination  that  a 
witness  will  be  closely  questioned  as  to  his  qualifications,  his  age,  the  time 
during  which  he  has  been  engaged  in  practice,  the  accuracy  of  his  judg- 


RE-EXAMINATION QUOTATIONS    FROM    BOOKS.  45 

merit,  his  g'eneral  professional  knowlodj^e,  and  his  special  experience  in 
reference  to  the  matter  in  issue,  the  number  of  cases  he  has  seen,  etc. 
Straijihtforward  answers  should  be  given  to  all  these  questions.  No 
harm  can  be  done  to  the  witness  by  the  answers  unless  they  are  given 
evasively,  since  it  is  not  to  be  supposed  that  a  witness  wishes  to  represent 
himself  differently  from  what  he  is.  If  he  does  make  the  attempt,  he 
will  assuredly  fail.  The  most  striking  distinction  between  the  examina- 
tion-in-chief and  cross-examination  is  in  reference  to  leading-  ({uestions. 
It  rests  upon  the  assumption  that  there  is  a  danger  that  a  witness  will 
say  whatever  is  suggested  to  him  by  the  one  side,  and  conceal  everything- 
that  is  not  extorted  from  him  on  the  other.  It  need  scarcely  be  observed 
that  witnesses  whose  evidence  is  of  little  importance  in  the  case  are  rarely 
cross-examined.  This  is  reserved  in  its  most  stringent  form  for  those 
whose  facts  and  opinions  are  likely  to  affect  the  fate  of  a  ])risoner  on  a 
criminal  trial.  In  dealing  with  a  skilled  witness  whose  evidence  may  be 
of  importance,  the  questions  in  cross-examination  are  usually  put  by  the 
counsel  for  the  prisoner  with  great  caution,  or  the  answers  brought  out 
may  be  even  more  adverse  to  his  own  case  than  those  elicited  in  the 
examination-in-chief. 

lie-e.xaminatiov . — The  cross-examination  is  usually  followed  by  a  re- 
examination on  the  part  of  the  counsel  for  the  Crown,  or  of  the  counsel 
by  whom  the  witness  has  been  called.  The  object  of  this  is  to  clear  up  or 
explain  any  portion  of  the  evidence  wiiich  may  have  been  rendered 
obscure  or  doubtful  by  the  cross-examination.  It  is  sometimes  unneces- 
sary to  put  a  question,  and  if  the  witness  has  given  his  evidence  consist- 
ently and  fairly,  no  questions  may  be  asked.  As  a  rule  the  re-examination 
must  be  confined  to  those  matters  which  have  arisen  out  of  the  cross- 
examination.  Any  questions  upon  new  subjects  may  render  a  further 
cross-e.xamination  on  them  necessary.  In  reference  to  facta,  a  medical 
witness  must  bear  in  mind  that  he  should  not  allow  his  testimony  to  be 
influenced  by  the  consequences  which  may  follow  from  his  statement  of 
them,  or  their  probable  effect  on  any  case  which  is  under  trial.  In  refer- 
ence to  ofdnions,  their  possilile  influence  on  the  fate  of  a  prisoner  should 
inspire  caution  in  forming  them,  but  when  once  formed  they  should  be 
honestly  and  candidly  stated  without  regard  to  consequences.  It  will  Ije 
well  to  remember,  in  reference  to  each  stage  of  the  examination,  what 
William  Hunter  has  said  : — "  To  make  a  show  and  appear  learned  and 
ingenious  in  natural  knowledge  may  flatter  vanity.  To  know  facts,  to 
separate  them  from  supposition,  to  arrange  and  connect  them,  to  make 
them  plain  to  ordinary  capacities,  and  above  all  to  point  out  their  useful 
applications,  should  be  the  chief  object  of  ambition." 

Quotations  from  Books. — It  is  a  not  unfrequent  custom  with  counsel 
to  refer  to  medical  works  during  the  examination  of  a  witness.  He  is 
expected  to  have  a  fair  knowledge  of  the  writings  of  professional  men  on 
the  subject  of  inquiry.  The  authority  is  mentioned,  the  passage  is  quoted, 
and  the  witness  may  be  then  asked  whether  he  agrees  with  the  views  of 
the  author  or  whether  he  differs;  and  if  so,  his  reasons.  In  cases  con- 
nected with  medical  treatment,  the  views  of  the  profession  are  and  have 
been  so  various,  that  a  barrister  would  have  no  great  difficulty  in  finding 
some  book  to  oppose  to  the  opinions  of  a  witness.  Standard  works  of 
recent  date  are  so  well  known  to  the  profession,  that  there  are  few  medical 
men  engaged  in  practice  who  are  not  well  acquainted  with  and  able  to 
explain  the  views  of  the  writers,  and  how  far  they  agree  or  conflict  with 
their  own.  The  witness  must  be  on  his  guard  that  the  quotation  is  fairly 
made,  and  that  it  is  properly  taken  w,ith  the  context,  or  he  may  unex- 


46      MEDICAL  EVIDENCE QUOTATIONS  FROM  BOOKS. 

pectedly  find  himself  involved  in  a  difficulty.  On  one  occasion  a  barrister 
stopped  in  his  quotation  at  a  comma,  and  on  another  occasion  the  quota- 
tion ended  at  a  colon  ;  the  remainder  of  the  sentence  in  each  case 
materially  weakening  the  inference  which  it  was  intended  to  draw  with 
the  apparent  sanction  of  the  witness. 

When  a  quotation  from  a  standard  work  is  thus  opposed  to  the  evidence 
of  a  medical  witness,  he  should  ask  to  look  at  the  book,  and  see  by  refer- 
ence to  the  work  itself  that  the  passage  is  correctly  quoted.  A  remark- 
able instance  of  the  importance  of  this  caution  occurred  at  the  Swansea 
Lent  Ass.,  1869,  in  an  action  brought  against  a  railway  company  for 
compensation  for  personal  injury.  The  plaintiff  was  proved  to  have  had 
pneumonia  shortly  after  the  accident,  and  the  counsel  for  the  company 
wished  to  show  that  the  pneumonia  had  not  arisen  from  the  physical 
injury.  In  cross-examining  the  medical  witness  he  asked:  "Cannot 
pneumonia  be  produced  by  shock?"  Witness:  "  I  do  not  believe  it  to  be 
possible."  Counsel:  "What!  do  you  mean  to  say  you  do  not  believe 
what  is  asserted  in  fact  by  no  less  an  authority  than  Professor  Taylor? 
Have  you  read  Dr.  Taylor's  work  on  'Medical  Jurisprudence?'  "  Witness: 
"Yes."  Counsel:  "  Have  you  seen  the  last  edition  ?"  Witness:  "No." 
Counsel:  "  I  have  it  here  (turning  over  the  leaves  of  a  book),  and  a  case 
,is  given  of  pneumonia  being  caused  by  shock."  It  was  subsequently  dis- 
covered, on  referring  to  the  work,  that  the  case  in  question  was  one  in 
which  the  lung  had  been  wounded  b}^  a  fractured  rib.  The  cause  of  the 
pneumonia  was  thus  sufficiently  explained :  it  was  proved  to  have  been 
the  simple  result  of  physical  injury  and  not  of  shock.  A  reference  at  the 
time  to  the  work  which  is  quoted,  is  always  necessary  if  any  use  is  to  be 
made  of  a  quotation.  Without  suggesting  that  there  is  intentional  mis- 
representation to  bear  out  a  particular  view  of  the  case,  a  barrister  in 
dealing  with  the  medical  facts  may  wholly  misunderstand  the  author's 
views  and  statements,  and  in  some  instances  wrongly  assign  to  the  author 
himself  opinions  which  he  has  merely  quoted  from  other  authorities  for 
comment  or  illustration. 

As  a  rule,  the  works  of  a  living  author  cannot  be  quoted,  it  being  a 
legal  maxim  that  secondary  evidence  is  only  admissible  when  primary 
evidence  cannot  be  obtained:  hence,  as  a  living  author  can  be  called  as  a 
witness,  his  works  cannot  be  quoted  in  evidence.  (Reg.  v.  Lamson, 
C.C.C,  March,  1882.) 

[In  the  courts  of  our  country  books  of  science  are  usually  held  inadmis- 
sible. Medical  books  by  authors  admitted  or  proven  to  be  standard,  have 
been  admitted  with  proper  explanation  of  technicalities :  (Stoudenmeier  t'. 
Williamson,  29  Ala.  558;  Meckle  v.  State,  37  Ala.  139;  s.  c.  Ala.  Sel. 
Cases,  45  ;  Bowman  v.  Woods,  1  Green  (Iowa),  1 ;  Contra  Carter  v. 
State,  2  Ind.  617.)  The  court  may  in  its  discretion  prohibit  the  reading 
of  medical  or  scientific  books  to  the  jury  as  a  matter  of  evidence  or 
authority.  (Luning  v.  State,  1  Chand.  (Wis.),  178  ;  Wale  v.  Dewitt,  20 
Texas,  398  ;  Washburn  v.  Cuddhy,  8  Gray  (Mass.),  430  )  If  an  expert 
bases  his  opinion  upon  a  work  it  would  be  admissible  to  contradict  the 
expert.  (Bloomington  v.  Schrock,  110  111.  219;  s.  c.  51  Am.  Rep.  678.) 
In  Indiana  extracts  from  medical  works  were  excluded  as  evidence.  (Epp 
V.  State,  102  Ind.  529.)  Medical  works  are  so  contradictory  and  confusing 
that  courts  are  disinclined  to  allow  them  to  be  read  in  evidence,  as  they 
tend  to  confuse  and  mislead  juries.] 

Presence  in  Court. — In  England  medical  and  scientific  witnesses,  except 
under  special  circumstances,  are  allowed  to  be  present  in  court,  and  hear 
the  whole  of  the  evidence  of  the  case.     This  is  in  some  instances  abso- 


TRESENCE    OF    AVITNESSES    IN    COURT.  4T 

lutelj  necessary  if  the  court  requires  medical  opinions,  for  unless  the 
witnesses  are  fully  acquainted  w  ith  the  facts  they  can  give  no  opinions, 
and  they  can  only  become  well  acquainted  with  the  facts  by  beint>-  allowed 
to  be  present  and  hearin,i>'  the  evidence  in  court.  If  excluded,  thejudiie 
or  counsel  will  be  compelled  to  read  to  the  witness  notes  of  the  evidence 
before  an  opinion  can  be  g-iven,  and  it  may  then  appear  that  some  small 
point  which  counsel  did  not  think  of  importance,  has  been  omitted:  this, 
if  known  to  the  witness,  might,  however,  materially  affect  his  opinion.  A 
failure  of  justice  is  likely  to  occur  when  medical  witnesses  are  excluded, 
and  it  is  generally  when  there  is  no  defence  or  a  false  defence  that  the 
right  of  excluding  them  is  exercised.  The  rule  in  Scotland  is  similar  ; 
medical  and  scientific  witnesses  are  allow-ed  to  be  in  court  during  the  trial. 
The  examination  of  the  witnesses  for  the  Crown  is  followed  by  the  de- 
fence of  the  prisoner,  either  in  person  or  by  his  counsel,  who  acts  through- 
out the  part  of  an  advocate,  simply  securing  for  his  client  every  advantage 
the  facts  or  the  law  may  afford  him.  In  other  words,  he  sees  that  his 
client  is  tried  strictly  according  to  law,  and  not  condemned  contrary  to 
law^  A  key  to  some  of  the  difficulties  which  medical  witnesses  must  be 
prepared  to  encounter  will  be  found  in  the  exposition  given  by  Stephen, 
J.,  of  the  tacit  rules  which  regulate  the  duties  of  counsel  for  the  prosecu- 
tion and  defence  : — "In  practice  it  is  universally  admitted  that  the  counsel 
for  the  prosecution  is  morally  and  professionally  bound  always  to  keep  in 
sight  the  ultimate  object — namely,  the  discovery  of  truth ;  whereas  no 
such  obligation  is  laid  upon  the  prisoner  and  those  who  represent  him, 
because  it  is  too  much  to  expect  of  human  nature  that  they  should  dis- 
charge it,  and  it  is  better  not  to  impose  an  obligation  which  is  sure  to  be 
systematical!}"  violated.  Both  sides,  on  the  other  hand,  are  bound  in  the 
strongest  way  not  to  do  anything  to  propagate  falsehood.  The  counsel 
for  the  Crown  is  bound  not  to  suppress  any  fact  within  his  knowledge 
favorable  to  the  prisoner ;  and,  on  the  other  hand,  the  counsel  for  the 
prisoner  is  bound  not  to  bring  to  light  facts  within  his  knowledge  unfavor- 
able to  the  prisoner.  The  counsel  for  the  Crown  may  not  use  arguments 
to  prove  the  guilt  of  the  prisoner  which  he  does  not  himself  believe  to  be 
just,  and  he  is  bound  to  warn  the  jury  of  objections  w^hich  may  diminish 
the  weight  of  his  arguments ;  in  short,  as  far  as  rergards  the  evidence 
which  he  brings  forward,  his  speech  should  as  much  as  possible  resemble 
the  summing-up  of  the  judge.  He  should  contend  not  for  the  success  of 
his  cause  at  all  events,  but  for  the  full  recognition  by  the  judge  and  jury 
of  that  side  of  the  truth  which  makes  in  favor  of  it.  On  the  other  hand, 
the  counsel  for  the  prisoner  may  use  arguments  which  he  does  not  believe 
to  be  just.  It  is  the  business  of  the  jury,  after  hearing  the  judge,  to  say 
whether  they  are  or  are  not  just."  The  last  remark  shows  what  appears 
to  be  a  serious  defect  in  the  administration  of  the  criminal  law.  While 
in  a  case  of  misdemeanor  a  prisoner  may  be  tried  by  a  special  jury,  in  a 
case  of  felony,  involving  an  analvsis  of  important  questions  of  medical 
science  in  reference  to  murder  or  manslaughter,  the  trial  takes  place  before 
a  common  and  comparatively  ignorant  jury.  Such  a  jury  is  hardly  in  a 
position  to  cope  with  an  ingenious  counsel,  who  has  it  in  his  power  to 
misrepresent  and  distort  medical  facts  and  opinions  in  any  manner  that  he 
pleases.  The  defences  made  are  frequently  such  as  no  barrister  would 
venture  to  place  before  a  jury  of  educated  men. 

Another  observation  made  by  Stephen,  J.,  more  nearly  concerns  the 
medical  witness: — "There  are  many  obligations  which  affect  each  side 
equally.  Neither  is  at  liberty  to  attempt  to  browbeat,  intimidate,  or  con- 
fuse a  witness,  although  they  may  expose  any  real  confusion  which  exists 


48  PRESEJS'CE    OP    WITNESSES    IN    COURT. 

in  his  mind,  or  test,  by  the  strictest  cross-examination,  the  accuracy  of 
his  statements.  Neither  is  at  liberty  wilfulh^  to  misunderstand  a  witness, 
or  to  misstate,  in  his  address  to  the  jury,  the  eft'ect  of  what  he  has  said, 
either  by  distortion  or  suppression.  The  neglect  or  observation  of  these 
and  other  rules  of  the  same  kind  practically  establishes  a  wide  distinction, 
and  one  which  is  easih'  recognized,  between  those  who  exercise  a  noble 
profession  and  those  who  disgrace  it." 

Assuming  that  a  medical  witness  is  properly  prepared  for  the  discharge 
of  his  duties,  and  that  the  questions  put  to  him  are  answered  fair!}"  and 
truly,  according  to  his  knowledge  and  experience,  without  exaggeration 
or  concealment,  he  has  no  reason  to-fear  any  attempt  at  intimidation. 

The  normal  barrister,  as  depicted  by  Stephen,  J.,  is  not  at  liberty,  in 
his  address  to  the  jury,  to  misrepresent,  either  by  distortion  or  sup- 
pression, the  medical  facts  or  opinions  given  in  a  case.  According  to  our 
experience,  however,  misrepresentation  is  a  not  unfrequent  practice,  and 
one  of  which  medical  witnesses  have  very  strong  reason  to  complain. 
"Whether  such  misstatements  are  Avilful  or  not  it  may  be  difficult  to  de- 
termine, but  their  effect  on  a  jury  is  well  known  to  those  Avho  employ 
them,  and  they  frequently  escape  the  observation  of  the  counsel  on  the 
other  side,  and  even  of  the  judge,  unless  he  is  well  versed  in  medical 
subjects. 

Intimidation  is  sometimes  carried  ver}^  far.  On  a  trial  for  murder  by 
poisoning,  a  respectable  country  practitioner,  who  had  given  his  evidence 
for  the  Crown  in  a  fair  and  proper  manner,  was  thus  addressed  in  cross- 
examination  by  counsel: — "On  your  oath,  sir,  and  in  the  face  of  the 
whole  profession,  will  you  venture  to  persist  in  that  statement?"  etc.  A 
writer,  in  commenting  upon  this  subject,  says:  "But  the  hardest  and 
most  unfair  part  of  the  system  (of  cross-examination)  is  when  witnesses 
have  to  bear  a  loud  and  insulting  tone  or  gesture  without  remonstration 
or  retaliation."  At  the  trial  of  Kelly  for  the  murder  of  Police-constable 
Talbot  (Reg.  v.  Kelly,  Dublin  Commis.  Court,  Nov.  1871),  Tuffnell,  a 
surgeon  of  repute,  and  formerly  professor  of  surgery,  Avas  summoned  as 
a  witness  for  the  prosecution.  Having  deposed  to  the  nature  of  the 
wounds,  and  that  the  deceased  had  died  from  the  effects,  he  was  subjected 
to  the  usual  orde'al  of  a  cross-examination,  but  in  a  somewhat  unusual 
form.  Counsel  for  the  prisoner  having  begun  by  addressing  him  in  a 
loud  and  offensive  tone,  he  turned  to  the  Chief  Baron,  and  said,  "My 
Lord,  I  am  very  excitable,  and  if  this  gentleman  has  a  right  to  roar  at  me, 
I  consider  that  I  have  a  right  to  roar  too."  The  court  expressed  a  hope 
that  it  would  not  be  necessary  for  him  to  roar,  and  intimated,  after  a  short 
trial  of  vocal  strength  between  the  two  opponents,  that  counsel's  manner 
to  the  witness  was  not  what  it  ought  to  be.  Counsel  disclaimed  any 
intention  of  being  offensive,  but  claimed  the  liberty  which  is  usually  con- 
ceded in  cases  of  importance.  Whatever  may  be  the  importance  of  a  case 
to  a  prisoner,  nothing  can  justify  the  putting  of  questions  in  a  loud  and 
insulting  tone  to  a  skilled  professional  witness.  The  very  mild  rebuke 
administered  to  counsel  on  this  occasion  was  not  likely  to  produce  much 
effect,  and  accordingly  this  trial  presents,  in  a  concentrated  form,  all  the 
defects  of  our  method  of  getting  at  truth  by  cross-examination. 

Bides  for  the  delivery  of  Evidence. — There  are  a  few  rules  bearing 
upon  medical  evidence  which,  if  observed,  may  save  the  witness  from 
interruption  or  reproof,  and  place  him  in  a  favorable  position  with  the 
court : — 

1.  The  questions  put  on  either  side  should  receive  direct  answers,  and 
the  manner  of  the  witness  should  not  be  perceptibly  different,  whether  he 


RULES  FOR  THE  DELIVERY  OF  MEDICAL  EVIDENCE.     i\) 

is  replying  to  a  question  put  by  the  counsel  for  the  prosecution  or  for  the 
defence.  Most  of  the  questions  put  by  counsel  in  cross-examination  will 
admit  of  an  answer  "  yes"  or  "  no."  If,  from  the  ingenious  or  casuistical 
mode  in  which  the  question  is  framed,  the  witness  should  feel  that  the 
simple  affirmative  or  negative  miglit  mislead  the  court,  then,  after  giving 
the  answer,  he  can  appeal  to  the  judge  to  allow  him  to  qualify  it,  or  add 
to  it  any  matter  within  his  oivn  knowledge  and  which  is  at  the  same  time 
relevant  to  the  case.  The  witness  must  remember  that  he  takes  an  oath 
to  state  the  truth,  the  lohole  truth,  and  nothing  but  the  truth.  On  the 
other  hand,  while  the  counsel  for  the  defence  is  bound  not  to  introduce 
falsehood,  his  object  is  yiot  the  discover}^  or  development  of  truth.  Unless 
the  witness  is  on  his  guard,  he  may  find  that  his  affirmatives  and  nega- 
tives may  be  worked  into  a  shape  representing  the  reverse  of  what  he 
intended. 

Some  counsel  adopt  the  ingenious  plan  of  compressing  two  or  three 
questions  into  one;  or  they  submit  a  series  of  questions,  more  than  one 
of  which  may  contain  two  opposite  alternatives,  and  then  ask  for  a  plain 
answer  "yes"  or  "no"  to  both  of  them  together.  A  witness  may  un- 
thinkingly answer  that  question,  which  has  most  fixed  his  attention.  The 
same  answer  may  not  be  strictly  applicable  to  all,  but  it  may  be  found, 
Avhen  too  late,  that  it  is  made  so  in  the  defence.  Under  these  circum- 
stances he  should  ask  for  a  severance  of  the  questions  and  give  separate 
replies.  Direct  answers  are  necessary,  because  it  is  only  by  them  that 
the  case  can  be  brought  clearly  before  the  court  and  jury  in  all  its  details. 
Medical  witnesses  sometimes  forget  this,  and  fall  into  answers  to  questions 
floating  in  their  own  minds,  or  which  they  think  are  likely  to  be  put  to 
them.  They  are  also  sometimes  disposed  to  anticipate  many  questions  bv 
one  general  answer.  This  simply  creates  confusion,  and  the  witness  will 
be  told  by  counsel  to  keep  to  the  question,  and  that  he  is  coming  to  the 
other  matters  presently.  Care  should  Ije  taken  by  a  medical  witness  not 
to  argue  with  counsel.  Argument  is  not  evidence,  and  the  entering  into 
it  disturbs  the  order  of  the  proceedings.  Arguments  between  counsel  and 
w^itnesses,  and  even  between  medical  witnesses  themselves,  are  not  allowed. 
The  mode  in  which  questions  are  put  by  counsel  in  cross-examination 
sometimes  tends  to  the  introduction  of  argument,  but  the  witness  should 
avoid  the  temptation  to  enter  into  it.  What  he  says  under  such  circum- 
stances is  not  evidence,  except  in  the  form  of  answers  to  questions,  and 
he  is  there  only  for  the  purpose  of  stating  what  is  relevant  to  the  case. 

2.  The  replies  should  be  concise,  distinct,  and  audible ;  and,  except 
where  explanation  may  be  necessary,  they  should  be  confined  strictly  to 
the  terms  of  the  questions.  The  judge  who  tries  the  case  generally  takes 
full  notes  of  the  medical  evidence — hence  the  necessity  for  a  slow  and  dis- 
tinct delivery  of  the  evidence.  Some  witnesses  have  a  habit  of  not 
answering  the  question  which  is  asked,  but  one  which  is  not  asked.  Others 
give  an  answer  in  such  a  voluble  form  that  there  is  great  difficulty  in  re- 
ducing it  to  its  proper  proportions.  A  wntness  who  is  so  profuse  of  infor- 
mation generally  supplies  abundant  matter  for  a  long  and  troublesome 
cross-examination.  It  has  been  a  question  whether  a  witness  should  vol- 
unteer evidence,  assuming  that  the  examination-in-chief  and  cross-exami- 
nation have  failed  to  bring  out  all  that  he  knows  of  the  case.  If  that 
"which  he  has  to  state  is  some  matter  of  fact  within  his  own  knowledge, 
or  an  opinion  based  on  facts  within  his  knowledge,  he  will  be  allowed,  on 
application  to  the  judge,  to  make  the  statement  in  spite  of  the  efi'orts  of 
counsel  on  either  side  to  shut  it  out. 

It  is  scarcely  necessary  to  observe,  that  the  language  in  which  the 
4 


50    RULES  FOR  THE  DELIVERY  OF  MEDICAL  EVIDENCE. 

answers  are  returned  should  neither  be  technical  nor  metaphorical.  Coun- 
sel who  are  unacquainted  with  medical  terms  frequently  misapply  them,  or 
use  them  in  a  wrong-  sense.  On  a  trial  for  murder,  in  which  one  of  the 
questions  at  issue  was  whether  dysentery  or  poison  was  the  cause  of  death, 
the  counsel  puzzled  one  of  the  medical  witnesses  by  asking  him  whether 
during  his  attendance  he  found  any  traces  of  '' dysuria^^  in  the  feces. 
There  is  no  doubt  he  intended  a  state  of  the  feces  like  that  met  with  in 
dysentery,  but  the  professional  term  employed  by  him  signified  a  "  diffi- 
culty in  passing  urine."  A  judicious  witness  will  avoid  anything  like  a 
triumph  over  his  examiner  under  such  circumstances,  and  simply  put  him 
right. 

B.  Answers  to  questions  should  be  neither  ambiguous,  undecided,  nor 
evasive.  An  ambiguous  answer  necessarily  leaves  the  witness's  meaning 
doubtful,  and  calls  for  an  explanation.  An  undecided  answer  is  not  suffi- 
cient for  evidence.  Did  the  wound  cause  death  ?  Was  death  caused  by 
loss  of  blood,  or  by  poison  ?  If,  b}'-  a  proper  consideration  of  all  the 
medical  facts,  the  witness  has  come  to  a  conclusion  on  the  subject,  his 
answer  should  be  expressed  in  plain  and  decided  language,  either  in  the 
affirmative  or  negative.  A  man  who  has  formed  no  conclusion  is  not  in 
a  position  to  give  evidence.  No  opinion  should  be  given  for  which  the 
witness  is  not  prepared  to  assign  reasons,  and,  except  by  permission  of  the 
court,  no  medical  opinion  should  be  expressed  on  facts  or  circumstances 
observed  by  others'.  A  hesitating  witness  will  be  met  with  the  question, 
Have  you  any  doubt  about  it  ?  or,  Was  it  so,  or  not  ? — to  which  a  reply 
in  the  affirmative  or  negative  must  be  given.  If  the  witness  fairly 
entertains  doubts  about  the  matter  at  issue,  it  is  his  duty  to  express 
them,  and  not  allow  them  to  be  extorted  from  him  piecemeal  by  a  series 
of  questions. 

Chemists  have  occasionally  certified  to  the  discovery  of  "  imperceptible," 
"  unmistakable,"  or  "  undoubted"  traces  of  poison  in  the  liver,  etc. 
Such  terms  naturally  convey  to  the  shrewd  mind  of  an  examiner  that  the 
witness  has  some  lurking  doubt  or  suspicion  of  mistake  in  his  mind,  for 
that  of  which  we  are  sure  requires  no  such  terms  to  express  our  meaning. 
If  poison  has  been  discovered,  the  statement  of  the  fact  is  sufficient. 

4.  The  replies  should  be  made  in  simple  language,  free  from  technicali- 
ties and  exaggeration.  Some  remarks  have  been  elsewhere  made  in 
reference  to  the  use  of  technical  terms  in  drawing  up  medico-legal  reports 
(p.  14).  If  medical  men  could  be  made  aware  of  the  ridicule  which  they 
thus  bring  on  their  evidence,  otherwise  good,  they  would  at  once  try  to 
dispense  with  such  language.  A  witness  is  perhaps  unconsciously  led  to 
speak  as  if  he  were  addressing  a  medical  assembly,  instead  of  plain  men 
like  the  members  of  a  common  jur}^  who  are  Avholly  ignorant  of  the 
meaning  of  medical  terms,  and  barristers  who  are  but  imperfectly 
acquainted  with  them.  A  court  may  be  told  that  the  ''  ivtegvmevta  were 
rejiected  from  the  thorax,  and  the  codaJ  cartilages  laid  bare,  when  a 
wound  was  found  which  had  penetrated  through  the  anterior  medias- 
tinum,^^ and  had  involved  the  arch  of  the  aorta,  etc.  A  simple  cut  in  the 
skin  is  described  as  "  an  incision  in  the  integuments."  In  a  case  of 
alleged  child-murder,  a  medical  witness  being  asked  for  a  plain  opinion  of 
the  cause  of  death,  said  that  it  was  owing  "  to  atelectasis  and  a  general 
engorgement  of  the  pulmonary  tissue."  On  a  trial  for  an  assault,  a 
surgeon,  in  giving  his  evidence,  informed  the  court  that  on  examining 
the  prosecutor,  he  found  him  suffering  from  a  severe  contusion  of  the 
integuments  under  the  left  orbit,  with  great  extravasation  of  blood  and 
ecchymosis  in  the  surrounding  cellular  tissue,  which  was  in  a  tumefied 


RULES  FOR  THE  DELIVERY  OF  MEDICAL  EVIDENCE.     51 

state.  There  was  also  considerable  abrasion  of  the  cuticle.  "  Judge :  You 
mean,  I  suppose,  that  the  man  had  a  black  eye?  Witness:  Yes.  Jtidge: 
Then  why  not  say  so  at  once?"  It  would  be  easy  to  multiply  examples 
of  this  kind.  This  is  not  science,  but  pedantry,  and  if  such  lang-uage  is 
employed  by  a  witness  with  a  view  to  impressing-  the  court  with  some 
idea  of  his  learning,  it  wholly  fails  of  its  efl'ect.  Barristers  and  reporters 
put  down  their  pens  in  despair,  and  the  time  of  the  court  is  wasted  until 
the  witness  has  condescended  to  translate  his  ideas  into  ordinary  language. 
Lord  Hatherley  well  observed  that  "a  scientific  witness  in  giving  his 
(.■vidence  should  avoid,  as  much  as  possible,  the  use  of  technical  scientific 
language,  if  the  case  is  before  a  jury.  This  is  especially  desirable  when 
the  evidence  is  medical,  for  really  many  technical  words  in  medicine 
seem  to  be  invented  to  cover  ignorance.  But  be  this  as  it  may,  a  witness 
is  always  suspected  of  affectation,  and  the  court  and  jury  are  but  little 
instructed,  when  a  vast  amount  of  learned  phraseology  is  poured  forth 
instead  of  a  clear  statement  of  the  witness's  opinion." 

Exaggerated  language  should  be  avoided.  There  is  a  tendency  among 
some  medical  witnesses  to  express  their  own  views  in  the  superlative  de- 
gree. If  a  part  is  simply  inflamed,  it  is  frequently  described  as  "in- 
tensely" inflamed.  This  use  of  exaggerated  language  often  leads  to 
apparent  conflict  in  medical  testimony.  It  is  not  creditable  to  the  witness, 
and  throws  a  doubt  upon  the  whole  of  his  evidence. 

5.  In  giving  evidence  of  opinion  a  medical  witness  must  take  care  not  to 
base  it  on  any  statements  made  by  others,  or  on  circumstances  which  may 
have  come  to  his  knowledge  by  public  rumor.  Again,  his  evidence  should 
be  confined  only  to  subjects  properly  within  the  range  of  medical  science, 
and  on  which,  as  a  professional  man,  he  is  competent  to  speak.  In  a  trial 
for  murder  by  wounding,  in  which  the  identity  of  the  prisoner  was  in 
question,  a  medical  man  stated  that  he  compared  certain  footmarks  with 
the  boots  taken  from  the  prisoner,  and  he  found  that  they  corresponded. 
A  comparison  had  also  been  made,  but  not  at  the  same  time,  by  a  police 
officer,  more  accustomed  to  matters  of  this  kind.  On  cross-examination, 
there  was  such  a  want  of  agreement  between  the  surgeon  and  the  con- 
stable, respecting  the  number  of  nails  in  the  boots  and  the  number 
indicated  by  the  footprints,  that  no  reliance  could  be  placed  on  this  portion 
of  the  evidence.  In  reference  to  this  discrepancy,  the  learned  judge  re- 
marked that  a  medical  man  should  confine  himself  to  matters  belonging  to 
his  own  profession,  and  not  take  upon  himself  the  duties  of  a  police-con- 
stable. There  are  some  points  in  reference  to  gunshot  wounds  which 
can  be  better  explained  by  a  gun  or  shot-manufacturer  than  by  a  medical 
witness. —  Guique  in  sud  arte  credendum. 

Fees. — The  following  information  as  to  fees  payable  to  medical  wit- 
nesses may  be  useful  to  the  medical  practitioner  : — 

In  the  Supreme  Court  of  Judicature  and  in  the  Court  of  Appeals,  £1 
Is.  a  day  if  resident  in  the  metropolis ;  and  £2  2s.  to  £S  3s.  a  day  if 
resident  at  a  distance  from  the  place  of  trial,  inclusive  of  all  except 
travelling  expenses.  For  travelling  expenses  a  sum  not  exceeding  Sd. 
per  mile  each  way  if  there  be  a  railway,  and  6(7.  per  mile  each  way  if 
there  be  no  railway.  It  is  customary  to  pay  return  first-class,  or  some- 
times second-class,  railway  fare  only.  In  the  Divorce  Court,  £1  Is.  a 
day  if  resident  within  five  miles  of  the  General  Post-Office.  Higher 
charges  are  allowed  for  experts  Sundays  are  never  counted.  In  the 
County  Court,  10s.  to  £1  Is.  a  day  is  allowed.  At  Assizes,  medical  men 
attending  to  give  professional  evidence  are  usually  allowed  £1  Is.  a  day, 
2s.  for  every  night  they  are  away  from  home,  and  second-class  travelling 


52  EXPERT    EVIDENCE. 

expenses  by  rail,  or  a  sum  not  exceeding  ScZ.  a  mile  each  way  when  there 
is  no  railway. 

Every  registered  medical  practitioner  is  entitled,  if  formally  summoned, 
to  a  fee  of  £1  Is.  for  attending  to  give  evidence  at  a  coroner's  inquest, 
where  no  post-mortem  examination  is  ordered,  and  to  an  additional  fee  of 
£1  Is. — £2  2s.  in  all — when  an  examination  is  ordered.  The  fee  for  a 
post-mortem  examination  will  not  be  paid  if  the  examination  has  not  been 
ordered  in  writing.  These  fees  are  to  be  paid  by  the  coroner  immediately 
after  the  close  of  the  inquest.  There  is  no  provision  for  a  second  attend- 
ance at  an  adjourned  inquest,  nor  for  making  a  second  post-viortem  ex- 
amination. Some  coroners  are  in  the  habit  of  paying  £1  Is.  for  each 
day's  attendance.  Others  pay  ^1  Is.  only  for  all  the  attendances,  how- 
ever many.  No  unregistered  medical  practitioner,  whatever  his  diplomas 
may  be,  can  claim  fees  for  giving  medical  evidence.  In  all  cases  where 
attendance  is  required  in  a  civil  court  to  give  expert  evidence,  a  special 
agreement  should  be  made  in  writing,  binding  the  solicitor  who  requires 
the  attendance  to  himself  pay  the  fees,  as  these  are  only  recoverable  from 
principals,  unless  there  is  a  special  agreement  to  the  contrary. 

The  fee  for  attendance  in  a  Police  Court  is  10s.  %d.,  or  £\  Is.  if  more 
than  two  miles  distant. 

[In  the  United  States  the  fees  of  witnesses  in  civil  actions  are  regulated 
by  the  statutes  of  each  State.  In  New  York  in  civil  cases  the  fee  of  a 
Avitness  is  fifty  cents  per  day  and  eight  cents  a  mile,  one  way  for  each 
mile,  from  the  place  of  his  residence  to  the  court-house  where  the  trial  is 
had,  while  in  criminal  cases  no  fee  whatever  is  allowed. 

To  enable  the  medico-legal  jurist,  alienist  and  expert  to  understand  the 
present  state  of  the  law  regarding  experts,  and  expert  and  opinion  evidence, 
the  American  editor  has  given  a  carefully-prepared  statement  of  the  law 
as  it  now  exists,  with  a  full  reference  to  the  authorities  upon  each  branch, 
and  this  is  intended  for  the  use  of  lawyers  as  well  as  medical  men,  medico- 
legal jurists,  and  all  witnesses  who  are  called  as  experts,  or  to  give  expert 
opinions,  or  medical  evidence. 

1.  Experts  and  Expert  Testimony  and  Opinion  Evidence. — An  expert 
is  one  who  has  made  the  subject  upon  which  he  gives  his  opinion,  a  matter 
of  particular  study,  practice  or  observation,  and  he  must  have  a  particular 
and  special  knowledge  upon  the  subject  concerning  which  he  testifies : 
Page  V.  Parker,  40  N.  H.  59  ;  Jones  v.  Tucker,  41  N.  H.  134  ;  Heald  v. 
Thing,  45  Me.  392 ;  Mobile  Life  Ins.  Co.  v.  Walker,  58  Ala.  290  ;  Slater 
V.  Wilcox,  Barb.  N.  Y.  608;  Dole  v.  Johnson,  50  N.  H.  454;  Hyde  v. 
Woolfolk,  1  Iowa,  159  ;  State  v.  Phair,  48  Yt.  366  ;  Nelson  v.  Sun  Mutual 
Ins.  Co.,  n  N.  Y.  453-460;  Yander  Denckl  v.  Helluson,  8  M.  G.  &  S. 
812;  Bird  v.  State,  21  Graft.  (Ya.)  800;  Dickinson  v.  Fitchburgh,  13 
Gray  (Mass.),  546,  553;  Nelson  v.  Johnson,  18  Ind.  334;  Estate  of 
Toomes,  54  Cal.  514;  Travis  v.  Brown,  43  Pa.  St.  12;  Buffum  v.  Harris, 
5  R.  I.  250. 

2.  E.xpert  evidence  is  that  testimony  given  by  one  expert  and  specially 
skilled  in  the  subject  to  which  it  relates,  or  is  applicable ;  concerning 
information  beyond  the  range  of  ordinary  observation. 

3.  The  general  rule  of  law  is,  that  witnesses  must  testify  to  facts  and 
not  to  opinions:  Clark  v.  Fisher,  1  Paige  (N.  Y.),  Ill;  s.  c.  Am.  Dec. 
402;  Neilson  v.  Chicaijo,  etc.,  R.  Co.,  59  Wis.  516;  Watson  v.  Mil- 
waukee, etc.,  R.  Co.,  57  Wis.  332;  McNiel  v.  Davidson,  37  Ind.  336; 
l^indar  v.  Kings  Co.  Fire  Ins.  Co.,  36  'N.  Y.  648;  Bass  Furnace  Co.  v. 
Glasscock,  82  Ala.  452;  Heath  v.  Slocum,  115  Pa.  St.  549;  Amer.  and 
Eng.  Ene.  of  Law,  vol.  7,  p.  495  (note  1). 


EXPERT    AND    OPINION    EVIDENCE.  53 

a.  The  witness  must  only  state  facts  and  not  draw  conclusions  or  infer- 
ences from  facts:  Lunin.-i"  v.  State,  2  Pin.  (Wis.)  215;  s.  c.  Chand. 
(Wis.)  178;  s.  c.  2  Pin.  (Wis.)  285;  s.  c.  1  Chand.  (Wis.)  264;  Abbott 
V.  People,  8G  X.  Y.  460;  People  v.  Murphv,  101  N.  Y.  126;  Sloan  v. 
X.  Y.  Cen.  R.  Co.,  45  X.  Y.  125  ;  Campbell  v.  State,  10  Tex.  Ct.  of 
Appeals,  560. 

b.  It  has  been  held  that  to  allow  witnesses  to  draw  conclusions  from 
facts  or  inferences,  is  to  usurp  the  province  of  the  court  or  jury,  and  is 
illeo-al:  Booth  v.  Cleveland  Rolling  Mill  Co.,  Y4  N.  Y.  15  ;  s.  c.  11  Hun, 
278;  Allen  v.  Stout,  51  N.  Y.  668;  Campbell  v.  State,  10  Texas  App., 
500  ;  la  re  Sale  of  Infant  Land,  6  C.  C.  Greene  (X.  J.),  92. 

4.  Exceptions  to  the  General  Rule. — While  these  are  the  general  rules 
of  law,  there  are  exceptions  where  the  opinions  of  skilled  experts  may  be 
taken  as  before  stated  (supra,  3  a-b). 

a.  In  cases  of  necessity,  where  it  is  impossible  to  make  the  court  and 
jury  understand  the  matter  in  controversy  without  it. 

b.  To  inform  the  court  or  jury  as  to  physical  laws  or  phenomena,  which 
practice  dates  back  to  the  old  Roman  law:  L.  8,  section  1,  xl. ;  L.  3, 
section  4,  xi.  6.  And  this  has  been  followed  in  France :  2  Beck's  Med. 
Juris.,  896.  And  in  England  in  analogous  cases:  9  Henry,  7,  16  ;  7  Henry 
6,  11 ;  Buckley  v.  Rice,  1  Plow.  125. 

c.  To  show  the  results  of  voluminous  facts  collated  by  a  competent 
person  who  has  examined  and  is  shown  to  be  competent  to  make  the 
deductions:  Burton  v.  Driggs,  20  Wall.  (U.  S.)  125;  Ton  Sachs  v. 
Kretz,  72  X.  Y.  548;  s.  c.  10  Hun  (X.  Y.),  95. 

5.  Opinion  and  Opinion  Evidence. — Opinion  evidence  is  the  conclu- 
sions or  opinions  of  witnesses  concerning  propositions  based  upon  ascer- 
tained or  supposed  facts,  by  one  who  has  had  superior  opportunities  and 
greater  knowledge  than  the  ordinary  person  or  witness,  to  judge  of  the 
subject-matter  of  the  inquiry,  and  who,  by  reason  of  his  especial  knowl- 
edge of  and  experience  with  the  subject,  is  believed  to  be  capable  of 
arriving  at  a  better  and  more  reliable  conclusion  and  judgment  from  facts 
within  his  own  knowledge,  concerning  the  questions  involved  in  the  inquiry 
or  controversy. 

a.  Any  witness  not  an  expert,  who  personally  knows  the  facts,  may 
give  an  opinion  in  a  matter  regarding  skill,  after  having  stated  the  facts 
on  which  he  bases  his  opinion  ;  or  as  to  matters  with  which  he  is  especi- 
ally acquainted,  or  has  personal  or  peculiar  knowledge,  but  which  cannot 
be  exactlv  or  specifically  described  to  the  court  or  jury:  Indianapolis  v. 
Huffer,  30  Ind.  235;  Doe  v.  Reagan,  5  Blackf.  (Ind.)  217;  s.  c.  33  Am. 
Dec.  466  ;  Wilkinson  v.  Moselev,  30  Ala.  562  ;  S.  &  X.  Ala.  R.  Co.  v. 
McLeudon,  63  Ala.  266;  Chic,  etc.,  R.  Co.  v.  Gtorge,  19  Ilk  510;  Willis 
V.  Quimby,  11  Post.  (X.  H.)  485;  Elliott  v.  VanBuren,  33  Mich.  49; 
s.  c.  20  Am.  Rep  668;  Culver  v.  Dwight,  6  Gray  (Mass.),  444;  Irish 
V.  Smith,  8  S.  &  R.  Co.  (Pa.)  573;  Cole  i-.  State,  75  Ind.  511; 
Wharton's  Evidence,  section  512;  Stephens's  Evidence,  103;  Porter  v. 
Requonnoe,  etc.,  Co.,  17  Conn.  249;  Curtis  v.  Chic.  R.  R.  Co.,  18  Wis. 
312;  Bennett -u.  Mehan,  83  Ind.  566;  Ceru  r.  Doudican,  114  Mass.  257; 
State  t).  Folwell,  14  Kan.  105  ;  Alexander  v.  Jonquill  &  Sterling,  71  111. 
366  ;  Blake  v.  People,  73  X.  Y.  586  ;  Bradley  v.  Salmon  Falls  Mfg.  Co., 
30  X.  H.  487  ;  Ray  v.  State,  50  Ala.  104;  Raisler  r.  Springer,  38  Ala. 
703;  Aulago  Co.  v.  Davis,  32  Ala.  703;  Pook  v.  State,  62  Ala.  237; 
State  V.  Babb,  76  Mo.  501 ;  State  v.  Miller,  53  Iowa.  84. 

b.  An  expert  physician  may  testify  concerning  the  health  of  a  certain 
person  whom  he  knows  personally,  or  has  treated,  and  so  may  any  witness 


54:  EXPERT    AND    OPINION    EVIDEN<;E. 

not  an  expert,  as  to  facts  within  his  knowledge  and  observation,  regarding 
the  health  or  physical  condition  of  another,  or  whether  he  was  or  had 
been  apparently  in  good  health  :  Louisville,  etc.,  E.  Co.  v.  Wood,  12  N. 
E.  Rep.  572;  same  Plff.  v.  Falery,  104  Ind.  409;  Van  Deusen  v.  New- 
comer, 40  Mich.  120;  Tierney  v.  Minneapolis,  etc.,  K.  Co.,  24  Araer.  L. 
Keg.  669  ;  Higbie  v.  Guardian"'Mut.  Life  Ins.  Co.,  53  N.  Y.  603  ;  Smalley 
V.  City  of  Appleton,  35  N.  W.  Rep.  729  ;  Hanly  a;.  Merrill,  56  N.  H.  227  ; 
Cousin  V.  Sturtivant,  117  Mass.  122  ;  s.  c.  19  Amer.  Rep.  401  ;  Wilkinson 
V.  Moseley,  30  Ala.  562;  Barker  t).  Coleman,  35  Ala.  221  ;  Carthage,  etc., 

Co.  V. ,  102  Ind.  138  ;  Evans  v.  People,  12  Mich.  27  ;  Irish  tOSmith, 

8  S.  &  R.  (Pa.)  573;  Elliott  v.  Van  Buren,  33  Mich.  49;  s.  c.  20  Amer. 
Rep.  668. 

c.  A  ph3'sician  or  surgeon,  shown  to  be  competent,  may  give  his 
opinion  as  to  the  probable  effect  of  wounds  and  injuries,  after  he  has 
viewed  the  body  and  examined  the  wounds,  and  as  to  whether  the  wounds 
or  injuries  would  produce  death:  Montgomery  v.  Scott,  34  Wis.  338; 
Batten  v.  State,  80  Ind.  394;  McDaniel  v.  State,  76  Ala.  1  ;  Xoblesville, 
etc..  Gravel  Road  Co.  v.  Ganse,  76  Ind.  142;  Davis  i;.  State,  38  Md.  15; 
State -u.  Crenshaw,  32  La.  Ann.  406  ;  Armstrong  v.  Town  of  Acklev,  71 
Iowa,  76  ;  Rash  v.  State,  61  Ala.  16  ;  Doolittle  v.  State,  93  Ind.  272'. 

d.  A  non-expert  cannot  testify  as  to  the  effect  of  Avounds  or  injuries. 

e.  Physicians  shown  to  be  qualified  may  testif}^  and  give  opinions. 

(1)  As  to  the  cause  of  death  of  a  person  :  Boyle  v.  State,  61  Wis.  349 ; 
Eirgler  v.  People,  56  N.  Y.  642  ;  State  v.  Clark,  15  S.  C.  403  ;  Citizens' 
Gas  Light  Co.  v.  O'Brien,  118  111.  1 74  ;  Sullivan  v.  Cowen,  93  Pa.  St.  285  ; 
Bovd  V.  State,  14  Lea.  (Tenn.)  161 ;  Comin  v.  Piper,  120  Mass.  188  ;  Eidt 
V.  Cutler,.  127  Mass.  523;  State  v.  Cross,  68  Iowa,  180. 

(2)  In  malpractice  cases,  as  to  whether- the  treatment  complained  of  was 
proper:  Quinn  v.  Higgins,  63  Wis.  664;  Kay  v.  Thompson,  10  Am.  L. 
Reg.  (N.  Brunsw.)  594;  Boydston  v.  Gittner,  3  Oregon,  118;  Williams 
V.  Poppleton,  3  Oregon,  139:  Wright  u  Hardv,  22  Wis.  348;  Mertz  v. 
Detweiler,  8  W.  &  S.  (Pa.)  376  ;  Roberts  v.  Johnson,  58  N.  Y.  613. 

(3)  In  cases  of  rape,  after  an  inspection  and  examination  of  the  parts  as 
to  health,  physical  condition  ;  and  from  the  condition,  whether  there  had 
been  an  actual  penetration,  the  capacity  of  the  defendant  to  resist,  and  the 
effect  the  crime  Avould  produce  upon  the  sexual  organs:  State  v.  Smith, 
Phill.  (N.  Car.)  302;  State  v.  Knapp,  45  N.  H.  148;  Woodin  v.  People, 
1  Park.  Crim.  Cases  (N.  Y.),  464 ;  Cook  v.  State,  24  K  J.  843.  See 
also  Com.  v.  Lynes,  142  Mass.  577  (in  a  case  of  alleged  incest). 

(4)  As  to  whether  an  abortion  had  been  performed  or  attempted  :  State 
V.  Smith,  32  Me.  370  ;  State  v.  Wood,  53  N.  H.  484  ;  Regina  v.  Still,  30 
U.  C.  (C.  B.)  30  ;  Com.  v.  Browne,  14  Gray  (Mass.),  419. 

(5)  As  to  the  nature  of  a  disease  wnth  which  a  person  is  or  has 
been  afflicted;  its  continuance;  its  severity  and  probable  duration;  the 
probability  of  its  recurrence  ;  its  effect  upon  the  general  health  ;  its  cause  ; 
the  remedy  ;  its  characteristics,  whether  hereditary  ;  and  as  to  the  prob- 
able state  of  health  of  the  person  examined  :  Napier  v.  Ferguson,  2  P.  &  B. 
(N.  B.)  415  ;  Jones  v.  White,  11  Humph.  (Tenn.)  268  ;  Flvnt  v.  Boden- 
hamer,  80  N.  Car.  205  ;  Polk^.  State,  36  Ark.  117  ;  Hook  v.  Stovel,  26  Ga. 
704;  Cock  v.  Potter,  68  Pa.  St  342;  Linton  v.  Hurley,  14  Gray  (Mass.), 
191  ;  Cooper  v.  State,  23  Tex.  336. 

Litch  V.  McDaniel,  13  Ired.  (N.  Car.)  485  ;  Edington  v.  .^tna  Life  Ins, 
Co.,  77  N.  Y.  564;  Eckles  v.  Bates,  26  Ala.  655. 
Wiley  V.  Portsmouth,  35  N,  H.  303 
Filer  v.  N.  Y.  Central  R.  Co..  49  N.  Y.  42  ;  Pidcock  v  Porter,  68  Pa.  St. 


EXPERT    AND    OTINIOX    EVIDENCE.  55 

344;  Anthony-  v.  Smith,  4  Bosw.  (X.  Y.)  503  ;  Flvnt  v.  Bodenhamer,  80 
N.  C.  205. 

Matteson  v.  N.  Y.,  etc.,  R.  Co.,  fi2  Barb.  (N.  Y.)  3G4;  Cooper  v.  State, 
23  Texas,  336  ;  Jones  v.  Tucker,  41  N.  H.  54(3. 

Welch  u.  Brooke,  10  Rich.  (S.  C.)  124;  Laker.  People,  1  Parker's  Crim. 
Cases,  495  ;  Pitts  t'.  State,  43  Miss.  472  ;  U.  S.  v.  McGlue,  1  Curtis  (U.  S.), 
1 ;  Napier  v.  Ferguson,  2  P.  &  B.  (N.  B.),  415. 

Washington  v.  Cole,  66  Ala.  212  ;  Janes  i'.  White,  11  Humph.  (Tenn.) 
268. 

Moore  v.  State,  17  Ohio,  521. 

Morrissey  v.  Ingham,  111  Mass.  63. 

Sanderson  v.  Nashua,  44  N.  H.  492. 

/.  Experts  in  the  use  of  the  microscope,  the  micrometer,  or  familiar 
with  the  scientific  chemical  tests,  may  give  opinions  as  to  whether  blood  is 
human,  or  that  of  animals,  birds,  or  amphibia :  Knoll  v.  State,  55  Wis. 
249;  s.  c.  42  A.  M.  Rep.  704;  Com.  v.  Sturtivant,  117  Mass.  122  ;  State 
V.  Knight,  43  Me.  1. 

g.  The  confusion  into  which  expert  testimony,  in  this  respect,  has  fallen 
in  American  courts  is  worthy  of  notice. 

(1)  Certain  experts  affirm  that  they  can  discriminate  between  human 
blood  and  that  of  all  the  domestic  animals,  save  a  dog,  and  from  all  mam- 
malian blood,  except  the  opossum,  the  guinea-p!g,  the  rabbit,  the  wolf,  seal, 
beaver,  monkey  and  a  few  others,  by  the  diameters  of  the  red  blood-cor- 
puscles, under  a  microscope  of  very  high  powers 

Others  deny  this,  and  assert  that  while  all  mammalian  blood  can  be 
distinguished  from  birds,  fishes,  and  the  amphibia,  by  the  shape  of  the  red 
corpuscles  and  their  structure;  that  the  extent  to  which  the  expert 
can  go,  is  to  state  that  the  blood  is  mammalian  and  is  consistent  with 
and  similar  to  human,  or  other  mammalian  blood:  R.  U.  Piper,  in  15 
Amer.  Law  Register,  561 ;  16  Amer.  Law  Register,  257  ;  19  Amer. 
Law  Register,  529  and  593;  10  Central  Law  Jo'urnal,  183;  26  Amer. 
Law  Register,  20;  Thomas  v.  State,  67  Ga.  460;  Reese,  Text-Book 
Med.  Jur.,  2d  Ed.,  133;  Wormley  on  Micrometry  of  Poisons,  735-6; 
1  Tidy  Legal  Medicine,  Phila.  Ed.,  231;  Prof.  Richardson,  in  London 
Lancet,  IL,  p.  210,  1875;  I.,  pp.  321  and  700;  Prof.  M.  D.  Ewell,  of 
Chicago,  Micrometric  Study  of  the  Red  Blood-Corpuscles,  Amer.  Prac- 
titioner, of  Chicago,  1890,  pp.  79  and  173;  Prof.  H.  F.  Formad,  of 
Phila.,  Studies  of  Mammalian  Blood,  Journal  of  Compar.  Med.  and  Sur- 
gery, JuIt,  1888  ;  Clark  Bell,  Blood  and  Blood-Stains,  Med. -Legal  Journal, 
vol.  10,  No.  2. 

(2)  A  non-expert  may  testify  that  certain  stains  resembled  blood.  That 
is  a  fact  that  does  not  require  skilled  witnesses  to  see  and  recos-nize  : 
Thomas  v.  State,  67  Ga.  460  ;  McLain  v.  Com.,  99  Pa.  St.  86  ;  Dillard  v. 
State,  58  Miss.  368;  People  v.  Greenfield,  30  N  Y.  Sup.  Ct.  462;  s.  c. 
85  N.  Y.  75;  People  v.  Gonzalez,  35  N.  Y.  49;  Rickerson  v.  State, 
vol.  1,  s.  E.,  Rep.  (Ga.),  178. 

h.  Competent  experts,  after  a  chemical  analysis,  may  give  an  opinion 
as  to  the  presence  of  poison  in  the  internal  organs  of  the  body. 

(1)  If  a  chemist  or  toxicologist,  the  witness  need  not  be  a  phvsician 
or  surgeon. 

(2)  A  physician,  if  shown  to  be  competent,  may  also  so  testify,  and 
as  to  the  symptoms  of  any  particular  person,  and  as  to  AA'hether  death 
resulted  from  the  effects  of  any  poison  :  State  i-.  Bowman.  78  N.  Car. 
500;  1  Crim.  Law  Mag.  294;  State  v.  Cook,  17  Kan.  394;  State  v. 
Terrell,  12  Rich.  (S.  Car^)  321 ;  People  v.  Robinson,  2  Park.  Crim.  Cases 


66  EXPERT    AKD    OPINION    EVIDENCE. 

(N.  Y.)  236  ;  Polk  v.  State,  36  Ark.  lit ;  Mitchell  v.  State,  58  Ala.  448; 
State  V.  Slagle.  83  N.  Car.  630  ;  Joe  v.  State,  6  Fla.  591 ;  State  v.  Hin- 
kle,  6  Iowa,  "380. 

i.  A  chemist  may  give  his  opinions  concerning  scientific  facts  or 
knowledge,  upon  scientific  or  technical  facts,  which  his  superior  and  sci- 
entific learning  enables  him  to  understand  and  elucidate,  and  which  are 
bcN'ond  the  reach  of  persons  not  skilled  or  informed  in  chemical  science. 
Examples: — 

(1)  Concerning  the  probability  of  the  evaporation  of  spirits  in  certain 
eat^ks:  Turner  uThe  Black  Warrior,  1  McAllister  (U.  S.),  181. 

(2)  Concerning  the  constituent  parts  of  a  mixture :  Allen  u.  Hunttr, 
6  McLean  (U.  S.),  303. 

(3)  Concerning  the  safety  of  lamps:  Bierce  v.  Stocking,  11  Gray 
(Mass.),  174. 

(4)  Concerninir  the  nature  of  inks:  18  Am.  Law  Reg.  2t3  ;  Goodyear 
V.  Yosburgh,  63  Barb.  (N.  Y.)  154  •  Clark  v.  Bruce,  12  Hun  (N.  Y.),  211  ; 
Sheldon  v.  Warner,  45  Mich.  638;  Ellingwood  v.  Bragg,  52  N.  H.  448; 
People  V.  Brotherton,  47  Cal.  388. 

(5)  Concerning  noxious  gases  and  their  effect  upon  ground  contiguous 
to  a  copper  mill  and  the  result  of  experiments  therewith:  Lincoln  v. 
Taunton  M'ftr  Co.,  9  Allen  (Mass.),  182;  Salvin  v.  North  Brancepeth 
Coal  Co.,  L.  R.  Ch.  App.  705. 

(6)  Concerning  the  analysis  of  dirt  drained  by  a  filter  basin,  as  to  the 
practical  utility  of  the  drainage:  Williams -u.  Taunton,  125  Mass.  34. 

j.  A  competent  farrier  may  testify  as  to  whether  a  horse  is  sound  or 
not,  and  a  veterinary  surgeon  may  give  his  opinion  :  Pierson  v.  Hoag, 
47  Barb.  (N.  Y.)  243;  Pinney  i;.  Cahill,  48  Mich.  584;  Spear  v.  Rich- 
ardson, 14  N.  H.  428. 

(1)  One  not  a  farrier,  if  experienced  with  horses,  is  competent  to  say 
whether  the  eves  are  good  or  bad,  and  give  his  opinion  as  to  defects  in 
the  eves:  House  v.  Frost,  4  Blackf.  (Ind.)  293;  Slater  v.  Wilcox,  57 
Barb.^N.  Y.)  604. 

(2)  Any  one  familiar  with  horses  is  competent  to  state,  whether  a  horse 
seemed  M^ell  or  sick;  Spear  v.  Richardson,  34  N.  H.  428;  Willis  v. 
Quimby,  11  Post.  (N.  H.)  489. 

(3)  A  non-expert  cannot  give  an  opinion  as  to  the  appearance  and  symp- 
toms of  cattle  alleged  to  be  starved  to  death  :  Stonan  v  Waldo,  17  Mo.  489. 
IS'or  as  to  certain  appearances  in  horses  alleged  to  have  been  overdriven  or 
exposed:  Moulton  v.  Scruton,  39  Me.  288.  ^Nor  as  to  whether  a  certain 
wound  is  likely  to  be  fatal :  Harris  v.  Panama  R.  Co.,  3  Bosvv.  (N.  Y.)  7. 

k.  Insanity. — 1.  The  opinions  of  expert  alienists  and  of  medical  men  who 
are  shown  to  be  competent,  from  knowledge,  study,  or  experience  in  such 
cases,  are  admissible  as  to  the  sanity  or  insanity  of  a  person  at  a  given 
time ;  and  this  evidence  can  be  based  upon  their  personal  knowledge  and 
information,  or  in  answer  to  hypothetical  questions  based  upon  the  testi- 
mony disclosed:  Conn.  Mutual  Life  Ins.  Co.  v.  Lathrop,  111  U.  S.  612; 
Dexter  v.  Hall,  15  Walk  (U.  S.)  9;  Fairchildi'.  Bascomb.  35  Yt.  398-408; 
Tulis  V.  Kidd,  12  Ala.  648;  Grant  v.  Thompson,  4  Conn.  203;  s.  c.  10 
Am.  Dec.  119 ;  Rawble  v.  Tryson,  7  S.  &  R.  (Pa.)  90  ;  s.  c.  10  Am.  Dec. 
444  ;  State  v.  Feltes,  51  Iowa,  495  ;  Dejarnette  v.  Commonwealth,  75  Va. 
867  ;  V.  S.  V.  Guiteau,  3  Crim.  Law  Mag.  347  ;  State  v.  Baber,  74  Mo. 
292  ;  People  v.  Hall,  48  Mich.  482 ;  People  v.  Schuyler,  106  N.  Y.  298 ; 
Quaife  v.  Chicairo,  etc.,  R.  Co.,  48  Wis.  513;  In  the  matter  of  the  Will 
of  Blakelv.  48  Wis.  294 ;  Goodwin  v.  State,  96  Ind.  550  ;  Coryell  v.  Stone, 
62  Ind.  307  ;  Davis  v.  State,  35  Ind.  496 ;  Buswell  on  Insanity,  section 


EXCEPTIONS  TO  GENERAL  RULES.  57 

250 ;  Boardman  v.  Woodman,  4T  X.  H.  120  ;  Commonwealth  v.  Rogers, 
7  Met.  (Mass.)  500. 

2.  Non-professional  witnesses  who  are  not  experts,  who  have  known 
and  been  familiar  with  the  person  whose  mental  condition  is  in  question, 
may  state  facts,  convei'sations,  and  circumstances  within  their  personal 
knowledge,  and  then  give  their  opinions  as  to  the  sanity  or  insanity  of 
the  person:  Cram  v.  Cram,  33  Vt.  15;  Charter  Oak  Life  Ins.  v.  Rodel, 
95  U.  S.  232;  Hardy  v.  Merrill,  56  N.  Y.  227  (overruling  the  previous 
decision  of  the  court  upon  the  point) ;  Beaubien  v.  Cicatte,  12  Mich.  459  ; 
Grant  v.  Thompson.  4  Conn.  203;  Clark  v.  The  State,  12  Ohio  St.  483; 
Clarv  L'.  Clarv,  2  Ired.  (N.  Car.)  78;  Baldwin  v.  State,  12  Mo.  223;  State 
V.  Erb,  74  Mo.  199;  Walker  v  Walker,  14  Ga.  242;  Chace  v.  State,  31 
Ga.  424 ;  Wood  v.  The  State,  58  Miss.  741  ;  Webb  v.  State,  5  Tex.  App. 
596  (overruling  previous  decisions  in  Texas)  ;  Garrison  v.  Blanton,  48 
Tex.  299;  Norris  v.  State,  16  Ala.  776;  Leach  v.  Prebster,  39  Ind.  492; 
Schleneker  u.  State,  9  Xeb.  241;  Kilgrove  v.  Cross,  1  McCrary  C.  C. 
144;  Finney's  Wdl,  27  Minn.  280;  Conn.  Mut.  Life  Ins.  Co.  v. 
Lathrop,  111  U.  S.  612;  O'Brien  v.  People,  36  N.  Y.  276;  s.  c.  48 
Barb.  (X.  Y.)  274;  s.  c.  22  Amer.  Rep.  441  (overruling)  ;  State  v.  Pike, 
49  X.  H.  399  ;  s.  c.  6  Am.  Rep.  533  ;  Pidcock  v.  Potter,  68  Pa.  St.  342  ; 
s.  c.  40  Am.  Dee.  481;  Sutherland  v.  Hankins,  56  Ind.  343;  Eggers  v. 
Eggers,  57  Ind  461;  State  v.  Xewlin,  69  Ind.  108;  Doe  v.  Reagan,  5 
Blackf.  (Ind.)  217;  s.  c.  Am.  Dec.  466;  State  v.  Havden,  51  Vt.  296; 
ITptone  V  People,  109  III  169;  Polin  v.  State,  14  Xeb.  540;  People  v. 
Wreden,  59  Cal.  392;  Coles  v.  State,  75  Ind.  511  ;  Dejarnette  u.  Com- 
monwealth, 75  Ya.  867;  Dunham's  Appeal,  27.  Conn.  193;  Hathaway  v. 
Ins.  Co.,  48  Yt.  335;  Morse  v.  Crawford,  17  Yt.  499;  Potts  v.  House,  6 
Ga.  324;  Yanauken's  Case,  2  Stock.  Ch.  (X.  J.)  190;  Brooke  v.  Towns- 
hend,  7  Gill  (Md  ),  10;  Dewitt  v.  Barley,  17  X.  Y.  342;  Hewlett  v. 
Wood,  55  X.  Y.  634:  Clapp  v.  Fullerton,  34  X.  Y.  190;  Rutherford  v. 
Morris,  77  111.  397;  Duffield  v.  Morris,  2  Harr.  (Del.;  375;  Wilkinson  v. 
Pearson,  23  Pa.  St.  119;  Dove  v.  State,  3  Heisk.  (Tenn.)  348;  Butler  v. 
Ins.  Co.,  45  Iowa,  93;  People  v.  Sanford,  43  Cal.  29;  State  v.  Klino-er, 
46  Mo.  229;  Holcorabe  v.  State,  41  Tex.  125;  McClaskley  i'.  State,  5 
Tex.  App.  320;  Xorton  v.  Moore,  3  Head  (Tenn.),  482;  Powell  v.  State, 
25  Ala.  28. 

6.  Exceptions  to  both  rules. — (1)  The  subscribing  witnesses  to  a  will 
may  always  give  their  opinions,  as  to  the  sanity  or  insanity  of  the  testator, 
at  the  time  he  signed  the  will  in  their  presence,  whether  they  are  experts 
or  not,  and  without  reference  to  who  they  are.  The  reason  of  this  lies  in 
the  fact  that  the  law  provides,  that  the  proof  of  the  will  must  rest  upon 
their  evidence,  and  in  the  nature  of  things  their  evidence  is  competent, 
upon  all  questions  necessary  to  be  established  to  prove  the  will.  And 
this  does  not  depend  upon  whether  they  state  the  facts  or  circumstances 
upon  which  their  opinion  is  Imsed  or  not:  Williams  v.  Lee,  47  Md.  321  ; 
Yan  Huss  v.  Rainbolt,  42  Tenn.  139;  Hardv  v.  Merrill,  56  X.  H.  227; 
Poole  V.  Richardson,  3  Mass.  330  ;  Potts  v.  House,  6  Ga.  324 ;  Dewitt  v. 
Barlev,  9  X.  Y.  371;  Grant  v.  Thompson,  4  Conn.  203;  Wo^-an  v. 
Small,  11  S.  &  R  (Pa.)  141  ;  Robinson  v.  Adams.  62  Me.  369;  Williams 
V.  Lee,  47  Md.  321  ;  Yan  Huss  v.  Rainbott,  42  Tenn.  139  ;  Buswell  on 
Insanity,  §§  240,  265-266. 

(2)  In  some  States  the  opinion  of  a  non-expert  witness,  as  to  the  sanity 
or  insanity  of  a  person,  is  not  received,  and  has  been  excluded  upon  the 
ground,  that  they  are  not  proper  exceptions  to  the  general  rule,  w'hich  ex- 


68       COMPETENT  EXPERTS  IN  CASES  OF  INSANITY. 

eludes  the  opinions  of  witnesses  upon  subjects  concerning  which  they 
have  no  special  or  scientific  knowledge. 

Kotably  in  Massachusetts,  where  the  courts  still  adhere  to  this  doctrine  : 
Hastings  v.  Rider,  99  Mass.  622 ;  Townsend  v.  Pepperell,  99  Mass.  40  ; 
Phelps  V.  Hartwell,  1  Mass.  11;  Poole  v.  liichardsou,  3  Mass.  330; 
Needham  v.  Ide,  5  Pick.  (Mass.)  510;  Commonwealth  v.  Wilson,  1  Gray, 
337  ;  Commonwealth  v.  Fairloanks,  2  Allen  (Mass.),  511  ;  Buswell  on  In- 
sanity, section  248;  Amer.  and  Eng.  Encyclo.  of  Law,  vol.  7,  p.  504; 
Cowles  V.  Merchants,  140  Mass.  377;  May  v.  Bradley,  127  Mass.  414  ; 
Commonwealth  v.  Brayman,  136  Mass.  438  ;  Baxter  v.  Abbott,  7  Gray 
(Mass.),  71. 

Also  in  Maine:  Wyman  v.  Gould,  47  Maine,  159;  Heald  v.  Thing.  45 
Me.  392;  Inhabitants  of  Fayette  v.  Inhabitants  of  Chesterville,  77  Me. 
28 ;  s.  c.  52  Am.  Rep.  741. 

Also  in  Texas:  Gehrke  v.  State,  13  Texas,  508:  Hickman  v.  State,  38 
Texas,  191. 

And  in  Iowa  and  Mississippi :  State  v.  Geddis,  42  Iowa,  268 ;  Reed  v. 
State,  62  Miss.  405. 

In  New  York  the  earl}"  decisions  were  adverse  to  the  admission  of  non- 
ex])ert  evidence:  Sears  v.  Shafer,  1  Barb.  408  ;  Dewitt  v.  Barlev,  9  N.  Y. 
371  ;  Same  v.  Same,  17  K  Y.  340;  People  v.  Lake,  12  K  Y.  358; 
Gardiner  v.  Gardiner,  34  N.  Y.  155  :  Deshon  v.  Merchants'  Bk.,  8  Bosw. 
(N.  Y.)  461  ;  Clapp  v.  Fullerton,  34'N.  Y.  190,  461 ;  approved  in  O'Brien 
V.  People,  36  N.  Y.  27G. 

But  the  doctrine  has  since  been  settled  in  that  State,  that  non-experts 
may  testify  as  stated  in  above  subdivision,  a,  in  accordance  with  what 
mav  be  regarded  as  now  the  well-settled  general  rule  :  Hewlett  v.  Wood, 
55  K  Y.  634;  Howell  v.  Taylor,  11  Hun  (N.  Y.),  214:  Arnold's  Will, 
14  Hun  (N.  Y.),  525  ;  Sisson  v.  Conger,  1  T.  &  C.  (N.  Y.)  564  ;  Goodell 
V.  Harrington,  3  T.  &  C.  (N.  Y.)  315  ;  Real  v.  People,  55  Barb.  (N.  Y.) 
576  ;  s.  c.  42  N.  Y.  270. 

(3)  Courts  have  held  that  a  Roman  Catholic  priest,  who  is  required  by 
his  priestly  office  to  pass  upon  the  sanity  or  mental  state  of  those  who 
receive  the  sacraments  at  his  hands,  is  a  qualified  expert,  and  as  such  may 
answer  a  hypothetical  question  as  to  the  sanity  of  any  individual :  Estate 
of  Toomes,  54  Cal.  509;  s.  c.  35  Am.  Rep.  83;  Amer  and  Eng.  Enc.  of 
Law,  vol.  7,  p.  504. 

7.  WJio  is  a  Compefeyit  Expert  in  Gases  of  Insuvity. — To  entitle  a 
person  to  give  an  opinion  as  an  expert,  the  witness  must  be  a  person  who 
is  conversant  with  insanity,  who  has  made  the  sulgect  of  mental  diseases 
a  special  study,  and,  as  stated  in  the  rule  defining  what  an  expert  is,  he 
must  be  shown  to  have  a  particular  and  special  scientific  and  technical 
knowledge  upon  the  subject  of  insanity:  Reese,  Med.  Juris.  &  Tox. 
(1891),  p.  19;  Hastings  v.  Rider,  99  Mass.  622;  Buswell  on  Insanity, 
sec.  248,  and  cases  there  cited;  Commonwealth  v.  Rogers,  7  Met.  (Mass.) 
500;  s.  c.  4  Am.  Dec.  458;  Commonwealth  v.  Rich,  14  Gray  (Mass.), 
855;  Clark  v.  Bruce,  12  Hun  (N.  Y.),  271;  Kennedy  v.  People,  39  N. 
Y.  245. 

a.  An  exception  is  made  in  case  of  the  family  physician,  who  is  assumed 
to  have  superior  knowledge  and  means  of  information  more  than  ordinary 
persons,  and  who  may  give  an  opinion  :  Hastings  f.  Rider,  99  Mass.  625  ; 
Dickinson  v.  Barber,'  9  Mass.  225  ;  s.  c.  6  Am.  Dec.  58  ;  Hathorne  v. 
King,  8  Mas^.  371  ;  s.  c.  5  Am.  Dec.  106. 

8.  As  all  persons  can  testify  from  their  knowledge,  based  upon  facts 
under  their  own  observation,  as  shown  in  subdivision  a  ivfra,  this  em- 


COMPETENT  EXPERTS  IN  CASES  OF  INSANITY.        59 

braces  not  only  all  physicians,  but  all  experts,  and  leaves  the  question  of 
opinion  evidence  by  sivilled  experts  narrowed  to  the  true  rule  of  opinion, 
testimony  by  skilled  witnesses,  and  should  be  confined  to  hypothetical 
questions,  a  fact  frequently  lost  siyht  of  by  courts  and  counsel. 

a.  Opinions  of  experts  which  usurp  the  functions  or  province  of  the 
jury  are  inadmissible,  and  should  have  little  weight  with  courts  or  juries. 

For  example,  the  question  of  insanity  is  a  question  of  fact  to  be  shown 
by  evidence.  The  question  of  whether  the  accused  is  responsible  is  a 
question  of  law.  The  opinions  of  a  medical  expert,  who  by  his  opinion 
passes  on  the  qu-estion  of  responsibility,  usurps  the  functions  of  the  jury, 
and  such  testimony  lacks  all  the  elements  of  evidence,  and  should  have  no 
weig-ht:  Buswell  on  Insanitv,  sections  253  and  254;  Princep  v.  Dvce 
Sombre,  10  Mo.  P.  C.  232;  S^tackhouse  v.  Horton,  2  McCart,  202;  Wat- 
son V.  Anderson,  13  Ala.  202;  McAllister  v.  State,  IT  Ala.  434;  Slais  v. 
Slais,  9  Mo.  App.  96  ;  Francke  v.  His  Wife,  29  L.  Arm.  302  ;  Parnell  vr 
Commonwealth,  8G  Penn.  St.  260  ;  Reg-ina  v.  Richards,  1  F.  &  F.  87  ; 
Fairchild  v.  Bascombe,  35  Yt.  398  ;  The  Province  of  Medical  Expertism, 
by  Judge  Chas.  G.  Garrison,  Med.  Legal  Journal,  1890,  p.  486. 

h.  It  has  been  held  "  that  the  opinions  of  medical  experts  upon  the  sub- 
ject of  insanity  are  to  be  received  with  peculiar  caution,  for  the  reason 
that  while  an  expert  in  the  exact  sciences,  or  in  mechanics,  has  tangible  or 
ascertainable  facts  on  which  to  base  his  opinions,  those  scientists  who 
profess  to  understand  the  quality  or  emotions  of  the  human  mind,  have  in 
great  part  to  rely  upon  mere  conjectures  for  their  inductions,  which  are 
often  warped  or  fitted  to  pet  theories  or  prejudices." 

The  trend  of  judicial  thought  in  America  and  England  is,  that  the  mere 
opinions  of  medical  experts  are  of  little  or  no  value,  in  enlightening  courts 
or  juries  as  to  the  facts  of  the  cases  which  are  to  be  determined:  People 
V.  Lake,  12  N.  Y  358;  Buswell  on  Insanitv,  section  253;  Dou^htv  i;. 
Doughtv,  3  Halst.  Ch.  643;  People  t;.  Fiulev,  38  Mich.  482;  Regina  v. 
Southey,  4  F.  &  F.  864. 

And  in  Xew  York  it  has  been  held,  that  w^here  an  expert  witness  has 
heard  all  the  testimony  and  based  his  opinions  upon  it,  he  is  not  compe- 
tent to  give  an  opinion  upon  the  general  question  of  sanity  or  insanity ; 
because  his  answerpracticallv  usurped  the  province  of  the  jury,  and  that 
he  should  only  be'  allowed  to  give  an  opinion  as  to  what  the  facts  proved 
or  claimed  to  be  proved  indicated  as  to  the  mental  condition  of  the  partv : 
People  V.  Lake,  12  ^^.  Y.  358  ;  People  v.  Thurston,  2  Parker  Cr.  (N.  Y.) 
49  ;  Sanchez  v.  The  People,  22  N.  Y.  147  ;  Arnold's  Will,  14  Hun  (N.  Y.), 
525  ;  Hagadorn  v.  Conn.  Mut.  Life  Ins.  Co.,  22  Hun  (N.  Y.),  249. 

9.  The  dicta  of  the  court  in  Conn.  Mut.  Life  Ins.  Co.  v.  Lathrop,  111 
U.  S.  612,  in  explaining-  the  reason  of  the  now  almost  universal  rule 
allowing  any  one,  and  especially  non-experts,  to  give  an  opinion  based 
upon  facts  within  their  own  personal  knowledge  correctly  states  the  law 
and  the  reasons  of  its  general  adoption. 

"  Whether  an  individual  is  insane  or  not  is  not  always  best  solved  by 
abstruse  metaphysical  speculations  expressed  in  the  technical  language  of 
medical  science.  The  common  sense,  and  we  may  add  the  natural  instincts, 
of  mankind  reject  the  supposition  that  only  experts  can  approximate 
certainty  upon  such  a  subject."       .... 

"The  truth  is,  that  the  statement  of  a  non-professional  witness,  as  to  the 
sanity  or  insanity  at  a  particular  time  of  an  individual  whose  appearance, 
manner,  habits,  and  conduct  come  under  his  personal  observation,  is  not 
the  expression  of  a  mere  opinion.  In  form  it  is  opinion,  because  it 
expresses  an  inference  or  conclusion  based  upon  observation  of  the  appear- 


60       COMPETENT  EXPERTS  IN  CASES  OF  INSANITY. 

ance,  manner,  and  motions  of  another  person,  of  which  a  correct  idea 
cannot  well  be  communicated  in  words  to  others,  without  embodying 
more  or  less  the  impressions  or  judgment  of  the  witness.  But  in  a  sub- 
stantial sense,  and  for  every  purpose  essential  to  a  safe  conclusion,  the 
mental  condition  of  an  individual  as  sane  or  insane  is  a  fad.  Not, 
indeed,  a  fact  established  by  direct  and  positive  proof,  because  in  most,  if 
not  all,  cases,  it  is  impossible  to  determine,  Avith  absolute  certainty,  the 
precise  mental  condition  of  another.  Yet,  being  founded  on  actual  obser- 
vation, and  being  consistent  with  common  experience  and  the  ordinary 
manifestations  of  the  condition  of  the  mind,  it  is  knowledge  so  far  as  the 
human  intellect  can  acquire  knowledge  upon  such  subjects." 

a.  As  to  the  disposition,  characteristics,  or  idiosA'ncrasies  of  a  person, 
any  witness  who  knows  is  competent  to  testify  and  need  not  be  an  expert. 

(1)  As  to  whether  he  was  fickle-minded  :    Mills  v.  Winter,  94  Ind.  329. 

(2)  Whether  he  was  intoxicated:  City  of  Aurora  v.  Hillman,  90  111.  66  ; 
State  V.  Huxford,  47  Iowa,  16;  Stacv  v.  Portland  Put.  Co.,  68  Me.  279; 
Pierce  v.  State,  53  Ga.  365  ;  State  v.  Pike,  49  N.  H.  407. 

(3)  Whether  he  was  angry  at  a  certain  time:  State  v.  Shelton,  64 
Iowa,  333. 

(4)  Peculiar  affection  for  a  third  person,  if  known  to  the  witness  or 
observed  b}^  him :  McKee  v.  l^elson,  4  Cow.  (N.  Y.)  355  ;  s.  c.  15  Am. 
Dec.  384. 

h.  Masters  of  vessels  or  experienced  seamen  may  give  their  opinions  on 
questions  pertaining  to  nautical  science  or  affairs.  For  examples,  vid. : 
Delaware  &  Co.  v.  Starrs,  69  Pa.  St.  36  ;  Baird  v.  Daily,  63  N.  Y.  547  ; 
Western  Ins.  Co.  v.  Tobin,  32  Ohio,  77  ;  Perkins  v.  Augusta  Ins.  Co.,  10 
Grav  (Mass.),  312  ;  Parsons  v.  Mig.,  etc..  Ore  Co.,  16  Gray  (Mass.),  463  ; 
Zugasti  V.  Lainer,  12  Moore  P.  C.  331  ;  Reed  v.  Dick  &  Watts  (Pa.),  479  ; 
Jameson  r.  Drinkald,  12  Moore,  148;  Fenwick  v.  Bell,  1  C.  &  K.  312; 
Carpenter  v.  Eastern  Trans.  Co.,  71  N.  Y.  574  ;  Dolz  v.  Morris,  17  N.  Y. 
Sup.  Ct.  202;  Steamboat  Clipper  Co.  v.  Logan,  18  Ohio,  375;  N.  E. 
Glass  Co.  r.  Lovel,  7  Gushing  (Mass.),  319;  Eastern  Trans,  v.  Hope,  95 
U.  S.  297  ;  Walsh  v.  Wash.,  etc.,  Ins.  Co.,  32  N.  Y.  427  ;  Guiterman  v. 
Liverpool,  etc.,  Ins.  Co  ,83  N.Y.358;  Ogden  u  Parsons,  23  IIo ward  (N.  S.), 
167  ;  Laphain  v.  Atlas  Ins.  Co..  24  Pick.  (Mass.)  1 ;  Paddock  v.  Con.  Ins. 
Co.,  104  Mass.  521  ;  Moore  v.  Westervelt,  7  Bosw.  (N."  Y.)  558  ;  Price  v. 
Powell,  3  N.  Y.  322  ;  Leitch  v.  Al.  Mut.  Ins.  Co.,  66  IS".  Y.  100. 

c.  Opinions  may  iDe  given  by  persons  skilled  therein  concerning  the 
running  and  management  of  railway  trains,  and  as  to  questions  concerning 
raihvav  construction,  repairs,  or  management:  Bellefontaine,  etc.,  II.  Co. 
V.  Bailev,  11  Ohio.  333;  Seaver  v.  Boston,  etc.,  R.  Co.,  14  Gray  (Mass.), 
466;  Cinn.,  etc.,  R.  Co.  v.  Smith,  22  Ohio,  227  ;  Mobile,  etc.^R.  Co.  v. 
Blakelv,  59  Ala.  471  ;  JefFersonville  R.  Co.  v.  Lanham,  27  Ind.  171  ;  Hil- 
ton V 'Mason,  92  Ind.  157;  Fitts  v.  Creon  City  R.  Co.,  59  Wis.  323; 
Baldwin  V.  Chic,  etc.,  Pv.  Co.,  18  Am.  Law.  Reg.  761  and  note;  s.  c.  50 
Iowa,  680. 

d.  Generally  an  artizan,  mechanic,  or  person  skilled  in  any  pursuit, 
avocation,  or  calling,  may  be  examined  as  to  matters  relating  to  his  avo- 
cation, concerning  which  be  is  shown  to  have  peculiar  and  especial 
knowledge.  Examples:  Sheldon  ^'.  Booth,  50  Iowa,  209;  Scattergood 
V.  Wood,  79  N.  Y.  263  ;  Burns  r.  Welch,  8  Yerir.  (Tenn.)  117  ;  Inpitz  v. 
People,  34  111.  516:  Union  Pacific  R.  Co.  v.  Clopper,  102  (U  S.)  708; 
Woodruff  V.  Imperial  Fire  Ins.  Co.,  83  N.  Y.,  133;  Ward  v.  Kilpatrick, 
85  N.  Y.  413;  Campbell  "u.  Russell,  139  Mass.  278;  Terre  Haute  v. 
Hudnut,  18  Am.  and  Eng.  Corp.  Cas.  302  ;  Folkes  v.  Chadd,  3  Doug. 


HYPOTHETICAL    QUESTIONS.  61 

(Mich.)  157;  Barnes  v  Ino-als,  39  Ala  193;  Davis  v.  Mason,  4  Peck. 
(Mass)  156;  Knox  v.  Clark,  123  Mass.  216;  lirantlv  t;.  Swift,  24  Ala. 
390;  Phelps  v.  Terry,  3  Abb.  Dec.  (N.  Y.)  607. 

e.  Competent  experts,  qualified  by  study  and  experience,  may  testify 
as  to  the  identity  or  ,2:enuineness  of  handwriting :  Plunketti;.  Bowman,  2 
McCord  (S.  Car.),  139  ;  Morrison  v.  Porter,  35  Minn.  425  ;  s.  c.  59  Am. 
Rep.  331  ;  Moore  v.  United  States,  91  U.  S.  270. 

/.  Foreign  laws  can  be  proved  by  an  expert  shown  to  be  competent,  if 
unwritten.  If  written,  a  certified  copv  is  the  best  evidence:  Talbot  t\ 
Seeman,  1  Cranch  (U.  S.),  1;  Drake  v.  Glover,  30  Ala.  382;  Shed  v. 
Augustine,  14  Kansas,  282;  Church  v.  Hubbard,  2  Cranch  (U.  S.),  187  ; ' 
Dougherty  u 'Snyder,  15  S.  &  R.  (Pa.)  84;  Walker  v.  Forbes,  31  Ala. 
9;  Hoes  v.  Van  Alstine,  20  III.  202;  Barrows  t;.  Downs,  9  R.  I.  446, 
453;  Roberts's  Will,  8  Paige  (N.  Y:),  446. 

10.  Opinions  of  witnesses  are  never  received,  if  all  the  facts  can  be  other- 
wise ascertained  and  made  intelligible  to  the  jury,  or  if  the  question  is  one 
that  men  in  general  can  understand  and  comprehend  :  Clark  v.  Fisher,  1 
Paige  (N.  Y.),  171  ;  s.  c.  19  Amer.  Dec.  402;  Stowe  v.  Bishop,  58  Yt. 
498  ;  Penn  Co.  v.  Conlan,  101  111.  93  ;  Passmore's  Appeal,  27  N.  W.  Rep. 
601  ;  Hallahan  v.  N.  Y.,  etc.,  R.  Co.,  102  N.  Y.  104. 

a.  Concerning  the  ordinary  affairs  of  life  the  jury  can  form  intelligent 
opinions,  and  opinions  of  experts  are  inadmissible:  Bemis  v.  Centr.  Vt. 
R.  Co.,  58  Vt.  636;  Milwaukee,  etc.,  R  Co.  v.  Kellogg,  94  U.  S.  469; 
Schneider  v.  Barney,  113  U.  S.  645;  Durrell  v.  Bederly,  1  Holt,  285; 
Campbell  v.  Richards,  5  B.  &  Ad.  846;  Carter  v.  Boehm,  3  Burr,  1905; 
Higgins  V.  Dewey,  107  Mass.  494;  Neilson  v.  Chic,  etc.,  R.  Co.  59  Wis. 
516  •  s.  c.  Watson  v.  Milwaukee,  etc.,  R.  Co.,  57  Wis.  332;  Gilbert  v. 
Guild,  144  Mass.  361 ;  Knole  v.  State,  55  Wis.  249  ;  s.  c.  42  Am.  Rep.  704. 

11.  The  competency  of  an  expert  is  a  question  for  the  court,  and  it 
must  be  clearly  shown  before  his  testimony  can  be  received  as  an  expert: 
Stennett  v.  Pa.  Ins.  Co.,  68  Iowa,  674;  Russell  v.  Crittenden,  53  Conn, 
564;  Ft.  Wayne  t;.  Coombes,  107  Ind.  75;  Higbee  u.  Guardian  Ins.  Co., 
53  N.  Y.  603;  Russell  v.  Crittenden,  53  Conn.  564;  Hinds  v.  Harbon, 
58  Ind.  121;  McBwen  y.  Bigelow,  40  Mich.  215;  Dole  v.  Johnson,  50 
N.  H.  452;  Castner  u.  Sliker,  33  N.  J.  L.  96;  Flint  u  Bodenheimer,  80 
N.  Car.  205;  Perkins  v.  Sticknev,  132  Mass.  217;  Wright  u.  Williams's 
Estate,  47  Vt.  222. 

12.  Hi/pothetical  Questions. — The  rule  is,  that  a  party  is  entitled  to  put 
his  case  hypothetically,  as  he  claims  it  to  have  been  proved,  and  take  the 
opinion  of  the  witnesses  thereon,  leaving  the  jury  to  determine  whether 
the  question  pat  covers  the  case  as  proved:  Bishop  v.  Spining,  38  Ind. 
143;'Guetigu  State,  66  Ind.  94;  Goodwin  v.  State,  96  Ind.  550;  Cow- 
ley V.  People,  83  N.  Y.  464;  s.  c.  38  Am.  Rep.  464;  Quinn  v.  Higgins, 
63  Wis  664;  s.  c.  53  Am.  Rep.  305  ;  Page  v.  State,  61  Ala.  16;  Board- 
m.an  t).  Woodman,  47  N.  H.  120:  Yardlev  t;.  Cuthbertson,  108  Pa.  St. 
395;  s.  c.  56  Amer.  Rep.  218;  Dexter  v.  Hall,  15  Wall.  (IJ.  S.)  9;  Com- 
monwealth V.  Rogers,  7  Met.  (Mass)  500;  s.  c.  41  Amer. -Dec.  458; 
Forsyth  v.  Doolittle,  120  U.  S.  73;  State  u  Cross,  68  Iowa,  180;  Morrill 
V.  Tegarden,  19  Neb.  534 ;  Ray  v.  Ray,  98  N.  Car.  566  ;  People  v.  Augs- 
burgh,  97  N.  Y.  501. 

a.  The  court  should  allow  counsel  great  latitude  in  framing  a  question 
based  upon  the  facts  as  claimed  to  be  proved,  if  evidence  tending  to  show 
the  facts  as  claimed  to  be  proved  has  been  given  ;  but  the  court  should 
not  allow  hypothetical  questions  based  on  alleged  facts  which  have  not 
been  proved,  or  not  within  the  range  of  legitimate  evidence,  or  containing 


62  COMPENSATION    OF    EXPERTS. 

inferences  or  conclusions,  or  when  they  aslv  for  conjectures;  nor  those 
ouiitting  material  facts  that  are  conclusively  shown  :  Goodwin  v.  Slate, 
90  Inch  550,  disapproving  People  v.  Thurston,  2d  Park.  Crim.  Cases  (N. 
Y.),  49;  Strong  v.  Stevens  Point,  62  Wis.  255;  Haisle  v.  Payson,  107 
111.  365;  Cowley  v.  People,  83  ]S^.  Y.  4G4,  and  cases  there  cited;  Higbie 
V.  Guardian,  etc.,  Co.,  53  N.  Y.  603;  State  v.  Stanley,  34  Minn.  430. 

13.  It  is  the  peculiar  province  of  the  jury  to  decide  what  weight,  if  any, 
they  will  give  to  the  opinion  of  an  expert.  They  are  not  bound  by  it, 
and  may  exercise  their  own  experience  upon  the  subject  as  to  what  weight 
it  is  entitled  to  receive. 

The  court  has  no  power  over  it,  and  where  judges  have  instructed 
juries  to  give  greater  weight  to  the  evidence  of  professional  witnesses 
than  to  non-expert  evidence,  the  verdicts  have  been  set  aside  as  illegal : 
Congress,  etc.,  Co.  v.  Edgar,  90  U.  S.  645;  Schwenger  v.  Kaymond,  105 
N.  Y.  648  ;  Guetig  v.  State,  64  Ind.  94  ;  State  v.  Bailey,  4  La.  Ann.  376  ; 
Von  Valkenburgh  1'.  Yon  Yalkenburgh,  90  Ind.  433;  Stone  v.  Chicago, 
etc.,  Pv.  Co.,  33  N.  W.  Rep.  (Mich.)  24;  Head  v.  Hargrave,  105  IT.  S. 
45;  Atchison,  etc.,  v.  Thul,  32  Kan.  255;  Davis  v.  State,  35  Ind.  496; 
McGregor  v.  Armill,  2  Iowa,  30;  Tolum  v.  Mohr,  21  Ark.  349;  Chandler 
V  Barrett,  21  La.  Ann.  58:  Sanders  v.  State,  94  Ind.  147;  People  v. 
Montgomery,  13  Abb.  Pr.  (N.  S.)  (N.  Y.)  207;  Cunee  v.  Bessorne,  63 
Ind.  524;  State  v.  Cole,  63  Iowa,  695;  Epps  v.  State,  102  Ind.  539; 
United  States  v.  Molloy,  31  Fed.  Pep.  19;  Templeton  v.  People,  10  Hun 
(N.  Y.),  357  ;  Eggers  v.  Eggers,  57  Ind.  461 ;  Goodwin  v.  State,  96  Lid. 
550;  Humphries  v.  Johnson,  20  Ind.  190;  Spenaley  v.  Lancashire  Ins- 
Co.,  62  Wis.  443. 

.  14.  An  expert  witness  cannot  be  compelled  to  give  his  opinion  as  an 
expert,  unless  he  is  compensated. 

He  cannot  be  punished  for  contempt  in  refusing  to  appear  or  testify  as 
such  without  he  is  compensated,  but  he  can  be  compelled  to  appear  and 
testify  to  facts  within  his  knowledge,  the  same  as  any  other  witness,  with- 
out compensation  above  the  statutory  fee  to  which  any  witness  is  entitled: 
Buchanan  v.  State,  59  Ind.  1  ;  s.  c.  26  Am.  Rep.  75;  17  Alb.  Law  J. 
242 ;  Dillis  v.  State,  59  Ind.  15  ;  Webb  v.  Page,  1  E.  &  K.  23 ;  Parkinson 
V.  Atkinson,  31  L.  J.  (N.  S.)  C.  P.  199;  In  re  Roelker  Sprague,  276; 
People  V.  Montffomery,  13  Abb.  Pr.  (jST.  S.)  207  ;  United  States  v.  HoAve, 
12  Cent.  L.  J.  193. 

The  courts  of  Alabama  and  Texas  have  held  that  experts  are  not  entitled 
to  extra  compensation  :     Ex  parte  Dement,  53  Ala.  389  ;  Sumner  v.  State, 

5  Tex.  App.  365  ;  but  the  weight  of  authority  is  otherwise.  This  subject 
has  been  exhaustively  treated  by  Lawson  in  his  work  on  Expert  and 
Opinion  Evidence,  and  by  Rogers  on  Expert  Evidence. 

The  medico-legal  authors  all  treat  it,  but  in  a  general  wav.  Among 
them:  Wharton^A  Stille  (1882) ;  Dean  (1873);  Elwell  (1881),  (1887) ; 
McClellan  (1872) ;  Ordronaux  (1869),  (1878) ;  Medico-Legal  Papers,  series 
1,  2  and  3  (N.  Y.)  ;  Tavlor  (all  English  and  Phil,  editions) ;  Woodman 

6  Tidv  (1«76),  (1884);  Naquet's  Legal  Chemistry  (1876)  ;  Taylor  on 
Poisons  (1875);  Field's  Medico-Legal  Guide  (1882);  Reese,  Med.  Jur. 
&  Tox.  (1884),  (1889),  (1891);  Bucknill  &  Tuke  (all  editions). 

The  law  authors  on  Evidence  (Wharton,  Starkie,  Greenleaf,  Taylor, 
Best,  Wood)  all  treat  the  subject  in  their  works  on  Evidence,  to  which 
the  student  and  the  expert  should  refer  ;  vid.  also  Prof.  Washburn's 
paper  in  1  Am.  Law  Review,  62. 

For  references  to  authorities  and  decisions,  the  American  and  English 
Encyclopaedia  of  Law  and  Abbott's  New  Digest  are  the  best  sources  of 
information.] 


SYMCOPE.  63 


CHAPTER   III. 

MODES    OF    DYING.  —  SYNCOPE,   ASPHYXIA,   COMA. SUDDEN  DEATH. SIGNS    OF    DEATH. CES- 
SATION     OF      CIKCULATION      AND       KEKPIRATION.  —  COOLING      OF      THE      BODY. CADAVERIC 

RIGIDITY. PUTREFACTION. CHANGES    PRODUCED    IN    THE  VISCEEA. PUTREFACTION    MIS- 
TAKEN   FOR    GANGRENE. 

Medical  jurisprudence  takes  cognizance  of  all  violent  causes  of  death, 
and  is  only  indirectly  involved  in  those  cases  of  natural  death  which  simu- 
late the  effects  of  violence.  Thus,  all  causes  which  operate  to  produce 
death  suddenly  especially  demand  the  attention  of  a  medical  jurist.  These 
may  be  either  natural  or  violent ;  and  the  distinction  between  them  is  of 
importance,  since  the  guilt  or  innocence  of  a  person  charged  with  crime 
may  depend  on  a  correct  determination  of  the  cause. 

The  continuance  of  life  depends  upon  the  proper  and  regulated  action 
of  the  heart,  the  lungs,  and  the  brain  ;  and  the  interdependence  of  these 
organs  is  such  that  the  arrest  of  the  functions  of  one  of  them  is  speedilv 
followed  by  the  arrest  of  the  functions  of  the  others.  Hence,  they  have 
been  called  the  tripod  of  life.  When  the  suspension  of  the  motions  of 
the  heart  is  the  primary  cause  of  death,  the  person  is  said  to  die  by  syn- 
cope. The  term  asphyxia  is  applied  to  death  which  begins  by  the  lungs ; 
and  coma  to  that  which  arises  from  a  primary  disturbance  of  the  func- 
tions of  the  brain. 

Syncope  (avyxonti^,  signifying  to  strike  down). — In  order  that  the  action 
of  the  heart  should  be  maintained,  it  is  necessary,  first,  that  the  blood  sup- 
plied to  it  should  be  in  sufficient  quantity ;  and,  secondly,  that  this  blood 
should  be  of  proper  quality.  In  death  from  hemorrhage  we  have  an  in- 
stance of  deficiency,  and  in  death  from  certain  poisons  as  well  as  diseases, 
an  illustration  of  defect  of  blood  (asthenia).  In  ordinary  syncope  (faint- 
ing or  swooning)  there  is  simply  a  deficiency  in  the  quantity  of  blood 
which  passes  through  the  heart,  although  there  is  no  actual  loss  of  this 
fluid  from  the  circulation.  Certain  diseases  which  affect  the  muscular 
structure  of  the  heart,  as  well  as  its  valves  and  bloodvessels,  may  also 
lead  to  a  sudden  arrest  of  its  functions.  These  morbid  conditions  produce 
a  mechanical  impediment  to  the  motions  of  the  organ  by  which  the  blood 
is  propelled,  and  death  by  syncope  is  the  necessary  result.  One  of  the 
most  striking  of  the  phenomena  which  attend  this  mode  of  dying  (death 
from  hemorrhage  or  anaemia)  is  an  extreme  palor  of  the  face,  hands,  and 
lips,  and  indeed  of  the  body  generally.  The  patient  is  very  restless,  toss- 
ing the  limbs  about  in  all  directions.  Giddiness  and  nausea  are  often 
complained  of,  and  actual  vomiting  may  occur.  In  many  cases  vision  is 
extinguished,  everything  appearing  black.  There  is  transient  delirium, 
which  soon  passes  into  insensibility.  The  pulse  becomes  more  and  more 
weak  and  irregular,  until  at  length  it  is  imperceptible.  The  respiratory 
movements  are  repeated  at  uncertain  intervals,  and  have  a  sighing  or 
gasping  character.  Towards  the  last  there  are  general  convulsions  (Fagge 
on  the  Different  Modes  of  Dying,  Guy's  Hosp.  Rep.,  1879,  p.  34.3). 
In  these  cases  the  heart  is  found  empty  and  contracted  at  the  autopsy. 
When,  however,  from  any  cause,  there  Is  sudden  stoppage  of  the  heart, 
the  right  and  left  cavities  of  this  organ  are  found  to  contain  blood  in  the 


64  DEATH    FROM    ASPHYXIA. 

normal  proportion  in  which  that  fluid  is  ordinarily  circulated.  Blood  is 
found  in  the  large  veins  (venfe  cavse)  as  well  as  in  the  arterial  trunks. 
There  is  no  congestion  or  accumulation  of  blood  in  the  lungs  or  brain. 

Asphyxia  (d  priv.  and  0^1)15  pulse,  signifying  pulselessness). — This  state 
is  induced  by  any  cause  which  arrests  the  function  of  respiration.  The 
term  apnoea  (from  d  priv.  and  rtcfio,  I  respire)  is  less  appropriate,  and  is 
now  applied  by  physiolog-ists  to  an  exactly  opposite  condition — that  which 
consists  in  an  excessive  supply  of  oxygen  to  the  blood,  rendering-  respira- 
tory movements  for  the  time  unnecessary.  The  various  forms  of  death  by 
sutl'ocation,  as  in  the  obstruction  of  the  air-passages  from  mechanical 
causes  in  drowning,  hanging,  and  strangulation,  furnish  illustrations  of 
death  commencing  by  the  lungs,  or  asphyxia.  The  effect  of  cutting  off 
air  from  the  lungs  is  that  the  blood  is  not  aerated,  and  it  is  therefore  cir- 
culated in  a  state  unfitted  to  support  the  nutrition  of  the  heart  and  brain. 
It  is  necessarily  distributed  with  the  impurities  derived  from  the  Avaste  of 
tissue,  and  thus  acts  as  a  poison  to  all  the  organs.  It  is  incapable  of  sus- 
taining nerve-force  or  muscular  irritability.  It  stagnates  in  the  capillary 
vessels  of  the  lungs,  produces  a  languid  action,  of  the  heart  by  its  circula- 
tion through  the  muscular  structure  of  this  organ,  and  causes  insensibility 
by  its  distribution  through  the  bloodvessels  of  the  brain.  The  lungs,  by 
purifying  the  blood,  are  essential  to  the  circulation.  Death  from  asphyxia 
may  be  therefore  regarded  as  death  from  defect  of  the  blood.  The  obser- 
vations of  Brodie  and  others  have  clearly  proved  that,  in  spite  of  the  im- 
purity of  the  blood,  the  heart  will  continue  to  act  and  the  circulation  to 
be  maintained  for  two  or  three  minutes,  or  longer,  after  breathing  has 
entirely  ceased.  This  may  be  proved  by  hanging  or  strangling  an  animal, 
and  observing  the  condition  of  the  heart.  As  the  action  of  this  organ 
continues  after  the  animal  has  ceased  to  breathe,  life  is  not  actually  ex- 
tinct;  and,  under  favorable  circumstances,  it  may  be  restor-^d,  if  no  injury 
be  done  to  the  air-cells  of  the  lungs,  so  long  as  this  action  continues. 
The  circulation  of  the  unaerated  blood  through  the  brain,  appears  to  anni- 
hilate sensibility,  so  that  no  consciousness  or  feeling  exists,  and  the  person 
is  to  all  appearance  dead.  Supposing  that  the  suspension  of  respiration 
is  complete,  the  action  of  the  heart  gradually  slackens  and  finall}^  stops. 
It  is  at  this  period  of  the  complete  arrest  of  the  motions  of  the  heart  that 
asphyxia  passes  into  death.  There  are  many  diseases  which  operate 
fatally  by  arresting  the  functions  of  the  lungs;  and  these  may  be  regarded 
as  furnishing  the  natural  causes  of  asphyxia.  The  violent  causes,  in- 
cluding not  only  the  ordinary  modes  of  suffication,  but  the  effects  of 
certain  poisons,  are  not  difficult  to  appreciate,  provided  a  true  history  of 
the  case  can  be  obtained.  Michael  Foster  has  shown  how,  in  experiments 
on  animals,  it  is  very  soon  observed  that  the  expiratory  eflTorts  become 
exaggerated  out  of  all  proportion  to  the  inspiratory,  and  how  they  quickly 
pass  into  convulsions.  This  period  lasts  about  a  minute,  during  whicli 
time  the  pulse  is  increased  in  frequency,  and  the  arterial  blood-pressure 
rises.  Deep,  slow  breathing  then  supervenes,  and  the  inspiratory  move- 
ments are  now  more  marked  than  the  expiratory,  the  more  yielding  parts 
of  the  chest  wall  receding  at  every  inspiration.  The  cardiac  beats  decrease 
in  number,  but  remain  forcible,  though  the  arterial  pressure  falls.  The 
respiratory  rhythm  becomes  irregular,  long  pauses  being  followed  by  quick 
inspirations  with  brief  intervals.  The  inspirations  next  become  shallow 
and  gasping,  the  acceleratory  muscles  of  respiration  being  brought  into 
active  play,  and  at  last  the  gasps  end  in  a  convulsive  stretching  of  the 
whole  body;  and,  with  extended  limbs  and  a  straightened  trunk,  with  the 
head  thrown  back,  the  mouth  widely  open,  the  face  drawn  and  the  nostrils 


DEATH  FROM  ASPHYXIA COMA-  65 

dilated,  the  last  breath  is  drawn.  There  are  three  distinguishable  stages 
of  these  phenomena  of  asphyxia,  which  result  from  a  continued  deficiency 
in  air : — 1.  A  stage  of  d3^spncea,  characterized  by  an  increase  in  the  res- 
piratory movements  both  of  inspiration  and  expiration.  2.  A  convulsive 
stage,  characterized  by  the  dominance  of  the  expiratory  efforts,  and  cul- 
minating in  general  convulsions.  3.  A  sta^je  of  exhaustion,  in  which 
lingering  and  long-drawn  inspirations  gradually  die  out.  When  brought 
about  by  sudden  occlusion  of  the  windpipe,  these  events  run  through  their 
course  in  from  three  to  five  minutes.  The  phenomena  of  slow  asphyxia, 
where  the  supply  of  air  is  gradually  diminished,  are  fundamentally  the 
same,  and  the  same  stages  are  seen,  but  with  their  development  taking 
place  more  slowly  than  where  there  is  a  sudden  and  total  deprivation  of 
air.  The  heart  continues  to  beat  for  some  seconds  after  all  respiratory 
movements  have  ceased,  whether  the  asphyxia  be  rapidly  or  slowly 
developed. 

In  animals,  the  cardiac  chambers  at  the  moment  of  death  are  all  gorged 
with  blood — the  left  ones  as  well  as  the  right.  When  rigor  mortis  sets 
in,  the  left  auricle  and  ventricle  empty  themselves ;  and  in  ordinary  autop- 
sies in  the  human  subject,  the  pulmonary  artery,  the  right  cavities  of  the 
heart,  and  the  vena3  caviB  are  found  gorged  with  blood.  The  pulmonary 
veins,  the  left  cavities  of  the  heart,  and  the  aorta,  are  either  empty  or 
contain  but  little  blood.  In  certain  cases  of  asphyxia,  the  right  cavities 
of  the  heart,  as  well  as  the  left,  have  been  found  empt3^  When  the  access 
of  air  to  the  lungs  is  suddenly  and  completely  cut  off,  the  circulation  of 
the  blood  is  very  speedily  arrested  ;  but  supposing  the  occlusion  of  the 
air-passages  to  be  partial  or  gradual,  the  circulation  of  the  blood  may  con- 
tinue for  a  time,  and  thus  cause  congestion  of  certain  organs.  Hence  the 
appearances  in  asphyxia  differ  greatly.  A  mixed  condition,  under  the 
name  of  syncopal  asphyxia,  has  been  described  by  some  pathologists.  In 
this  the  cavities  of  the  heart  are  found  empty.  Geo.  Johnson  (As- 
phyxia, 1889)  states  that  when  the  chest  is  opened  immediately  after 
death  from  apnoea  (asphyxia)  the  right  cavities  of  the  heart  are  distended 
with  blood,  while  the  left  contain  comparatively  little  blood;  and  he  holds 
that  the  phenomena  of  asphyxia  are  characterized  by  two  well-defined 
stages.  In  the  first  stage  there  is  S3'stemic  arterial  resistance,  with 
resulting  distension  of  the  left  side  of  the  heart.  In  the  second  stage 
there  is  pulmonary  arterial  resistance,  with  distension  of  the  right  cavi- 
ties and  comparative  emptiness  of  the  left. 

Coma  (from  x6  xCj/^a,  a  deep  sleep). — Besides  a  due  supply  of  properly 
aerated  blood,  the  brain  requires  for  the  exercise  of  its  functions  a  proper 
quantity  of  blood,  so  that  either  by  the  sudden  withdrawal  of  this  fluid, 
or  by  a  circulation  of  impure  blood,  these  are  arrested.  A  person  thus 
affected  falls  into  a  state  of  complete  insensibility  (coma),  so  that  it  is 
impossible  to  rouse  him.  The  functions  of  the  heart  and  lungs  are  not 
always  suddenly  arrested  under  these  circumstances.  They  appear  to  be 
less  dependent  on  the  brain  than  the  brain  is  upon  them  ;  but  this  is  rather 
a  question  of  degree.  A  due  supply  of  nerve-force  is  required  for  the  ac- 
tion of  the  muscles,  whether  of  the  heart  or  of  the  chest;  and  when  this  is 
withdrawn,  the  heart  ceases  to  beat,  and  the  respiratory  muscles  cease  to 
act :  circulation  and  respiration  are  thus  arrested  by  the  absence  of  inner- 
vation. This  is  sometimes  described  as  death  by  paralysis  of  the  heart 
and  lungs.  The  blood  is  neither  aerated  nor  circulated.  Sudden  death 
from  apoplexy  is  an  illustration  of  death  by  the  brain.  Coma  may  also 
be  a  result  of  the  introduction  of  certain  poisons  into  the  blood,  and  of 
fractures  of  the  skull  leading  to  compression  of  the  brain  or  destruction 
5 


QQ  SIGNS    OR    INDICATIONS    OF    DEATH. 

of  its  substance.  Death  beginning  at  the  brain  is,  indeed,  scarcely  to  be 
regarded  as  a  mode  of  dying,  since  it  may  usually  be  resolved  into  either 
death  from  sudden  paralysis  of  the  respiratory  centre,  when  death  is  often 
absolutely  quiet ;  or  the  coma  ends  in  asphyxia,  when  the  extinction  of 
respiration  is  brought  about  more  slowly.  In  death  by  the  brain,  the  ap- 
pearances observed  consist  chiefly  in  a  congested  state  of  the  cerebral 
membranes  and  substances  of  the  brain.  As  before  death  the  breathing 
is  affected,  the  lungs  are  congested  and  blood  accumulates  in  the  cavities 
of  the  heart,  more  on  the  right  than  on  the  left  side. 

The  appearances  described  as  characteristic  of  the  different  modes  of 
death  by  the  heart,  lungs,  and  brain,  are  liable  to  variation  by  reason  of 
the  intimate  relations  of  these  organs.  Thus,  there  may  be  a  mixed  con- 
dition of  syncope  and  asphyxia,  or  of  asphyxia  with  cerebral  congestion. 

With  regard  to  the  interruption  of  the  functions  of  the  brain  as  a  result 
of  pressure  by  the  effusion  of  blood  or  serum,  it  is  to  be  observed  that  a 
very  small  effusion  at  the  base  or  in  the  substance  of  the  medulla  oblongata 
is  sufficient  to  cause  death ;  while,  generally  speaking,  a  larger  effusion  is 
required  into  the  membranes,  ventricles,  or  substance  of  the  brain,  in  order 
to  produce  a  fatal  result.  In  cases  of  chronic  hydrocephalus,  in  which  the 
brain  has  resisted  the  pressure  of  a  large  accumulation  of  serum  for  many 
years,  a  slight  and  sudden  increase  in  the  quantity  at  any  period  of  life 
may  lead  to  coma  and  death.  This  condition  may  be  mistaken  for  nar- 
cotic poisoning. 

All  causes  of  death,  whether  from  disease  or  violence,  are  referable  to 
an  effect  produced  primarily  on  the  heart,  the  lungs,  or  the  brain ;  but,  as 
it  has  been  elsewhere  stated,  death  does  not  take  place  until  the  action  of 
the  heart  has  entirely  ceased,  the  arrest  of  the  circulation  producing  an 
immediate  impression  upon  the  functions  of  the  brain  and  lungs. 

The  natural  causes  of  sudden  death  may  be  generally  traced  to  some 
injury  or  impediment  to  the  action  of  the  heart,  lungs,  or  brain  It  would 
be  foreign  to  the  objects  of  this  manual  to  give  a  description  of  them.  The 
violent  causes  are  those  which  demand  the  especial  attention  of  a  medical 
jurist ;  they  will  be  considered  hereafter.  In  its  relation  to  medicine  and 
medical  jurisprudence  the  subject  of  sudden  death  has  been  fully  treated 
by  Herrich  and  Kopp,  Der  Plotzliche  Tod  aus  inneren  Ursachen,  1848; 
by  Devergie,  Ann.  d'Hyg.,  1838,  2,  145;  and  by  Fagge,  Guy's  Hosp. 
Rep.,  1879,  p.  343. 

The  violent  causes  of  death,  whether  sudden  or  protracted,  which  chiefly 
require  the  skill  of  a  medical  jurist  for  their  elucidation,  are  poisoning, 
wounds,  and  personal  injuries,  such  as  burns  and  scalds,  as  well  as  those 
forms  of  death  which  commence  by  the  lungs,  including  drowning,  hang- 
ing, strangulation,  and  suffocation.  In  nearly  all  cases,  the  body  of  the 
deceased  is  produced,  and  a  medical  opinion  can  be  based  upon  a  careful 
examination. 

Signs  or  Indications  of  Death. — The  verification  of  death  is  occasionally 
a  duty  thrown  on  the  medical  jurist.  Certain  signs  or  indications  have 
been  pointed  out  as  proving  that  death  is  real,  and  not  apparent.  These 
are  taken  in  the  order  of  their  importance. 

1.  Cessation  of  Circulation  and  Respiration. — The  heart  is  considered 
to  be  the  organ  in  which  life  begins  and  ends — the  primiim  vivens  and 
ultimum  moriens — the  first  to  live  and  the  last  to  die.  The  proof  of  death 
is  the  proof  of  the  cessation  of  the  heart's  action  for  a  certain  period. 
The  more  visible  indication  of  death  is  the  cessation  of  breathing,  and, 
in  the  opinion  of  Brodie,  the  entire  cessation  of  breathing  alone  may  be 
regarded  as  a  decisive  test  of  the  extinction  of  life.     The  movements  of 


COOLING    OF    THE    BODY.  67 

respiration  cannot  be  overlooked  by  any  one  who  does  not  choose  to 
overloolv  them  ;  and  the  heart  never  continues  to  act  for  more  than  four 
or  five  minutes  alter  respiration  has  ceased.  The  proofs  of  the  continued 
action  of  this  organ  are,  however,  less  obvious  to  the  unskilled  observer 
than  the  movements  of  the  chest.  The  cessation  of  breathing-  for  a  period 
of  five  minutes  furnishes  a  certain  proof  that  the  person  is  really  dead. 
But  the  skilled  observer  would  apply  the  test  of  auscultation,  and  before 
giving-  an  opinion  should  satisfy  himself  of  the  permanent  cessation  of 
the  heart's  action.  It  is  impossible  to  admit  that  the  heart  can  remain 
for  even  half  an  hour  in  a  state  of  inaction  in  a  human  being,  and  then 
spontaneously  recover  its  activity. 

2.  Cooling  of  the  Body. — The  normal  temperature  of  the  interior  of 
the  living  body  in  health  is  about  98.4°  F.  It  is  liable  to  be  increased  in 
some  diseases,  and  to  be  diminished  in  others  In  a  case  of  typhoid  fever 
the  blood  was  found  to  have  a  temperature  of  113°  F. ;  and  in  strychnine  ' 
poisoning-  it  is  very  high.  The  time  usually  assigned  for  the  cooling-  of 
the  dead  human  body  is  ivoroi  fifteen  to  twenty  hours,  but  it  varies  accord- 
ing to  the  condition  of  the  body  at  the  time  of  death,  the  mode  of  death, 
and  the  circumstances  under  which  it  had  been  placed.  Thus,  if  exposed 
naked  to  a  cold  atmosphere,  the  cooling  of  the  body  is  very  rapid.  If  it 
is  well  covered,  the  cooling  takes  place  slowly.  When  death  has  taken 
place  suddenly  from  accident,  apoplexy,  or  acute  disease,  the  body  has 
been  observed  to  maintain  its  temperature  for  a  long  period.  Obviously, 
a  dead  body  cools  less  rapidly  as  its  temperature  approaches  that  of  the 
surrounding  medium.  Goodhart  found  the  average  rate  of  cooling  during 
the  first  three  hours  after  death  to  be  at  the  rate  of  about  4°  F.  per  hour, 
during  the  next  six  hours  the  rate  was  3°  per  hour;  and,  at  later  periods, 
rather  more  than  1°  per  hour.  Burman  found  the  average  rate  of  cooling 
during  the  first  eight  hours  after  death  to  be  2°  F.  per  hour:  Ed.  Med. 
and  Surg.  Jour.,  1880,  p.  993. 

3.  Cadaveric  Higidity.  Rigor  Mortis. — In  from  three  or  four  to  five 
or  six  hours  after  death,  and  generally  while  the  body  is  in  the  act  of 
cooling,  the  muscles  of  the  limbs  are  observed  to  become  hard  and  con- 
tracted in  the  attitude  in  which  the  body  is  placed  ;  the  joints  are  stiff,  and 
the  trunk  firm  and  unyielding.  This  peculiar  condition  is  known  under 
the  name  of  cadaveric  rigidity,  or  rigor  mortis.  The  first  effect  of  death 
from  any  cause  is  in  most  cases  a  general  relaxation  of  the  whole  of  the 
muscular  system.  The  lower  jaw  drops,  the  eyelids  lose  their  tension,  the 
limbs  are  soft  and  flabby,  and  the  joints  are  flexible.  The  muscular  tissue 
may  be  considered  as  passing  through  three  stages  in  a  dead  body.  1.  It 
is  at  first  flaccid,  but  contractile ;  although,  it  may  be  remarked,  that  muscles 
contracted  by  living  force  in  the  act  of  dying  do  not  necessarily  become 
relaxed  in  death.  2.  It  becomes  rigid  and  incapable  of  contraction.  3.  It 
is  once  more  relaxed,  and  does  not  regain  its  power  and  contractility.  The 
body  now  passes  into  the  state  of  incipient  putrefaction.  The  first  stage 
defines  the  duration  of  muscular  irritability ;  the  second  stage,  that  of 
cadaveric  rigidity ;  and  the  third,  that  of  the  commencement  of  chemical 
changes,  or  putrefaction. 

At  a  certain  period  after  death,  the  heart  is  found  rigid  and  firmly  con- 
tracted. If  examined  at  this  time,  it  may  appear  to  be  in  a  state  of  spasm, 
and  to  have  its  walls  thickened,  while  the  cavity  of  the  left  ventricle  may 
be  described  as  being  much  smaller  than  in  the  normal  state.  J.  Paget 
has  pointed  out  that  this  natural  condition  of  the  heart  after  death  has 
led  to  pathological  mistakes,  the  walls  being  described  as  thickened,  the 
cavities  diminished  in  size,  and  the  heart  itself  as  being  in  a  state  of  con- 


68  CADAVERIC    RIGIDITY,    OR    RIGOR    MORTIS, 

centric  hypertrophy  from  disease.  On  the  other  hand,  the  perfect  relaxa- 
tion of  the  heart  which  follows  at  a  later  period  after  death  has  been 
mistaken  for,  and  described  as,  a  morbid  flabbiness  and  flaccidity.  Spasm 
and  paralysis  cannot  be  inferred  to  have  necessarily  existed  during-  life 
when  we  discover  these  conditions  of  the  heart  in  the  recently  dead  body. 
["Besides  these  external  causes,  Prof.  Reese  says  there  are  others  sub- 
jective or  inherent  in  the  body,  such  as  age,  sex,  state  of  the  body,  manner 
of  death,  influence  of  disease,  etc. 

"  Aged  bodies  decompose  slowly,  probably  on  account  of  their  compara- 
tive want  of  moisture;  while  the  bodies  of  new-born  children  rapidly 
putrefy  for  the  opposite  reason.  Fat  and  flabby  bodies  undergo  decompo- 
sition more  rapidly  than  lean  ones,  because  they  contain  more  fluids;  the 
same  is  said  to  be  true  of  the  bodies  of  women  dying  in  childbed.  In 
cases  of  very  sudden  death  in  persons  of  previously  sound  health,  putrefac- 
tion is  more  rapid  than  when  it  has  resulted  from  an  exhausting  disease. 
When  the  blood  has  been  impoverished,  as  in  typhus,  and  when  the  body 
has  previously  been  much  contused  (provided  it  has  not  been  protected 
from  the  influence  of  the  air,  as  when  buried  under  rubbish),  the  process  of 
decomposition  is  accelerated. 

"  It  is  also  rapid  after  death  from  suffocation  by  smoke,  coal  gas,  or  sul- 
phuretted hydrogen  ;  also  by  strangulation,  draining  and  asphyxia  gener- 
ally ;  also  after  narcotic  poisoning  ;  but  it  is  slower  alter  death  from 
phosphorus,  alcohol,  sulphuric  acid,  and  arsenic. 

"  The  orcler  of  decomposition  of  the  internal  organs,  according  to  Caspar, 
is  as  follows:  Trachea  and  larynx,  brain  of  young  infants,  stomach  and 
intestines,  spleen,  omentum  and  mesentery,  liver,  brain  of  adults,  heart 
and  lungs,  kidney,  bladder  and  oesophagus,  pancreas,  diaphragm,  large 
vessels  (especially  the  arteries),  and,  last  of  all,  the  uterus."] 

Under  the  action  of  poisons  like  strychnine  and  those  other  alkaloids 
which  cause  death  by  convulsions,  the  more  violent  and  frequent  the  con- 
vulsions, the  sooner  rigidity  sets  in.  Whatever  exhausts  muscular  irrita- 
bility before  death,  appears  to  accelerate  rigor  mortis  in  the  muscles  after 
death.  In  those  instances  in  which  muscular  irritability  at  the  time  of 
death  is  slight,  either  in  consequence  of  a  bad  state  of  nutrition  or  of 
exhaustion  from  over-exertion,  or  from  convulsions  caused  b}^  disease  or 
poison,  it  is  observed  that  rigidity  sets  in  and  ceases  soon,  and  putrefaC; 
tion  appears  and  progresses  quickly :  Brown-Sequard,  Proc.  Roy.  Soc, 
1861,  p.  204.  Por  a  similar  reason  it  takes  place  at  an  earlier  period  in  the 
very  young  and  in  the  old,  than  in  an  adult  in  the  prime  of  life. 

If  we  allow  a  proper  interval  to  elapse  after  the  supposed  death  of  a 
person,  there  can  be  no  difficulty  in  solving  the  question  whether  the  body 
is  really  dead  even  before  any  of  those  changes  which  arise  from  putrefac- 
tion have  manifested  themselves.  The  circumstances  on  which  we  may 
rely  as  furnishing  conclusive  evidence  of  death  are  the  following:  1.  The 
absence  of  circulation  and  respiration  for  at  least  an  hour,  the  stethoscope 
being  employed.  2.  The  gradual  cooling  of  the  body  approximately  to 
the  temperatiire  of  the  air,  the  trunk  remaining  warm  while  the  members 
are  cold.  3.  As  the  body  cools,  the  gradual  supervention  of  a  rigid  state 
of  the  muscles,  successively  attacking  the  limbs  and  trunk,  and  ultimately 
spreading  through  the  whole  muscular  system.  When  these  conditions 
are  observed,  the  proofs  of  death  are  conclusive,  and  it  is  unnecessary  to 
wait  for  any  sign  of  putrefaction.  These  changes  are  certainly  the  fore- 
runners of  putrefaction,  as  the  process  of  putrefaction  is  itself  the  fore- 
runner of  the  entire  destruction  of  the  body.     It  may  safely  be  said  that 


CHANGES    IN    THE    VISCERA.  69 

there  has  not  been  a  single  instance  of  resuscitation  after  rigidity  had  once 
commenced  in  a  body.  During  the  raging  of  epidemics,  if  additional  evi- 
dence be  required  for  early  burial,  it  might  be  obtained  by  exposing  a 
superficial  muscle  to  the  galvanic  stimulus.  If  the  fibres  do  not  contract, 
death  is  certain.  If  they  do,  this  is  no  proof  that  the  person  can  be  restored 
to  active  life  ;  but  further  time  may  be  allowed  before  the  body  is  com- 
mitted to  the  grave.  For  a  full  discussion  of  rigor  mortis,  see  a  paper 
by  Rossbach:  Yirchow's  Arch.,  Bd.  51,  558. 

Putrefaction. — By  putrefaction  we  are  to  understand  those  chemical 
changes  which  take  place  in  dead  animal  matter,  during  which  offensive 
gases  are  evolved.  The  ultimate  effect  of  these  changes  is,  after  a  longer 
or  shorter  period,  to  reduce  the  organic  to  the  condition  of  inorganic  com- 
pounds, consisting  chiefly  of  water,  ammonia,  and  carbonic  acid.  It  is  in 
the  stage  of  transition  that  noxious  effluvia  are  evolved  from  which  the 
process  derives  its  name.  These  consist  of  compounds  of  carbon,  hydro- 
gen, nitrogen,  and  sulphur. 

This  process  does  not  begin  to  manifest  itself  in  the  dead  body  until 
after  the  cessation  of  rigor  mortis,  and  generally  about  the  third  day.  It 
is  then  observed,  if  the  body  has  been  exposed  to  the  atmosphere  in  an 
apartment  of  mean  temperature  (60°  F.),  that  the  limbs  and  trunk  become 
supple  and  pliant,  and  have  a  faint  odor.  The  skin  covering  the  abdomen 
becomes  of  a  pale  greenish  color,  which  gradually  deepens.  A  similar 
discoloration  slowly  makes  its  appearance  on  the  chest,  between  the  ribs, 
on  the  face,  the  neck,  the  legs,  and,  lastly,  on  the  arms.  The  color  appears 
to  depend  on  the  decomposition  and  infiltration  of  the  animal  fluids,  espe- 
cially of  thp  blood,  into  the  skin.  In  the  neck  and  limbs  it  is  observed  to 
be  more  marked  in  the  situation  of  the  large  venous  trunks ;  and  some- 
times, indeed,  the  course  of  the  superficial  veins  is  accurately  traced  out 
by  greenish-blue  or  dusky  lines,  which  have  been  mistaken  for  marks  of 
violence.  Gaseous  products  are  formed,  not  only  in  the  hollow  organs  of 
the  abdomen,  but  beneath  the  skin  generally ;  so  that  on  making  an  inci- 
sion, the  edges  of  the  skin  are  rapidly  forced  apart  or  everted.  The  pres- 
sure of  the  confined  gases  accounts  for  the  occasional  escape  of  alimentary 
and  fecal  matter  from  the  outlets — also  for  the  escape  of  Ijlood  some  days 
after  death  from  recent  wounds  involving  any  of  the  large  veins. 

The  gases  generated  in  the  cavities  of  the  head  and  face  by  putrefaction 
appear  to  meet  with  the  greatest  resistance  to  their  escape.  The  featui'es 
become  generally  swollen  or  bloated,  one  or  both  eyes  may  be  protruded, 
the  eyelids  swollen  and  dark-colored,  the  lips  swollen  and  the  tongue  pro- 
truded between  them,  gaseous  matter  with  fluid  escaping  in  bubbles  from 
the  mouth  and  nostrils.  As  the  skin  of  the  face  is  generally  livid,  or  even 
black,  it  is  impossible,  under  these  circumstances,  to  identify  the  body. 
In  death  from  drowning,  when  the  body  is  afterwards  exposed  to  a  warm 
atmosphere,  the  gases  of  putrefaction  are  so  copiously  produced  that  the 
head  appears  much  larger  than  natural,  and  the  skin  of  the  trunk  and 
limbs  is  distended  with  gas,  giving  to  the  whole  of  the  discolored  body  a 
bloated  appearance. 

Changes  in  the  Viscera. — During  putrefaction  various  discolorations 
take  place,  first  in  the  windpipe,  then  on  the  mucous  surface  of  the 
stomach  and  bowels,  often  closely  simulating  the  effects  of  disease  or 
poison.  The  mucous  membrane  of  the  stomach  may  be  found  of  various 
tints — from  a  red  brown,  becoming  of  a  brighter  red  by  exposure  to  the 
air,  to  a  deep  livid  purple  or  slate  color,  and  sometimes  black  from  decom- 
position of  the  blood.  When  the  stomach  is  in  contact  with  the  spleen 
or  liver,  the  lividity  is  often  well  marked  and  clearly  defined  through  all 


70  CHANGES    IN    THE    VISCERA. 

the  coats.  The  peritoneal  or  outer  coat  is  of  a  greenish  hue,  and  the  course 
of  the  superficial  vessels  is  marked  by  greenish-brown  or  black  lines. 
These  spontaneous  changes,  which  are  the  result  of  putrefaction,  may  be 
easily  mistaken  for  the  effects  of  irritant  poisons.  There  are  no  rules  that 
will  always  enable  a  medical  jurist  to  distinguish  such  cases.  Much  must 
depend  on  the  process  of  putrefaction,  and  the  period  after  death  at  which 
the  body  is  examined:  hence  each  case  must  be  judged  by  the  circum- 
stances which  attend  it.  We  may  presume  that  the  redness  has  taken 
place  during  life,  and  is  not  a  result  of  post-mortem  changes:  1.  When  it 
is  seen  soon  after  death.  2.  When  it  is  met  with  in  parts  neither  de- 
pendent nor  in  contact  with  other  organs  gorged  with  blood.  3.  When 
it  is  accompanied  by  a  considerable  effusion  of  coagulated  blood,  mucus, 
or  flakes  of  membrane,  the  result  of  ulceration,  corrosion,  or  destruction 
of  the  coats  of  the  viscera.  When  the  body  is  not  inspected  until  long 
after  death,  it  is  difficult  to  distinguish  pseudo-morbid  appearances  from 
those  depending  on  the  action  of  irritant  poison.  In  a  really  doubtful 
case,  it  is  therefore  better  to  withhold  an  opinion  than  to  express  one  which 
must  be  purely  conjectural. 

Putrefaction  takes  place  with  variable  rapidity.  It  commonly  show^s 
itself  in  this  country  about  the  second  or  third  day  in  warm,  and  about 
the  fifth  or  sixth  day  in  cold  weather.  In  some  instances,  however,  the 
body  has  been  found  in  an  advanced  state  of  putrefaction  in  the  short 
period  of  sixteen  hours  after  death,  and  in  others  the  process  has  been 
greatly  protracted.  The  time  of  its  appearance  is  dependent  on  the  dura- 
tion of  rigor  mortis,  and  the  condition  of  the  body  at  the  time  of  death. 

The  changes  caused  by  putrefaction  in  the  dead  body  have  in  some  cases 
been  mistaken  for  those  of  gangrene  in  the  living,  and  a  person  has  in 
consequence  been  wa'ongly  charged  with  manslaughter.  Parts  which  are 
the  seat  of  severe  injury  at  the  time  of  death  undergo  putrefaction  more 
rapidly  than  those  which  have  not  been  affected  by  the  accident.  When 
a  body  has  undergone  putrefaction  generally,  the  effects  of  gangrene  in  a 
wound  may  be  merged  in  the  changes  caused  by  this  process,  and  great 
care  should  be  taken  in  assigning  these  changes  to  one  or  the  other  condi- 
tion. Gangrene  implies  the  death  of  a  part  in  the  living  body,  and  pu- 
trefactive changes  take  place  in  the  dead  part,  as  in  the  entire  dead  body. 
If  changes  resembling  those  of  gangrene  are  found  in  a  wounded  limb 
while  the  rest  of  the  body  is  not  in  a  putrescent  state,  there  may  be  some 
reason  for  the  opinion  that  there  was  gangrene  during  life.  In  this  case, 
however,  due  allowance  should  be  made  for  the  more  rapid  decomposition 
of  wounded  parts.  The  best  evidence  will  be  that  which  shows  the 
actual  condition  of  the  injured  part  in  the  living  body.  If  putrefaction 
is  advanced,  the  opinion  of  a  person  w^ho  has  not  seen  the  deceased  while 
living  can  be  little  more  than  a  conjecture. 


DEFINITION    OF    A    POISON-  71 


POISONING. 


CHAPTER    IV. 

DEFINITION      OF      THE      TERM      POISON. MECHANICAL      IRRITANTS. INFLUENCE      OF     HABIT, 

IDIOSYNCRASY,     AND     DISEASE. CLASSIFICATION. SPECIAL    CHARACTERS    OF    CORROSIVE, 

IRRITANT,   AND  NEUROTIC  POISONS. 

Definition. — A  poison  is  commonly  defined  to  be  a  substance  which, 
when  administered  or  taken  in  small  quantity,  is  capable  of  acting  dele- 
teriously  on  the  body :  in  proper  language,  this  term  is  applied  only  to 
those  substances  which  destroy  life  in  small  doses.  This  popular  view 
of  the  nature  of  a  poison  is  too  restricted  for  the  purposes  of  medical 
jurisprudence.  It  would  obviously  exclude  numerous  compounds,  the 
poisonous  properties  of  which  cannot  be  disputed — as,  for  example,  the 
salts  of  copper,  tin,  zinc,  lead,  and  antimony ;  these,  generally  speaking, 
act  as  poisons  only  when  administered  in  large  doses.  Some  sub- 
stances, such  as  nitre,  have  not  been  observed  to  have  a  noxious  action 
except  when  taken  in  large  quantity,  while  arsenic  acts  as  a  poison  in  a 
small  dose ;  but  in  a  medico-legal  view,  whether  a  man  dies  from  the 
effects  of  an  ounce  of  nitre,  or  two  grains  of  arsenic,  the  responsibility 
of  the  person  who  criminally  administers  the  substance  is  the  same. 
Each  may  be  regarded  as  a  poison,  differing  from  the  other  only  in  its 
degree  of  activity  and  in  its  mode  of  operation.  The  result  is  the  same  ; 
death  is  caused  by  the  substance  taken,  and  the  quantity  required  to 
destroy  life,  even  if  it  could  be  always  accurately  determined,  cannot 
enable  us  to  distinguish  a  poisonous  from  a  non-poisonous  substance. 
If,  then,  a  medical  witness  is  asked  "  What  is  a  poison  ?"  he  must  bewai-e 
of  adopting  this  popular  view,  or  of  confining  the  term  "poison"  to  a 
substance  which  is  capable  of  operating  as  such  in  one  small  dose. 

In  legal  medicine,  it  is  difficult  to  give  such  a  definition  of  a  poison  as 
shall  be  entirely  free  from  objection.  Perhaps  the  most  comprehensive' 
which  can  be  suggested  is  this:  "  A  poison  is  a  substance  which,  when 
absorbed  into  the  blood,  is  [by  a  direct  action — Ed.]  capable  of  seriously 
affecting  health  or  of  destroying  life."  There  are  various  channels  by 
which  poisons  may  enter  the  blood.  Some  poisons  are  gases  or  vapors  : 
these  operate  rapidly  through  the  lungs  ;  others  are  liquid  or  solid,  and 
these  may  reach  the  blood  either  through  the  skin  or  through  a  wound, 
but  more  commonly  through  the  lining  membrane  of  the  stomach  or 
bowels,  as  when  they  are  taken  or  administered  in  the  ordinary  manner. 
The  latter  chiefly  give  rise  to  medico-legal  investigations.  Some  sub- 
stances act  as  poisons  by  any  one  of  these  channels :  thus  arsenic  is  a 
poison  whether  it  enters  the  blood  through  the  lungs,  the  skin,  or  the 
stomach  and  bowels ;  but  such  poisons  as  those  of  the  cobra,  the  viper, 
of  rabies,  and  of  glanders,  appear  to  greatly  affect  the  body  only  through 
a  wound.  When  introduced  into  the  stomach,  some  of  these  animal 
poisons  have  been  found  to  be  almost  inert.     In  adof)ting  the  above  defi- 


72  MEDICI^'ES  a:sd  poisons. 

nition  of  a  poison  in  a  medical  sense,  it  is  proper  to  remark  that  there 
are  some  substances  which  are  regarded  as  poisons,  although  absorption 
into  the  blood  does  not  appear  to  be  absolutel}-  necessary  to  their  action. 
The  mineral  acids  and  alkalies  belong  to  this  class  of  bodies.  They  are 
corrosive  poisons:  they  operate  injuriously  by  causing  the  destruction 
of  living  parts;  and  whether  applied  to  the  skin,  the  stomach,  or  (in  the 
form  of"vapor)  to  the  air-cells  of  the  lungs,  they  destroy  life  chiefly  by 
the  local  changes  to  which  they  gire  rise,  and  the  inflammation  which  is 
a  consequence  of  their  action. 

It  is  not  easy  to  define  the  boundary  between  a  medicine  and  a  poison. 
It  is  usually  considered  that  a  medicine  in  a  large  dose  is  a  poison,  and 
that  a  poison  in  a  small  dose  is  a  medicine ;  but  a  medicine  such  as  tar- 
tarated  antimony  may  be  easily  converted  into  a  poison  by  giving  it  in 
small  doses  at  short  intervals,  either  under  states  of  the  bod}-^  not  adapted 
to  receive  it,  or  in  cases  in  which  it  exerts  an  injuriously  depressing  eiiect. 
Some  deaths  have  been  occasioned  by  the  wilful  misuse  of  antimony  in 
doses  which  might  be  described  as  medicinal,  although,  in  the  cases  re- 
ferred to,  the  intention  existed,  in  the  secret  administration  of  this  sub- 
stance, of  destroying  life.  A  person  may  die  either  from  a  large  dose  of 
a  substance  given  at  once,  or  from  a  number  of  small  does  given  at  such 
interyals  that  the  system  cannot  recover  from  the  effect  of  one  before 
another  is  administered.  This  remark  applies  to  a  great  number  of  medi- 
cines which  are  not  commonly  included  in  a  list  of  poisons. 

The  retailing  of  poisons  is  by  lavr  restricted  to  pharmaceutical  chemists, 
chemists  and  druggists,  and  medical  men,  and  by  the  Pharmacy  Act, 
18G8,  poisons  are  scheduled  under  two  heads.  With  those  placed  in  the 
first  part  of  the  schedule,  a  registration  of  the  sale  is  obligatory  ;  whilst 
those  in  the  second  part  of  the  schedule  are  merely  required  to  be  labeled 
with  the  name  of  the  substance,  the  word  "poison,"  and  the  name  and 
address  of  the  vendor.  The  following  are  at  present  the  scheduled  poisons : 
Parf  /.  Arsenic  and  its  preparations;  prussic  acid,  cyanide  of  potassium, 
all  metallic  cyanides  and  all  preparations  of  these ;  strychnine,  its  prepara- 
tions and  ail  poisonous  vegetable  alkaloids  and  their  salts :  aconite 
and  its  preparations  ;  emetic  tartar  ;  corrosive  sublimate  ;  cantharides  ; 
savin  and  its  oil ;  ergot  of  rye  and  its  preparations.  Pa?~t  II.  Oxalic 
acid ;  chloroform ;  chloral  hydrate ;  belladonna  and  its  preparations ; 
essential  oil  of  almonds,  unless  deprived  of  prussic  acid ;  opium  and  all 
preparations  of  opium  or  of  poppies ;  preparations  of  morphine,  of  nux 
vomica,  of  corrosive  sublimate  and  of  cantharides  ;  white  precipitate  ;  red 
precipitate  ;  and  vermin  killers. 

In  reference  to  the  medical  definition  of  a  poison,  it  is  necessary  to 
observe  that  the  law  does  not  regard  the  manner  in  which  the  substance 
administered  acts.  If  it  is  capable  of  destroying  life  or  of  injuring  health, 
it  is  of  little  importance,  so  far  as  the  responsibility  of  a  prisoner  is  con- 
cerned, whether  its  action  on  the  body  is  of  a  mechanical  or  chemical 
nature,  and  whether  it  operates  fatally  by  absorption  into  the  blood  or  not. 
Thus,  a  substance  which  simply  acts  mechanically  on  the  stomach  or  bowels, 
may,  if  wilfully  administered*  with  intent  to  injure,  involve  a  person  in  a 
criminal  charge,  as  much  as  if  he  had  administered  arsenic  or  any  of  the 
ordinary  poisons.  It  is,  then,  necessary  to  consider  what  the  law  strictly 
means  by  the  act  of  poisoning  If  the  substance  criminally  administered 
destroys  life,  whatever  may  be  its  nature  or  mode  of  operation,  the  accused 
is  tried  on  a  charge  of  murder  or  manslaughter,  and  the  duty  of  a  medical 
witness  consists  in  showing  that  the  substance  taken  was  the  certain 
cause  of  death.       If,   however,   death   is  not  the  consequence,   then  the 


THE    ADMINISTERING    OP    A    POISON.  73 

accused  may  be  tried  for  the  attempt  to  murder  by  poison  under  the 
Criminal  Law  Consolidation  Act,  18G1:  24  &  25  Vict.,  c.  100,  s.  11. 
The  words  of  this  statute  are  general,  and  embrace  all  kinds  of  substances, 
Avhether  they  are  popularly  or  professionally  regarded  as  poisons  or  not. 
Thus  it  is  laid  down  that — 

"  Whosoever  shall  administer,  or  cause  to  be  administered,  to  or  taken  by 
any  person,  any  poison,  or  other  destructive  thing,  with  intent  to  commit 
murder,  shall  be  guilty  of  felony." 

Whether  the  administering  be  followed  by  any  bodily  injury  or  not, 
the  act  is  still  a  felony,  provided  the  intent  has  been  to  commit  murder. 
The  attempt  to  administer  or  the  attempt  to  cause  to  be  administered  to, 
or  to  be  taken  by  any  person,  any  poison  or  other  destructive  thincj,  with 
the  like  intent,  although  no  bodily  injury  be  eifected,  is  also  a  felony : 
s.  14.  If  any  doubt  formerly  existed  whether  the  extei^nal  application 
of  poison,  e.  g.,  by  wounds  or  ulcerated  surfaces,  would  be  included  in  the 
Avords  "administering  or  taking,"  they  are  now  entirely  removed  by  the 
above  Act.  The  22d  section  specially  applies  to  such  an  ofience,  and  the 
15th  section  provides  that  "  Whosoever  shall,  by  any  means  other  than 
those  specified  in  any  of  the  preceding  sections  of  this  Act,  attempt  to 
commit  murder,  shall  be  guilty  of  felony."  Under  sect.  22  of  this  statute, 
in  reference  to  attempted  poisoning,  some  offences  are  comprised  which 
formerly  escaped  punishment:  "Whosoever  shall  unlawfully  apply  or  ad- 
minister to,  or  cause  to  be  taken  by,  or  attempt  to  appl_^  or  administer  to, 
or  attempt  to  cause  to  be  administered  to  or  taken  by  any  person,  any 
chloroform,  laudanum,  or  other  stupefying  or  overpowering  drug,  matter, 
or  thing,  with  intent,  in  any  of  such  cases,  thereby  to  enable  himself  or 
any  other  person  to  commit,  or  with  intent.,  etc.,  to  assist  any  other 
person  in  committing  any  indictable  offence,  shall  be  guilty  of  felony." 

Poison  is  not  always  administered  Avith  intent  to  murder.  On  many 
occasions  it  has  been  mixed  with  food,  and  thus  administered  with  a 
view  to  injure  or  annoy  a  person.  Cantharides  have  been  thus  fre- 
quently given,  and  in  one  instance  (Nov.,  1859)  eight  members  of  a 
family  suffered  from  severe  symptoms  of  poisoning  by  reason  of  the 
wanton  administration  of  this  drug.  In  April,  1860,  several  members  of 
a  family  suifered  from  severe  sickness,  as  a  result  of  tobacco  having  been 
put  into  water  contained  in  a  tea-kettle ;  and  tartar  emetic  has  been  in 
some  cases  dissolved  in  beer  or  other  liquids  as  a  mere  frolic,  without  any 
proved  or  probable  intention  on  the  part  of  the  offender  to  destroy  life. 
In  1884,  a  man  was  tried  at  the  Newington  Sessions  for  poisoning  a 
family  by  putting  corrosive  sublimate  into  a  tea-kettle,  but  was  acquitted 
for  Avant  of  evidence.  In  the  same  year  a  servant-girl  Avas  conAdcted  of 
poisoning  her  mistress's  beer  by  means  of  sulphate  of  copper  (Reg.  v. 
Mary  Baker,  C.  C.  C,  Oct.,  1884),  and  Avas  sentenced  to  fifteen  months' 
hard  labor.  The  case  of  McMullen  (Liverpool  Aut.  Ass.,  1856)  revealed 
an  extensive  system  of  poisoning  in  the  northern  counties,  in  Avhich  tartar 
-emetic  Avas  the  substance  employed.  This  drug,  mixed  Avith  cream  of 
tartar,  Avas  openly  sold  by  druggists  under  the  name  of  "quietness  poAA^- 
ders,"  and  the  evidence  established  that  Avomen  gave  these  powders  to 
their  husbands  Avith  a  view  to  cure  them  of  habits  of  drunkenness.  Hith- 
erto, Avhen  the  intent  to  murder  Avas  not  proved,  the  offender  has  escaped, 
although  great  bodily  injury  may  have  been  done  by  the  Avanton  or  mali- 
cious act.  Sections  23,  24  and  25  of  24  &  25  Yict.,  c.  100,  provide  for 
this  omission  : — 

"  23.  Whosoever  shall  unlawfully  and  maliciously  administer  to,  or 
cause  to  be  administered  to  or  taken  by,  any  other  person  any  poison  or 


7-1  WHAT    IS    A    NOXIOUS    SUBSTANCE? 

other  destructive  or  noxious  tiling,  so  as  thereby  to  endanger  the  life  of 
such  person,  or  so  as  thereby  to  inflict  upon  such  person  any  grievous 
bodily  harm,  shall  be  guilty  of  felony." 

"24.  Whosoever  shall  unlawfully  and  maliciously  administer  to,  or 
cause  to  be  administered  to  or  taken  by,  any  other  person  any  poison  or 
other  destructive  or  noxious  thing,  with  intent  to  injure,  aggrieve,  or 
annoy  such  person,  shall  be  guilty  of  a  misdemeanor." 

"25,  If,  upon  the  trial  of  any  person  charged  with  the  felony  above 
mentioned,  the  jury  shall  not  be  satisfied  that  such  person  is  guilty  thereof, 
but  shall  be  satisfied  that  he  is  guilty  of  the  misdemeanor  above  men- 
tioned, then  and  in  every  such  case  the  jury  may  acquit  the  accused  of 
such  felony,  and  find  him  guilty  of  such  misdemeanor." 

It  will  be  •perceived  that  the  words  of  the  statute  leave  the  question 
"  "What  is  a  poison  ?"  to  depend  upon  the  medical  evidence  adduced  :  and 
in  order  to  include  all  substances  of  an  injurious  nature,  although  they 
may  not  be,  strictly  speaking,  poisons,  the  words  "  destructive  or  noxious 
thing''''  are  employed.  Hence,  on  these  occasions,  a  medical  witness  must 
be  prepared  to  prove  that  the  substance,  if  not  a  poison,  was  a  destructive 
or  noxious  thing.  Judges  have  taken  different  views  of  the  meaning  of 
the  word  noxious,  and  it  is  well  that  a  witness  should  be  on  his  guard  in 
dealing  with  this  question,  "  What  is  a  noxious  substance  ?"  From  a  case 
tried  in  Cornwall,  before  Cockburn,  C.  J.,  it  would  appear  to  depend,  not 
on  the  well-known  nature  of  the  substance,  but  on  the  quantity  of  it 
attempted  to  be  administered.  In  Keg.  v.  Hennah  (Cornwall  Lent 
Ass.,  1877)  the  prisoner  was  charged  with  administering  to  a  woman  a 
poison,  cantharides,  with  intent  to  injure,  aggrieve,  and  annoy — the  real 
purpose  being  to  excite  erotic  feelings.  The  poison  was  given  in  two  figs, 
and  a  glistening  appearance  which  they  presented,  OAving  to  the  shining 
particles  of  cantharides,  prevented  the  woman  from  eating  them.  One 
fig  was  examined  by  a  chemist  and  druggist,  and  he  found  it  to  contain 
from  a  grain  to  a  grain  and  a  half  of  cantharides  in  powder.  This  would 
be  equivalent  to  from  tAvo  to  three  grains  in  the  two  figs.  The  druggist, 
in  giving  evidence,  said  that  this  quantity  of  cantharides  would  be  insuffi- 
cient to  produce  any  effect  upon  the  human  sj^stem,  and  further  stated,  by 
misquotation  of  this  manual,  that  a  fatal  dose  would  amount  to  twenty- 
four  grains.  It  Avas  ingeniously  contended  in  defence  that  if  what  was' 
administered  could  produce  no  effect,  it  Avould  not  in  laAV  amount  to 
administering  a  "noxious"  thing  as  required  by  the  statute.  This  vicAV 
Avas  accepted  by  the  Lord  Chief  Justice,  and  he  directed  an  acquittal.  He 
ruled  that,  unless  the  thing  Avas  noxious  in  the  quantity  administered,  it 
cannot  be  said  that  there  has  been  a  noxious  thing  administered.  He 
said,  further,  that  there  must  be  a  distinction  betAveen  a  thing  only  noxious 
Avhen  given  in  excess,  and  a  thing  Avhich  is  a  recognized  poison  and  is 
known  to  be  a  thing  noxious  and  pernicious  in  its  effect.  The  fallacy  of 
this  reasoning  Avill  be  apparent  when  it  is  stated  that  cantharides  is  a 
poison  recognized  by  law  as  Avell  as  in  medicine ;  that  it  finds  a  place  in 
the  schedule  of  the  Act  for  regulating  the  sale  of  poisons,  by  the  side  of 
strychnine,  prussic  acid,  and  arsenic  ;  and,  further,  that  these  substances 
operate  as  poisons  or  are  noxious  only  Avhen  given  in  excess,  i.  e.,  beyond 
a  medicinal  dose.  The  court  was  no  doubt  misled  on  this  occasion  by 
relying  upon  the  opinion  of  a  chemist  and  druggist.  The  quantity  of 
cantharides  attempted  to  be  administered  Avas  quite  sufficient  to  cause 
irritation  of  the  bladder,  strangury,  and  other  unpleasant  symptoms,  and 
this  Avould  surely  come  under  the  head  of  annoyance  or  injury  to  health. 
Maclagan  reports  an  instance  in  Avhich  one  grain  and  a  half  of  cantharides, 


INFLUENCE    OP    HABIT    ON    POISONS.  75 

in  three  pills,  caused  strangury,  and  the  substance  was  necessarily  with- 
drawn:  Brit.  Med.  Jour.,  1877,  i.,  p.  466.  Until  the  above  judgment 
has  been  overruled,  medical  witnesses  must  look  closely  to  the  quantity 
of  the  substance  administered,  and  duly  consider  whether  this  was  Such 
as  to  be  likely  to  injure,  aggrieve,  or  annoy  a  person.  The  quantity  of 
a  poison  wilfully  administered  ought  not  to  aflect  the  culpability  of  the 
person  administering  it. 

Mechanical  In-itants. — The  substance  administered  may  not  be  a 
poison  in  the  medical  signification  of  the  term,  and  it  may  not  be  popu- 
larly considered  such  ;  yet,  when  taken,  it  may  be  noxious  to  health  or 
destructive  to  life.  AVe  have  examples  of  substances  of  this  description 
in  iron  filings,  powdered  glass,  sponge,  pins,  needles,  and  such-like  bodies, 
which  have  been  administered  with  the  wilful  design  of  injuring,  and 
have  on  various  occasions  given  rise  to  criminal  charges.  In  cases  of 
this  kind,  the  legal  guilt  of  a  prisoner  may  often  depend  on  the  meaning 
assigned  by  a  medical  witness  to  the  words  destructive  thing.  Thus, 
mercury  might  be  poured  down  the  throat  of  an  infant,  with  the  deliberate 
intention  to  destroy  it.  A  question  of  a  purely  medical  nature  will  then 
arise  whether  mercury  is  a  "  destructive  thing"  or  not ;  and  the  conviction 
of  a  prisoner  will  probably  depend  on  the  answer.  Should  a  difference 
of  opinion  exist,  the  prisoner  will  receive  the  benefit  of  the  doubt.  The 
injuries  produced  on  cattle  by  mechanical  irritants  have  occasionally  given 
rise  to  civil  actions  for  damages. 

Influence  of  Habit  on  Poisons. — Habit,  it  is  well  known,  diminishes 
tlie  effects  of  certain  poisons :  thus  it  is  that  opium,  when  frequently 
taken,  loses  its  effect  after  a  time,  and  requires  to  be  administered  in 
much  larger  doses.  Indeed,  confirmed  opium-eaters  have  been  enabled 
to  take  at  once  a  quantity  of  the  drug  which  would  have  killed  them 
had  they  commenced  with  it  in  the  first  instance.  Even  infants  and 
children,  who  are  well  known  to  be  especially  susceptible  of  the  effects  of 
opium,  and  are  liable  to  be  poisoned  by  small  doses,  may,  by  the  influence 
of  habit,  be  brought  to  take  the  drug  in  very  large  quantities.  It  appears 
that  the  system  of  drugging  children  with  opium  in  the  factory  districts 
and  in  the  fens  commences  as  soon  after  birth  as  possible ;  and  the  dose  is 
g-radually  increased  until  it  reaches  fifteen  to  twenty  drops  of  laudanum 
at  once.  This  has  the  effect  of  throwing  the  child  into  a  lethargic  stupor. 
Healthy  children  of  the  same  age  would  be  killed  by  a  dose  of  five  drops. 
The  same  influence  of  habit  is  manifested  more  or  less  in  the  use  of 
tobacco,  alcohol,  ether,  chloroform,  morphine,  strychnine,  and  other  alka- 
loids. Christison  has  remarked  that  this  influence  is  chiefly  confined  to 
poisons  derived  from  the  organic  kingdom  ;  it  is  so  limited  with  regard 
to  mineral  substances  that  it  can  scarcely  be  said  to  exist,  except  in  the 
case  of  arsenic  and  corrosive  sublimate. 

As  to  the  practice  of  arsenic-eating,  Roscoe  has  published  a  case  in 
which,  according  to  information  supplied  to  him,  a  Styrian  peasant  took 
in  one  day  four  grains  and  a  half,  and  on  the  day  following  five  grains 
and  a  half  of  white  arsenic,  crushing  the  mineral  between  his  teeth  and 
swallowing  it.  The  day  after  he  had  swallowed  the  second  dose,  the  man 
left  the  place  in  his  usual  health,  and  there  is  no  further  record  of  him. 
R.  C.  Maclagan  states  that  he  saw  a  Styrian  peasant,  aet.  26,  swallow 
between  four  and  five  grains  of  white  arsenic  in  powder.  In  tAvo  hours 
sonae  urine  which  he  passed  contained  arsenic.  This  man  suffered  no  ill 
effects  ;  he  stated  that  he  had  taken  arsenic  for  a  year  and  a  half  Avithout 
any  injury  to  his  health.  He  took  at  first  rather  less  than  a  grain  every 
fortnight.     In  another  case  a  man,  set.  46,  swallowed  six  grains.     In  three 


76  INFLUENCE    OF    IDIOSYNCRASY. 

quarters  of  an  hour  it  was  found  tbat  arsenic  Avas  eliminated  with  the 
urine :  Ed.  Med.  Jour.,  1864,  x.,  p.  200.  Knapp  informed  Maclagan 
that  a  man  once  took  in  his  presence  seven  and  a  half  grains  of  arsenic, 
and  no  injurious  effects  were  produced:  Ibid.,  1865,  x.,  p.  669.  Hahit 
appears  to  have  so  little  influence  on  arsenic,  under  the  most  careful 
medicinal  use  of  it  in  this  country,  that  no  medical  practitioner  has  ever 
succeeded  in  causing  a  patient  to  take  tioo  grains  at  a  dose,  the  smallest 
quantity  yet  known  to  have  destroyed  life.  Hunt,  who  had  had  a  large 
experience  in  the  use  of  this  mineral,  fixed  the  maximum  dose  to  be 
given  with  safety  at  one  grain. 

A  case  reported  in  the  same  journal  (1864,  x.,  p.  116)  shows  the  danger 
incurred  by  this  practice.  A  man  who  had  taken  arsenic  for  a  period  of 
three  or  four  years  died  under  the  usual  symptoms  of  chronic  poisoning. 
As  far  as  it  could  be  ascertained,  the  daily  dose  taken  \)j  deceased  for  the 
last  five  months  of  his  life  was  from  two  to  three  grains.  From  the 
beginning  of  the  practice  he  had  suffered  from  symptoms  of  poisoning 
Avith  arsenic,  gradually  assuming  the  form  of  arsenical  cachexia ;  but  he 
referred  the  symptoms  to  other  causes,  and  concealed  the  practice  from 
his  friends.  He  never  became  habituated  to  the  poison.  This  is  a  result 
which  may  be  generally  expected.  If  the  exceptional  cases  observed  in 
Styria  are  supposed  to  prove  that  arsenic  may  be  taken  in  large  doses 
Avith  impunity,  they  Avould  lead  to  error.  Such  cases  have  no  practical 
bearing  in  legal  medicine.  If  the  practice  of  arsenic-eating  produces  no 
sjanptoms,  then  no  question  of  poisoning  can  arise.  If,  as  in  the  above 
case,  it  does  produce  sjnnptoms.  then  the  case  would  fall  within  the 
range  of  ordinary  experience.  The  impunity  of  the  Styrians,  in  the 
habitual  use  of  arsenic,  may  be  occasionally  quoted  to  explain  the  detec- 
tion of  the  poison  in  a  dead  body  or  a  motive  for  its  purchase  ;  but  no 
scientific  Avitness  Avho  has  seen  anything  of  the  operation  of  arsenic  can 
alloAV  these  statements  to  influence  his  opinion  of  its  ordinary  effects  on 
human  beings.  Arsenic-eating  attracted  much  attention  in  a  lecent  trial: 
Reg.  V.  May  brick,  Liverpool  Ass.,  July,  1889. 

The  only  form  in  Avhich  the  question  of  habit  can  be  seriously  raised  in 
medical  jurisprudence  is  this:  Whether,  while  the  more  prominent  effects 
of  a  poison  are  thereby  diminished,  the  insidious  effects  on  the  constitu- 
tion are  at  the  same  time  counteracted.  The  answer  is  of  some  import- 
ance in  relation  to  the  subject  of  life-insurance  ;  for  the  concealment  of 
the  practice  of  opium-eating  by  persons  Avhose  lives  were  insured,  has 
given  rise  to  actions,  in  which  medical  evidence  on  this  subject  was  ren- 
dered necessar}^.  As  a  general  principle,  we  must  admit  that  habit  cannot 
altogether  counteract  the  insidious  effects  of  poisons  ;  and  that  the  practice 
of  taking  them  is  liable  to  give  rise  to  disease  or  to  impair  the  constitution. 

Injlaence  of  Idiosyncrasy. — IdiosyncrasA^  differs  from  habit:  it  does 
not,  like  this,  diminish  the  effect  of  a  poison  ;  for  it  is  not  commonly 
found  that  any  particular  state  of  body  is  a  safeguard  against  the  effects 
of  these  poAverful  agents.  Some  persons  are  observed  to  be  much  more 
affected  than  others  by  certain  poisons ;  thus,  opium,  arsenic,  mercury, 
lead,  antimony,  and  iodide  of  potassium  are  substances  of  this  description, 
and  this  difference  in  their  effects  is  ascribed  to  idiosyncrasy.  Christison 
mentions  a  remarkable  instance,  in  which  a  gentleman,  unaccustomed  to 
the  use  of  opium,  took  nearly  an  ounce  of  laudanum  without  any  effect. 
This  form  of  idiosyncrasy  is  very  rare.  Certain  substances  generally 
reputed  harmless,  and,  indeed,  used  as  articles  of  food,  are  observed'  to 
affect  some  persons  like  poisons.  This  is  the  case  with  pork,  certain  kinds 
of  shell-fish,   mushrooms,  onions,  and  ginger.     There   may  be   nothing 


INFLUENCE    OF    DISEASE.  77 

poisonous  in  the  food  itself;  but  it  acts  as  a  poison  to  particular  persons — 
whether  from  its  being  in  these  cases  a  poison  /^er  se,  or  rendered  so  by 
changes  during  the  process  of  digestion,  it  is  difficult  to  say.  The  subject 
of  idiosyncrasy  is  of  importance  in  a  medico-legal  view  when  symptoms 
resembling  those  of  poisoning  follow  a  meal  consisting  of  a  particular  kind 
of  food.  In  such  a  case,  without  a  knowledge  of  this  peculiar  condition,  we 
might  hastily  attribute  to  poison  effects  which  were  really  due  to  another 
cause.  It  would  appear  that  in  some  instances  idiosyncrasy  may  be 
acquired — i.  e.,  a  person  who,  at  one  period  of  his  life,  had  been  in  the 
habit  of  partaking  of  a  particular  kind  of  food  without  injury,  may  find 
at  another  period  that  it  will  disagree  with  him.  When  pork  has  been 
disused  as  an  article  of  dietary  for  many  years,  it  cannot  always  be 
resumed  with  impunity.  In  cases  in  which  the  powers  of  life  have 
become  enfeebled  by  age,  the  susceptibility  of  the  system  to  poisons  is 
increased  ;  thus  aged  persons  may  be  killed  by  comparatively  small  doses 
of  arsenic  and  opium.  In  1883,  the  editor  found  that  an  aged  woman 
died  narcotised  after  taking  an  opiate  containing  less  than  one  grain  of 
opiurc. — a  dose  which  on  previous  occasions  she  had  occasionally  taken 
with  impunity.  Cases  of  acquired  idiosyncrasy  are  very  rare:  it  appears 
to  be,  if  we  may  so  apply  the  term,  a  congenital  condition.  There  are, 
however,  certain  diseases  which  seem  to  confer  a  power  of  supporting 
large  and  even  poisonous  doses  of  some  substances.  Tery  large  doses 
of  opium  have  been  taken  without  producing  dangerous  symptoms  by 
persons  laboring  under  tetanus  and  hydrophobia.  This  condition  is 
called  tolerance.  It  has  been  witnessed  in  diseases  of  the  lungs  in  refer- 
ence to  the  use  of  antimonial  medicines. 

Influence  of  Disease. — A  diseased  state  of  the  body  may  render  a  per- 
son comparatively  insusceptible  to  the  action  of  certain  poisons,  while  in 
other  instances  it  may  increase  their  action  and  render  them  fatal  in  small 
doses.  In  dysentery  and  in  tetanus  a  person  may  take,  without  being 
materially  affected,  a  quantity  of  opium  sufficient  to  kill  an  adult  in  average 
health.  In  mania,  cholera,  hysteria,  and  delirium  tremens,  large  doses  of 
opium  may  be  borne  with  comparative  impunity.  In  a  case  of  hemiplegia, 
a  woman,  set.  29,  took  for  six  davs  three  grains  of  strychnine  daily  with- 
out injurious  consequences — the  dose  having  been  gradually  raised  (Gaz. 
Mel.,  Mai,  1845) ;  while  one  grain  of  strychnine  is  commonly  regarded 
as  a  fatal  dose  to  a  healthy  adult.  In  a  case  of  tetanus,  Dupuytren  gave 
more  than  two  ounces  of  opium  at  a  dose  (60  grammes)  without  serious 
consequences:  Flandin,  Traite  des  Poisons,  vol.  1,  p.  231.  It  has  also 
been  remarked  that  persons  affected  with  tetanus  are  not  easily  salivated 
by  mercury.  The  morbid  state  appears  to  create  the  power  of  resisting 
the  ordinary  effects  of  poisons.  The  effect  of  certain  diseases  of  the  ner- 
vous system,  as  well  as  of  habit,  either  in  retarding  the  appearance  of 
symptoms,  or  in  blunting  the  operation  of  a  poison,  it  is  not  difficult  to 
appreciate ;  they  are  cases  which  can  present  no  practical  difficulty  to  a 
medical  jurist.  On  the  other  hand,  in  certain  diseased  states,  there  may 
be  an  increased  susceptibility  of  the  action  of  poison.  Thus,  in  those  per- 
sons who  have  a  predisposition  to  apojjlexy,  a  small  dose  of  opium  may 
act  more  quickly,  and  prove  fatal.  In  a  person  laboring  under  inflamma- 
tion of  the  stomach  or  bowels,  there  would  be  an  increased  susceptibility 
of  the  effects  of  arsenic,  antimony,  and  other  irritants.  In  debility  from 
any  cause  these  mineral  substances  would  also  act  injuriously  even  in 
ordinary  doses.  Antimony  is  a  most  powerful  depressant,  and  might,  by 
its  effect  on  the  heart,  cause  sudden  death  by  syncope.  The  influence  of 
disease  in  increasing  the  operation  of  poison  has  been  noticed  in  cases  of 


78  CLASSIFICATION    OF    POISONS IRRITANTS. 

diseased  kidneys  (granular  degeneration),  in  which  small  doses  of  mercury 
have  produced  severe  salivation,  leading  to  exhaustion  and  death.  In 
diseases  of  the  lungs  affecting  aged  persons,  opium  in  medicinal  doses 
has  been  observed  to  exert  a  poisonous  action.  The  effect  of  the  drug 
appears  to  be  intensified  by  the  disease.  This  observation  applies  equally 
to  morphine.  A  fatty  condition  of  the  muscular  tissue,  leading  to  great 
feebleness  of  the  heart's  action,  ajtpears  to  be  highly  favorable  to  death 
by  syncope  under  the  use  of  chloroform.  A  knowledge  of  these  facts  is 
of  importance  in  reference  to  charges  of  malapraxis  when  death  has  arisen 
from  ordinar}^  or  extraordinary  doses  of  medicines  administered  to  persons 
laboring  under  disease.  In  such  cases  another  mode  of  treatment  should 
be  substituted,  or  a  smaller  dose  than  usual  given,  and  its  effects  carefully 
watched.  In  some  instances,  however,  full  and  large  doses  of  powerful 
drugs  have  been  recklessly  given,  and  when  a  fatal  result  has  followed, 
there  has  been  a  strong  disposition  to  refer  death  to  the  supposed  disease, 
of  which,  however,  sometimes  no  trace  could  be  found  in  the  body. 

Classification  of  Poisons. — Poisons  may  be  divided  into  two  classes, 
according  to  their  mode  of  action  on  the  system  ;  namel}',  Irritants  and 
iN'EUROTics,  as  the  special  action  of  the  latter  is  to  affect  directly  one  or 
more  parts  of  the  nervous  system.  No  quite  satisfactory  classification 
has,  however,  been  hitherto  proposed. 

Irritants. — The  irritants  are  possessed  of  these  common  characters. 
When  taken  in  ordinary  doses,  they  occasion  speedily  violent  vomiting 
and  purging.  The  symptoms  are  either  accompanied  or  followed  by  pain 
in  the  stomach  and  bowels.  The  peculiar  effects  of  the  poison  are  mani- 
fested chiefly  on  these  organs,  which,  as  their  name  implies,  they  irritate 
and  inflame.  Many  substances  belonging  to  this  class  of  poisons  possess 
corrosive  properties ;  such  as  tho  strong  mineral  acids,  caustic  alkalies, 
bromine,  corrosive  sublimate,  and  others.  These,  in  the  act  of  swallowing, 
are  commonly  accompanied  with  an  acrid  or  burning  taste,  extending 
from  the  mouth  down  the  gullet  to  the  stomach.  Some  irritants  do  not 
posses  any  corrosive  action — of  Avhich  we  have  examples  in  white  arsenic, 
the  poisonous  salts  of  barium,  carbonate  of  lead,  and  cantharides  ;  these 
are  often  called  pure  irritants.  They  exert  no  destructive  chemical  action 
on  the  tissues  with  which  they  come  in  contact ;  they  simply  irritate  and 
inflame  them. 

Difference  between  Cori^osive  and  Irritant  Poisons. — As  a  result  of 
the  action  of  corrosive  poisons,  symptoms  are  commonly  manifested  im- 
mediately, because  mere  contact  produces  the  destruction  of  a  part.  In 
the  action  of  the  purely  irritant  poisons,  the  symptoms  are  generally  more 
slowly  manifested,  rarely  showing  themselves  until  at  least  half  an  hour 
has  elapsed  from  the  time  of  swallowing  the  substance.  Of  course,  there 
are  exceptions  to  this  remark  ;  for  sometimes  irritants  act  speedily,  though 
rarely  with  the  rapidity  of  corrosive  poisons.  It  is  important  in  a  prac- 
tical view  to  ascertain  whether,  in  an  unknown  case,  the  poison  Avhich  a 
person  requiring  immediate  treatment  may  have  swallowed  is  irritant  or 
corrosive.  This  may  be  commonly  determined  by  a  knowledge  of  the 
time  at  which  the  S3"mptoms  appeared  after  the  suspected  substance  was 
taken.  "We  may  thus  often  easily  distinguish  between  a  case  of  poisoning 
from  arsenic  and  one  from  corrosive  sublimate.  There  is  also  another 
point  which  may  be  noticed.  As  the  corrosive  substance  exerts  a  local 
chemical  action,  an  examination  of  the  mouth  and  throat  may  enable  us 
in  some  cases  to  solve  the  question. 

It  has  already  been  stated  that  there  are  many  irritant  poisons  which 
have  no  corrosive  properties,  but  every  corrosive  may  act  as  an  irritant. 


NEUROTIC    POISONS.  79 

Thus  the  action  of  corrosive  sublimate  is  that  of  an  irritant  poison,  as, 
while  it  destroys  some  parts  of  the  coats  of  the  stomach  and  intestines, 
it  irritates  and  imfiames  others.  So,  again,  most  corrosive  poisons  may 
lose  their  corrosive  properties  by  dilution  with  water,  and  they  then  act 
simply  as  irritants.  This  is  the  case  with  the  mineral  acids  and  bromine. 
In  some  instances  it  is  not  easy  to  say  whether  an  irritant  poison  pos- 
sesses corrosive  properties  or  not.  Thus  oxalic  acid  acts  immediately,  and 
blanches  and  softens  the  mucous  membrane  of  the  mouth  and  throat,  but 
it  is  comparatively  rare  to  meet  with  any  decided  marks  of  chemical  cor- 
rosion produced  by  it  in  the  stomach  or  viscera.  Irritant  poisons,  for  the 
most  part,  belong  to  the  mineral  kingdom ;  and  they  may  be  divided  into 
the  Non-Metollic  and  IFetallic  Irritants.  There  are  a  few  derived  from 
the  animal  and  vegetable  kingdoms  ;  but  these,  if  we  except  cantharides, 
are  not  often  employed  criminally.  Some  of  the  gases  likewise  belong  to 
the  class  of  irritant  poisons. 

Neurotics. — Xeurotic  poisons  act  upon  the  nervous  system.  Either 
immediately  or  some  time  after  the  poison  has  been  swallowed,  the 
patient  suffers  from  headache,  giddiness,  numbness,  paralysis,  stupor,  or 
convulsions.  They  have  not  an  acrid  burning  taste  like  the  corrosive 
irritants;  and  they  rarely  give  rise  to  purging.  When  vomiting  or 
purging  follow  the  ingestion  of  the  poison  into  the  stomach,  the  effects 
may  be  generally  ascribed  either  to  the  form  or  C[uantity  in  which  it  has 
been  taken,  and  the  mechanical  effect  on  the  stomach  thereby  produced, 
or  to  the  poison  being  combined  wuth  some  irritating  substance.  The 
pure  narcotics,  or  cerebral  poisons,  are  not  found  to  irritate  or  inflame  the 
stomach  and  bowels. 

Notwithstanding  the  well-defined  boundary  thus  apparently  existing 
between  these  classes  of  poisons,  it  must  not  be  supposed  that  the  sub- 
stances arranged  in  each  class  always  act  in  the  manner  indicated.  Some 
irritants  have  been  observed  to  affect  the  brain  or  the  spinal  marrow,  and 
this  may  be  either  a  primary  or  secondary  consequence  of  their  action. 
Arsenic  and  oxalic  acid,  although  classed  as  irritants,  have  in  some  in- 
stances given  rise  to  symptoms  closely  resembling  those  of  narcotic  poison- 
ing ;  namely,  coma,  paralysis,  and  tetanic  convulsions.  In  a  case  of 
poisoning  by  arsenic,  which  occurred  to  Morehead,  the  symptoms  of  nar- 
cotism  w^ere  so  strongly  marked  that  it  was  believed  at  first  the  man  had 
taken  a  narcotic:  Med.  Gaz.,  vol.  43,  p.  1055.  A  case  has  been  met  with 
of  poisoning  by  arsenic  in  which  there  was  paralysis  of  the  limbs,  with  an 
entire  absence  of  purging  during  the  eight  days  that  the  deceased  sur- 
vived. On  the  other  hand,  in  a  case  of  poisoning  by  a  large  dose  of 
opium,  there  was  an  absence  of  the  usual  symptoms  of  cerebral  disturb- 
ance, and  the  presence  of  others  resembling  those  of  irritant  poisoning — 
bamely,  pain  and  vomiting.  Thus,  then,  we  must  not  allow  ourselves  to 
be  misled  by  the  idea  that  the  symptoms  are  always  clearly  indicative  of 
the  kind  of  poison  taken.  The  narcotic  or  cerebral  poisons  belong  mostly 
to  the  vegetable  kingdom.  Some  of  the  poisonous  gases  possess  a  nar- 
cotic action. 

Some  poisons  have  a  complex  action.  They  are  chiefly  derived  from 
the  vegetable  kingdom.  At  variable  periods  after  they  have  been  swal- 
lowed, they  give  rise  to  vomiting  and  purging,  like  irritants;  and  sooner 
or  later  produce  stupor,  coma,  paralysis,  and  convulsions,  owing  to  their 
effects  on  the  brain  and  spinal  marroAv.  In  the  state  of  vegetables,  as 
leaves,  seeds,  or  roots,  they  possess  the  property,  like  irritants,  of  irritating 
and  inflaming  the  stomach  and  bowels.  As  familiar  examples  w^e  may 
point  to  nux  vomica,  aconite,  hemlock,  and  poisonous  mushrooms.    These 


80  EVIDENCE    OF    POISONING    IN    THE    LIVING. 

poisons  are  veiy  numerous,  embracing  a  large  variety  of  well-known 
vegetable  substances ;  but  they  rarely  form  a  subject  of  difficulty  to  a 
medical  practitioner.  The  fact  of  the  symptoms  occurring  after  a  meal  at 
which  some  suspicious  vegetables  may  have  been  eaten,  coupled  with  the 
nature  of  the  symptoms  themselves,  will  commonly  indicate  the  class  to 
which  the  poison  belongs.  Some  of  these  poisons  have  a  hot  acrid  taste ; 
others,  like  aconite,  produce  a  sense  of  numbness  or  tingling;  while 
others  again  have  an  intensely  bitter  taste,  as  nux  vomica,  strychnine, 
veratrine,  and  picrotoxin.  Strychnine  may  be  regarded  as  a  pure  spinal 
poison. 

In  the  description  of  poisons  no  systematic  classification  can  be  con- 
sistently followed. 


CHAPTER    y. 

EVIDENCE  OF    POISONING    IN    THE  LIVING   BODY. SYMPTOMS  CONNECTED  WITH  FOOD  OR  MEDI- 
CINE.  SEVERAL  PERSONS  ATTACKED    SIMCLTANEOCSLY. EVIDENCE  FROM    THE  DETECTION 

OF  POISON  IN  THE  FOOD. 

We  now  proceed  to  consider  the  evidence  of  poisoning  in  the  living 
body.  To  the  practitioner  the  diagnosis  of  a  case  of  poisoning  is  of  great 
importance,  as,  by  mistaking  the  symptoms  produced  by  a  poison  from 
those  arising  from  natural  disease,  he  may  omit  to  employ  the  proper 
remedial  measures,  and  thus  lead  to  the  death  of  the  patient.  To  a  medi- 
cal jurist  a  correct  knowledge  of  the  symptonis  furnishes  the  chief  evi- 
dence of  poisoning,  in  those  cases  in  which  persons  are  charged  with  the 
malicious  and  unlawful  administration  of  poison.  The  symptoms  pro- 
duced during  life  constitute  also  an  important  part  of  the  evidence  in 
those  instances  in  which  a  poison  proves  fatal.  At  present,  however,  we 
will  suppose  the  case  to  be  that  poison  has  been  taken  and  the  patient 
survives.  Most  toxicological  writers  have  laid  down  certain  characters 
whereby  it  is  said  symptoms  of  poisoning  may  be  distinguished  from  those 
of  disease. 

1.  In  poisoning,  the  symptoms  appear  suddenly,  while  the  individual 
is  in  health. — It  is  the  common  character  of  most  poisons,  when  taken  in 
the  large  doses  in  which  they  are  usually  administered  with  criminal 
intent,  to  produce  serious  symptoms,  either  immediately  or  within  a  very 
short  period  after  they  had  been  swallowed.  Their  operation,  under  such 
circumstances,  cannot  be  suspended,  and  the  symptoms  are  then  mani- 
fested after  an  indefinite  interval ;  although  the  contrary  was  formerly  a 
matter  of  universal  belief,  and  gave  rise  to  many  absurd  accounts  of  what 
was  termed  sloiu  poisoning. 

The  symptoms  of  poisoning  by  nicotine,  prussic  acid,  oxalic  acid,  or  the 
salts  of  strychnine,  appear  immediately,  or  generally  within  a  very  few 
minutes  after  the  poison  has  been  swallowed.  In  an  exceptional  case,  in 
which  the  dose  of  prussic  acid  was  small,  and  insufficient  to  produce  death, 
the  poison  was  supposed  by  the  patient  not  to  have  begun  to  act  until 
after  the  lapse  of  fifteen  minutes  :  Ed.  Med.  and  Surg.  Jour.,  vol.  59,  p. 
72.  The  symptoms  caused  b}'  arsenic  and  other  irritants,  and,  indeed, 
by  poisons  generally,  are  commonly  manifested  in  from  half  an  hour  to  an 
hour.     It  is  rare  that  the  appearance  of  symptoms  is  protracted  for  two 


EVIDENCE    OF    POISONING    FROM    SY.MPTOxMS.  81 

hours,  except  under  certain  peculiar  states  of  the  system.  It  is  said  that 
some  neurotic  poisons,  such  as  the  poisonous  mushrooms,  may  remain  in 
the  stomach  twelve  or  twenty-four  hours  without  giving-  rise  to  symptoms  ; 
and  this  is  also  affirmed  to  be  the  case  with  some  animal  irritants,  such  as 
decayed  meat ;  but  with  regard  to  mushrooms,  it  has  been  shown  by 
I'eddie  that  they  have  produced  symptoms  in  half  an  hour;  and  a  case  fell 
under  the  author's  own  observation  in  which  the  symptoms  from  noxious 
animal  food  came  on  within  as  short  a  time  after  the  meal  as  is  commonly 
observed  in  irritant  poisoning  by  mineral  substances.  In  some  cases  of 
poisoning  by  phosphorus,  no  obvious  symptons  have  occurred  until  after 
the  lapse  of  some  days. 

2.  Symptoms  appear  dtn'ing  a  state  of  health. — Symptoms  of  poisoning 
may  manifest  themselves  in  a  person  while  in  a  state  of  perfect  health, 
without  any  apparent  cause.  This  rule  is,  of  course,  open  to  numerous 
exceptions,  because  the  person  on  whose  life  an  attempt  has  been  made 
may  be  actually  laboring  under  disease;  and  under  these  circumstances, 
the  symptoms  may  be  so  obscure  as  often  to  disarm  all  suspicion.  When 
poison  is  secretly  given  in  medicine,  a  practitioner  is  very  liable  to  be 
deceived,  especially  if  the  disease  under  which  the  person  is  laboring  is  of 
an  acute  nature,  and  is  attended  with  symptoms  of  disorder  in  the  ali- 
mentary canal.  Several  cases  of  poisoning  have  occurred  in  which  arsenic 
was  criminally  substituted  for  medicine,  and  given  to  the  person  while 
laboring  under  a  disorder  of  the  bowels.  A7e  are,  however,  justified  in 
saying,  with  respect  to  this  character  of  poisoning,  that  when,  in  a 
previously  healthy  person,  violent  vomiting  and  purging  occur  suddenlv 
and  without  any  assignable  cause,  such  as  disease,  indiscretion  in  diet,  or 
pregnancy,  to  account  for  them,  there  is  reason  to  suspect  that  irritant 
poison  has  been  taken.  When  the  patient  is  already  laboring  under  dis- 
ease, we  must  be  especially  w^atchful  of  the  occurrence  of  any  sudden 
change  in  the  character  or  violence  of  the  symptoms,  unless  such  change 
can  be  easily  accounted  for  on  well-known  medical  principles.  In  most 
cases  of  criminal  poisoning  we  meet  with  alarming  symptoms  without  any 
obvious  or  sufficient  natural  causes  to  explain  them.  The  practitioner  will, 
of  course,  be  aware  that  there  are  certain  diseases  which  are  liable  to 
occur  suddenly  in  healthy  people,  the  exact  cause  of  which  may  not  at 
first  sight  be  apparent ;  therefore  this  criterion  is  only  one  out  of  niany  on 
which  a  medical  opinion  should  be  founded. 

S.  In  poisoning  the  symptoms  appear  soon  after  a  meal,  or  soon  after 
some  kind  of  food  or  medicine  has  been  taken. — This  is  by  far  the  most 
important  character  of  poisoning  in  the  living  body.  It  has  been  already 
stated  that  most  poisons  begin  to  operate  within  about  an  hour  after  theV 
have  been  swallowed  ;  and  although  there  are  a  few  exceptions  to  this 
remark,  yet  they  occur  under  circumstances  easily  to  be  appreciated  by  a 
practitioner.  Thus,  then,  it  follows  that,  supposing  the  symptoms  under 
which  a  person  is  laboring  to  depend  on  poison,  the  substance  has  most 
probably  been  swallowed,  either  in  food  or  medicine,  from  half  an  hour  to 
an  hour  previously.  It  must  be  observed,  however,  that  cases  may  occur 
in  which  the  poison  has  not  been  introduced  by  the  mouth.  Oil  of  vitrol 
and  other  corrosive  liquids  have  been  thrown  up  the  rectum  in  enemata, 
and  have  thus  caused  death  ;  the  external  application  of  arsenic,  corrosive 
sublimate,  and  cantharides  to  ulcerated  surfaces  has  destroyed  life.  In  one 
case  arsenic  was  introduced  into  the  vagina  of  a  female,  and  she  died  in 
five  days  under  all  the  symptoms  of  arsenical  poisoning:  Schneider, 
Ann.  der  Ges.  Staatsarzneikunde,  i.  229.  Such  cases  are  rare,  but,  never- 
theless, the  certaintv  that  they  have  occurred,  where  their  occurrence  could 
6 


82  EVIDENCE    01'    POISONING    FROM    SYMPTOMS. 

hardly  have  been  anticipated,  shows  that  in  a  suspicious  case  a  medical 
man  must  not  deny  the  iact  of  poisoning  merely  because  it  may  be  proved 
that  the  person  could  not  have  taken  the  poison  in  the  usual  way,  by  the 
mouth.  Again,  persons  may  be  destroyed  by  the  vapors  of  ether, 
chloroform,  prussic  acid,  or  other  powerful  volatile  poisons,  introduced  into 
the  body  through  the  lungs.  Such  a  mode  of  suicide,  or  murder,  might 
disarm  suspicion,  from  the  fact  of  no  noxious  material  being  found  in  the 
stomach. 

Let  us  suppose,  however,  the  circumstances  to  have  been  such  that  these 
secret  means  of  destruction  could  not  have  been  resorted  to,  and  that  the 
poison  is  one  of  those  most  commonly  selected  by  a  murderer,  such  as  white 
arsenic,  tartar  emetic,  oxalic  acid,  strychnine,  or  corrosive  sublimate;  then 
we  may  expect  that  this  character  of  poisoning  will  be  made  evident  to 
us,  and'  that  something  must  have  been  swallowed  by  the  patient  shortly 
before  the  alarming  symptoms  appeared.  By  observations  attentively 
made,  it  may  be  in  our  power  to  connect  the  appearance  of  the  symptoms 
with  the  use  of  a  particular  article  of  food,  and  thus  indirectly  lead  to  the 
detection  of  a  criminal.  Supposing  that  many  hours  have  passed  since 
food  or  medicine  was  taken  by  the  patient,  without  an}^  effect  ensuing — it 
is  probable  that  the  symptoms  may  be  due  to  natural  causes  and  not  to 
poison.  When  sjmiptoms  resembling  those  of  poisoning  speedily  follow  the 
ingestion  of  food  or  medicine,  there  is,  however,  reasonable  ground  for 
suspicion  ;  but  caution  should  be  observed  in  drawing  inferences,  since  the 
most  extraordinary  coincidences  sometimes  present  themselves.  In  the 
case  of  Sir  Theodosius  Boughton,  who  was  poisoned  by  his  brother-in- 
law  DoncUan  in  1781,  the  fact  of  alarming  symptoms  coming  on  in  tioo 
minutes  after  the  deceased  had  swallowed  what  was  supposed  to  be  a 
simple  medicinal  draught,  was  a  most  important  part  of  the  evidence 
against  the  prisoner.  There  is  no  doubt  that  laurel-water  had  been  sub- 
stituted for  the  medicine  by  the  prisoner,  and  that  this  had  caused  the 
symptoms  which  preceded  death.  The  practice  of  substituting  poisonous 
mixtures  for  medicinal  draughts  or  powders  is  by  no  means  unusual, 
although  it  might  be  supposed  to  indicate  a  degree  of  refinement  and 
knowledge  not  commonly  to  be  found  among  criminals.  Medical  practi- 
tioners are  thus  apt  to  be  imposed  upon,  and  the  following  case  will  serve 
as  a  caution  :  An  apothecary  prepared  a  draught  into  which  another 
person  put  poisoning,  intending  thereby  to  destroy  the  life  of  a  patient 
for  whom  the  medicine  was  prescribed.  The  patient,  not  liking  the  taste 
of  the  draught,  and  thinking  there  was  something  suspicious  about  it,  sent 
it  back  to  tiie  apothecary,  who,  knowing  the  ingredients  of  which  he  had 
composed  it,  and  wishing  to  prove  to  his  patient  that  he  had  done  nothing 
wrong,  drank  it  himself,  and  died  from  its  effects.  He  was  thus  the  un- 
conscious agent  of  his  own  death  ;  and  although  the  draught  was  intended 
for  another,  the  party  who  poisoned  it  was  held  guilty  of  murder.  This 
case  contains  a  warning  to  medical  witnesses.  On  trials  for  poisoning, 
Avhen  the  poisoning  is  conveyed  through  medicine,  a  medical  witness  has 
offered  to  swallow  his  own  draught  in  a  court  of  law,  in  order  to  furnish 
a  convincing  practical  illustration  o'fthe  innocence  of  the  medicine.  It  need 
hardly  be  observed  that  an  exhibition  of  this  kind  is  never  required  of  a 
witness.  If  any  doubt  be  raised  of  the  innocent  properties  of  a  draught 
or  powder,  an  analysis  of  its  contents  will  be  far  more  satisfactory  as  evi- 
dence, and  be  attended  with  no  risk  to  the  practitioner. 

On  the  other  hand,  the  occurrence  of  symptoms  resembling  those  pro- 
duced by  poisoning,  soon  after  food  or  medicine  has  been  taken,  may  be  a 
pure  coincidence.     In  such  a  case,   poison  is  always  suspected  by  the 


EVIDENCE    OF    POISONING    FROM    SYMPTOMS.  83 

vulgar;  and  it  will  be  the  duty  of  a  medical  jurist  to  guard  against  the 
encouragement  of  such  a  suspicion,  until  he  has  strong  grounds  to  believe 
it  to  be  well  founded.  Xo  public  retractation  or  apology  can  ever  make 
amends  for  the  injury  which  may  in  this  way  be  inflicted  on  the  character 
of  another;  for  those  who  hear  the  accusation  may  never  hear  the  defence. 
In  all  such  cases  a  practitioner  may  entertain  a  suspicion  ;  but,  until 
confirmed  by  facts,  he  should  avoid  eayressing  it  or  giving  it  publicity. 
When  death"  is  not  a  consequence,  it  is  difficult  to  clear  up  such  cases  ex- 
cept by  the  aid  of  a  chemical  analy.sis  ;  but  this,  as  we  know,  is  not  always 
applicable.  If  death  ensues,  the  real  cause  is  usually  apparent,  and  a  sus- 
picion of  poisoning  is  thus  often  removed  by  an  examination  of  the  body. 
Cases  are  reported  in  which  persons  have  died  suddenly  after  a  meal,  and 
the  cause  of  death  has  been  traced  to  obstruction  of  the  air-passages  by 
food. 

4.  In  poisoning,  ivhen  several  partake  at  the  same  time  of  the  same 
food  or  medicine  {mixed  with  poison)  all  suffer  from  similar  symptoms. 
— This  character  of  poisoning,  when  it  exists,  furnishes  good  evidence  of 
the  fact.  Thus,  supposing  that  after  a  meal  made  by  several  persons  from 
the  same  dish,  only  one  suffers,  the  suspicion  of  poison  is  considerably 
weakened.  The  poisoned  article  of  food  may  be  detected  by  observing 
whether  they  who  suffer  under  any  symptoms  of  poisoning  have  partaken 
of  one  particular  solid  or  liquid  in  common.  In  a  case  of  accidental 
poisoning  at  a  dinner-party,  a  medical  man  who  was  present  observed 
that  those  who  suffered  had  taken  port  wine  only  ;  the  contents  of  the 
bottle  were  examined,  and  found  to  be  a  saturated  solution  of  arsenic  in 
wune.  In  general,  considerable  reliance  may  be  placed  upon  this  character, 
because  it  is  improbable  that  any  common  cause  of  disease  should  sud- 
denly attack  with  violent  symptoms  of  a  similar  character  many  healthy 
persons  at  the  same  time,  and  within  a  short  period  after  having  par- 
taken of  food  together.  We  must  beware  of  supposing  that,  when  poison 
is  really  present,  all  will  be  attacked  with  precisely  similar  symptoms ; 
because  there  are  many  circumstances  which  may  modify  their  nature  and 
progress.  In  general  that  person  who  has  partaken  most  freely  of  the 
poisoned  dish  will  suffer  most  severely;  but  even  this  does  not  always 
follow.  There  is  a  well-known  case,  recorded  by  Bonnet,  where,  among 
several  persons  who  partook  of  a  dish  poisoned  with  arsenic,  they  who 
had  eaten  little  and  did  vot  vomit,  speedily  died ;  while  others  who  had 
partaken  largely  of  the  dish,  and  had  in  consequence  vomited  freely, 
recovered. 

It  was  just  now  remarked  that  there  is  no  disease  resembling  poisoning 
which  is  likely  to  attack  several  healthy  persons  at  the  same  time  and  in 
the  same  manner.  This  is  undoubtedly  true  as  a  general  rule,  but  the 
following  case  will  show  that  mistakes  may  occasionally  arise  even  under 
these  circumstances.  It  occurred  in  London,  during  the  prevalence  of 
cholera  in  the  year  1832.  Four  of  the  members  of  a  family,  living  in  a 
state  of  great  domestic  unhappiness,  sat  down  to  dinner  in  apparently 
good  health ;  some  time  after  the  meal  the  father,  mother,  and  daughter 
were  suddenly  seized  with  violent  vomiting  and  purging.  The  evacua- 
tions were  tinged  with  blood,  while  the  blueness  of  the  skin,  observed  in 
cases  of  cholera,  was  absent.  Two  of  these  persons  died.  The  son,  who 
was  known  to  have  borne  ill-will  against  his  father  and  mother,  and  who 
suffered  no  symptoms  on  this  occasion,  was  accused  of  having  poisoned 
them.  At  the  inquest,  however,  it  was  clearly  shown  by  the  medical 
attendant  that  the  deceased  persons  had  really  died  of  cholera,  and  there 
was  no  reason  to  suspect  that  any  poison  had  been  administered  to  them. 


84  DISCOVERY  OF  POISON  IN  FOOD. 

In  this  instance  it  will  be  perceived  that  symptoms  resembling  those  of 
irritant  poison  appeared  suddenly  in  several  individuals  in  perfect  health, 
and  shortly  after  a  meal.  We  hereby  learn  that  the  utility  of  any  rules 
for  investigating- cases  of  poisoning  depends  entirely  on  the  judgment  and 
discretion  Avith  which  they  are  applied  to  particular  cases. 

It  is  well  to  bear  in  mind,  in  conducting  these  inquiries,  that  symptoms 
resembling  those  produced  by  irritant  poison  may  be  sometimes  traced  to 
food.  Meat  rendered  unwholesome  by  disease,  decay,  or  micro-organ- 
isms, pork,  bacon,  sausages,  cheese  and  bread,  as  well  as  mussels  and 
other  kinds  of  shell-fish,  may  give  rise  to  symptoms  of  poisoning,  and 
even  cause  death.  Such  cases  may  be  regarded  as  poisoning  by  animal 
or  vegetable  irritants.  All  the  characters  above  described,  as  indicative 
of  poisoning,  may  be  observed,  and  the  difficulty  of  forming  an  opinion 
is  often  increased  by  the  fact  that  some  of  the  persons  attacked  may  have 
previously  partaken  of  the  same  kind  of  food  without  inconvenience. 

5.  The  discovery  of  the  poison  in  the  food  taken  or  in  the  matters 
vomited. — One  of  the  strongest  proofs  of  poisoning  in  the  living  subject 
is  the  detection  of  poison  by  chemical  analysis;  or,  if  of  a  vegetable  nature, 
by  a  microscopical  examination,  either  in  the  food  taken  by  the  person 
laboring  under  its  effects,  and  the  matters  vomited,  or  in  the  urine.  The 
evidence  is,  of  course,  more  satisfactory  when  the  poison  is  detected  in 
the  matters  vomited  or  in  the  urine,  than  in  the  food,  because  this  will 
show  that  it  has  really  been  taken,  and  it  will  readily  account,  for  the 
symptoms.  If  the  vomited  matters  have  been  thrown  away,  we  must 
examine  the  food  of  which  the  patient  may  have  partaken.  Should  the 
results  in  both  cases  be  negative,  and  no  trace  of  poison  be  found  in  the 
urine,  it  is  probable  that  the  sym|)toms  were  due  to  disease. 

In  investigating  a  case  of  poisoning  in  a  living  subject,  a  medical  jurist 
must  remember  that  poisoning  is  sometimes  feigned,  and  at  others  im- 
puted. It  is  easy  for  an  artful  person  to  put  poison  into  food,  as  well  as 
to  introduce  it  into  the  matters  vomited  or  discharged  from  the  bowels, 
and  to  accuse  another  of  having  administered  it.  There  are  few  of  these 
accusers  who  go  so  far  as  to  swallow  poison  under  such  circumstances, 
as  there  is  a  great  dread  of  poisonous  substances  among  this  class  of 
criminals;  and  it  will  be  at  once  apparent  that  it  would  require  a  person 
well  versed  in  toxicology  to  feign  such  a  series  of  symptoms  as  would 
impose  upon  a  practitioner  at  all  acquainted  with  the  subject.  In  short, 
the  difficulty  reduces  itself  to  this  :  What  inference  can  be  drawn  from  the 
detection  of  poison  in  food  ?  All  that  a  medical  man  can  say  is,  whether 
poison  is  or  is  not  present  in  a  particular  article  of  food  :  he  must  leave 
it  to  the  authorities  of  the  law"  to  develop  the  alleged  attempt  at  adminis- 
tration. If  the  poison  has  been  actually  administered  or  taken,  then  we 
should  expect  to  find  that  the  person  had  suffered  from  the  usual  symp- 
toms. The  absence  of  these  symptoms  would  be  a  strong  fact  against  the 
alleged  administration.  The  detection  of  poison  in  the  matters  vomited 
alfords  no  decisive  proof  that  it  has  been  swallowed,  except  under  two 
circumstances:  1.  When  the  accuser  has  previously  labored  under  the 
usual  symptoms  of  poisoning,  in  which  case  there  will  be  no  feigning,  and 
the  question  of  imputation  is  a  matter  to  be  established  by  general  evi- 
dence. 2.  When  the  matters  are  actually  vomited  into  a  clean  vessel  in 
the  presence  of  the  medical  attendant  himself,  or  of  some  person  on  whose 
testimony  perfect  reliance  can  be  placed.  The  detection  of  absorbed  poison 
in  the  vrine,  passed  in  the  presence  of  the  medical  attendant,  furnishes  a 
clear  proof  that  poison  has  been  taken,  that  it  has  passed  into  the  blood, 
and  has  been  subsequently  eliminated. 

When  a  medical   man  is  called  to  a  case  of  suspected  poisoning,  it  is 


SUSPECTED    POISONING SYMPTOMS.  85 

necessary  that  he  should  know  to  what  points  he  ought  to  give  his  atten- 
tion. Eveiy  effort  should  be  made  by  him  to  save  life  when  the  individual 
is  living  ;  but,  while  engaged  in  one  duty,  it  is  also  in  his  power  to  per- 
form another,  supposing  the  case  to  be  one  of  suspected  criminal  poisoning, 
namely,  to  note  down  any  circumstances  which  may  tend  to  detect  the 
perpetrator  of  a  crime.  There  is  no  person  so  well  fitted  to  observe  these 
points  as  a  medical  man;  but  it  unfortunately  happens  that  many  facts 
important  as  evidence  are  often  overlooked.  The  necessity  for  observing 
and  recording  them  is  not,  perhaps,  generally  known.  A  medical  man 
should  not  make  himself  officious  on  such  occasions,  but  he  would  be  un- 
mindful of  his  dutv  as  a  member  of  society  if  he  did  not  aid  the  cause  of 
justice  by  extending  his  scientific  knowledge  to  the  detection  of  cyime.  It 
is  much  to  the  credit  of  the  medical  profession  that  the  crime  of  murder 
by  poisoning — a  form  of  death  from  which  no  caution  or  foresight  can 
protect  a  person — is  so  frequently  brought  to  light  by  the  announcement 
of  suspicious  facts  of  a  medical  nature  to  magistrates  and  coroners. 

The  following  are  the  principal  points  Avhich  demand  the  attention  of 
a  medical  jurist  in  all  cases  of  suspected  poisoning:  1.  The  time  of  the 
occurrence  of  symptoms,  and  their  nature.  2.  The  exact  period  at  which 
they  were  observed  to  take  place  after  a  meal,  or  after  food  or  medicine 
had  been  taken.  3.  The  order  of  their  occurrence.  4.  Whether  there 
was  any  remission  or  intermission  in  their  progress ;  or,  whether  they 
continued  to  become  more  and  more  aggravated  until  death.  5.  Whether 
the  patient  had  labored  under  any  previous  illness.  6.  Whether  the 
symptoms  were  observed  to  recur  more  violently  after  a  particular  meal, 
or  after  any  particular  kind  of  food  or  medicine.  1.  Whether  the  patient 
has  vomited.  The  vomited  matters,  if  any  (especially  those  j^rsi  ejected), 
should  be  procured ;  their  odor,  color,  and  acid  or  alkaline  reaction  noted, 
as  well  as  their  quantity.  8.  If  none  be  procurable,  and  the  vomiting  has 
taken  place  on  the  dress,  furniture,  or  floor  of  a  room,  then  a  portion  of 
the  clothing,  sheet,  or  carpet  may  be  cut  out  and  reserved  for  analysis ;  if 
the  vomiting  has  occurred  on  a  deal  floor,  a  portion  of  the  wood  may  be 
scraped  or  cut  out ;  or  if  on  a  stone  pavement,  then  a  clean  sponge  soaked 
in  water  may  be  used  to  remove  any  traces  of  the  substance.  The  vessel 
in  which  vomited  matters  have  been  contained  will  often  furnish  valuable 
evidence,  since  heavy  mineral  poisons  fall  to  the  bottom,  or  adhere  to  the 
sides.  9.  Endeavor  to  ascertain  the  probable  nature  of  the  food  or  medi- 
cine last  taken,  and  the  exact  time  at  which  it  was  taken.  10.  Ascertain 
the  nature  of  all  the  different  articles  of  food  used  at  a  meal.  11.  Any 
suspected  articles  of  food,  as  well  as  the  vomited  matters,  should  be  sealed 
up  as  soon  as  possible  in  clean  glass  vessels,  labelled  (the  labels  being 
attached  by  seals),  and  reserved  for  analysis.  12.  Note  down,  in  their 
own  words,  all  explanations  voluntarily  made  by  persons  present,  or  who 
are  supposed  to  be  concerned  in  the  suspected  poisoning.  13.  Note 
whether  more  than  one  person  partook  of  the  food  or  medicine ;  and,  if 
so,  whether  all  these  persons  were  affected,  and  how.  14.  Note  whether 
the  same  kind  of  food  or  medicine  had  been  taken  before  or  since  by  the 
patient  or  other  persons  without  ill  effects  following. 

[Prof  Reese  asserts  that  it  is  not  possible  from  the  symptoms  alone  to 
do  more  than'merely  infer  the  probability  of  a  poison,  because  there  is  no 
poison  that  possesses  absolutely  characteristic  symptoms.  The  great  uncer- 
tainty on  this  point  should  suggest  extreme  caution  to  "  experts"  in 
testifving  to  the  presence  of  poisons  from  the  symptoms  alone,  and  cites 
the  Wharton-Yanness  case  at  Annapolis  in  18T3,  where  medical  witnesses 
attempted  to  locate  tartar  emetic  merely  from  symptoms,  on  the  second 
trial,  which  was  shown  to  be  absurd.] 


86       EVIDENCE  OF  POISONIXa  IN  THE  DEAD  BODY. 


CHAPTER  YI. 

EVIDENCE  OF    POISOXIXG  IN  THE    DEAD  BODY. PERIOD    AT  WHICH    POISONS    PROVE    FATAL. 

CHRONIC  POISONING. APPEARANCES  PRODUCED  BY  THE  DIFFERENT  CLASSES  OF  POISONS. 

REDNESS  OF  THE    MUCOUS    MEMBRANE    MISTAKEN    FOR    INFLAMMATION. ULCERATION    AND 

CORROSION. SOFTENING. PERFORATION  OF  THE  STOMACH  FROM  POISON  AND  DISEASE. 

Supposing  that  the  person  is  dead,  and  we  are  required  to  determine 
whether  the  case  is  one  of  poisoning  or  not,  we  must,  in  the  first  instance, 
endeavor  to  ascertain  all  the  particulars  which  have  been  considered  in 
the  last  chapter  as  indicative  of  poisoning-  in  the  living  body.  Should  the 
deceased  have  died  from  poison,  the  circumstances  of  the  attack,  and  the 
symptoms  preceding  death,  ought  to  correspond  with  the  characters  already 
described  ;  and  in  these  investigations  it  is  well  to  bear  in  mind  the  follow- 
ing rule  :  There  is  no  one  symptom  of  pathological  condition  which  is 
peculiar  to  poisoning ;  but  at  the  same  time  there  is  probably  no  disease 
which  presents  oil  those  characters  which  are  met  with  in  an  actual  case 
of  poisoning.  The  points  which  require  to  be  specially  noticed  under  these 
circumstances  in  the  living  are  described  at  pp.  21  and  22,  ante.  The  addi- 
tional evidence  to  be  derived  from  the  death  of  a  person  may  be  considered 
under  the  following  heads  : — 

1.  The  time  at  which  death  takes  place  after  the  first  occurrence  of 
symptoms. — This  question  requires  examination,  because  the  more  common 
poisons,  when  taken  in  fatal  doses,  generally  cause  death  within  definite 
periods  of  time.  By  an  attention  to  this  point  we  may,  in  some  instances, 
be  enabled  to  negative  a  charge  of  poisoning,  and  in  others  to  form  an 
opinion  of  the  kind  of  poison  which  has  been  taken.  In  a  court  of  law,  a 
medical  practitioner  is  often  required  to  state  the  usual  period  of  time 
within  which  poisons  prove  fatal.  It  is  to  be  observed  that  not  onh^  do 
poisons  differ  from  each  other  in  this  respect,  but  the  same  substance, 
according  to  the  form  or  quantity  in  which  it  has  been  taken,  may  differ 
in  the  rapidity  of  its  action.  A  large  dose  of  the  ordinary  solution  of 
]>russic  acid,  i.  e.  from  half  an  ounce  to  an  ounce,  may  destroy  life  in  less 
than  two  minutes.  In  ordinary  cases  of  poisoning  by  this  substance  a 
person  dies,  i.  e.  all  signs  of  life  have  commonly  ceased,  in  from  ten  to 
twenty  minutes;  and  if  he  survives  half  an  hour,  there  is  some  hope  of 
recovery.  In  the  cases  of  seven  epileptics,  accidentall}^  poisoned  by  a 
similar  dose  of  this  acid  in  one  of  the  Parisian  hospitals,  the  first  died  in 
about  twenty  minutes ;  the  seventh  survived  three  quarters  of  an  hour. 
Oxalic  acid,  one  of  the  most  energetic  of  the  common  poisons,  when 
taken  in  a  dose  of  from  half  an  ounce  to  an  ounce,  may  destroy  life  in 
from  ten  minutes  to  an  hour  ;  but  if  the  poison  is  not  completely  dissolved 
when  swallowed,  it  is  a  longer  time  in  proving  fatal.  The  strong  mineral 
acids,  in  poisonous  doses,  destrov  life  in  about  eighteen  or  twenty-four 
hours.  White  arsenic  operates  fatally  in  from  eight  hours  to  three  or  four 
days.  It  has,  however,  in  more  than  one  instance,  killed  a  person  in  two 
hours.  Opium,  either  as  a  solid  or  in  the  form  of  laudanum,  commonly 
proves  fatal  in  from  six  to  twelve  hours  ;  but  it  has  been  known,  in  several 
instances,  to  destroy  life  in  less  than  three  hours  :  they  who  survive  the 
effects  of  this  poison  for  twelve  hours  are  considered  to  have  a  fair  chance 


SLOW    OR    CHRONIC    POISONING.  8T 

of  recovery.  This  must  be  understood  to  be  merely  a  statement  of  the 
average  re'sults,  as  nearly  as  we  are  warranted  in  giving  an  opinion  ;  but 
the  niedical  jurist  will,  of  course,  be  aware  that  the  fatal  period  may  be 
protracted  or  shortened,  according  to  all  those  circumstances  which  have 
been  elsewhere  stated  to  affect  the  action  of  poisons. 

There  are  various  forms  which  this  quesiiou  may  assume.  It  may  be 
said  that  the  death  of  a  person,  alleged  to  have  taken  poison,  has  occurred 
either  too  rapidly  or  too  slowly  to  justify  a  suspicion  of  poisoning.  The 
following  case  will  serve  as  an  illustration  :  A  woman  was  tried  and 
convicted  (Reg.  v.  Russell,  Lewes  Sum.  Ass.,  1826)  of  the  murder  of 
her  husband  by  arsenic.  The  poison  was  detected  in  the  stomach ;  but 
the  fact  of  poisoning  was  disputed  by  some  medical  witnesses,  for  this, 
among  other  reasons,  that  the  deceased  had  died  three  hours  after  the 
only  meal  at  which  the  poison  could  have  been  administered  to  him. 
Authorities  were  cited  to  show  that,  according  to  their  experience,  they 
had  never  known  a  case  of  poisoning  by  arsenic  to  have  proved  fatal  in 
less  than  seven  hours.  This  may  be  admitted  ;  but,  at  the  same  time, 
there  was  sufficient  authority  on  the  other  side  to  establish  that  some 
cases  bad  actually  proved  fatal  in  three  or  four  hours.  So  far  as  this 
objection  was  concerned,  the  prisoner  was  properly  convicted.  In  refer- 
ence to  the  medical  question  raised  at  this  trial,  it  may  be  observed  that 
two  distinct  cases  have  since  occurred  in  which  the  persons  died  certainly 
within  tiuo  hours  after  taking  arsenic ;  and  several  instances  have  been 
reported  in  which  death  has  taken  place  in  from  three  to  four  hours  after 
the  administration  of  this  poison.  It  seems  extraordinary  that  any  attempt 
should  have  been  made  by  a  professional  man  to  negative  a  charge  of 
criminal  poisoning  upon  so  weak  a  ground  as  this  ;  but  this  opinion  was 
expressed  many  years  ago,  when  the  facts  connected  with  the  poisoning 
were  but  little  known.  It  is  obvious  that  there  is  nothing,  so  far  as  we 
know,  to  prevent  arsenic  from  destroying  life  in  an  hour,  or  even  within 
a  shorter  period.  These  matters  can  be  settled  only  by  a  careful  observa- 
tion of  numerous  cases,  and  not  by  any  a  priori  reasoning,  or  by  a  limited 
individual  experience. 

In  all  instances  of  sudden  death  there  is  generally  a  strong  tendency  on 
the  part  of  the  public  to  suspect  poisoning.  They  never  can  be  brought 
to  consider  that  persons  may  die  a  natural  death  suddenly,  as  well  as 
slowly  ;  or,  as  we  shall  presently  see,  that  death  may  really  take  place 
slowly,  and  yet  be  due  to  poison.  This  prejudice  continually  gives  rise 
to  the  most  unfounded  suspicions  of  poisoning,  and,  at  the  same  time, 
leads  to  cases  of  chronic  or  slow  poisoning  being  frequently  mistaken  for 
natural  disease.  One  of  the  means  recommended  for  distinguishing 
narcotic  poisoning  from  apoplexy  or  disease  of  the  heart,  is  the  difference 
in  the  rapidity  with  which  death  takes  place.  Thus,  apoplexy  or  disease 
of  the  heart  may  prove  fatal  either  instantly  or  within  an  hour.  The 
only  poison  likely  to  operate  with  such  fatal  rapidity  are  prussic,  carbolic, 
and  oxalic  acids,  strychnine  and  nicotine.  Poison  by  opium  is  commonly 
protracted  for  five  or  six  hours.  This  poison  has  never  been  known  to 
destroy  life  instantaneously,  or  within  a  few  minutes.  Thus,  then,  it 
ma}^  happen  that  death  will  occur  with  such  rapidity  as  to  render  it  im- 
possible, under  the  circumstances,  to  attribute  it  to  narcotic  poison. 

Chronic  poisoning. — When  a  poison  destroys  life  rapidly,  it  is  called  a 
case  of  acute  poisoning,  to  distinguish  it  from  the  chronic  form,  i.  e.  in 
which  death  takes  place  slowly.  Chronic  poisoning  is  a  subject  which 
has  frequently  required  medico-legal  investigation.  Most  poisons,  when 
their  effects  are  not  rapidly  manifested,  owing  either  to  the  smallness  of 


88  SLOW    OR    CHRONIC    POISONINa, 

the  dose  or  to  timely  treatment,  are  capable  of  slowly  undermining^  the 
powers  of  life,  and  killing-  the  patient  by  producing  emaciation  and  ex- 
haustion. This  is  sometimes  observed  in  the  action  of  arsenic,  corrosive 
sublimate,  and  tartarated  antimony ;  but  it  has  been  remarked  also  in 
cases  of  poisoning  by  the  mineral  acids  and  caustic  alkalies.  Death  is 
here  an  indirect  consequence  :  in  poisoning  by  the  acids  or  alkalies,  either 
stricture  of  the  gullet  is  induced,  or  the  lining  membrane  of  the  stomach 
is  destroyed,  and  the  process  of  digestion  impaired — a  condition  which 
leads  to  exhaustion  and  death.  The  time  at  which  these  indirect  effects 
may  prove  fatal  is,  of  course,  liable  to  vary,  A  person  has  been  known 
to  die  from  a  stricture  of  the  gullet,  brought  on  by  sulphuric  acid,  eleven 
months  after  the  poison  was  swallowed  ;  and  there  is  no  reason  to  doubt 
that  instances  may  occur  of  a  still  more  protracted  nature;  In  cases  of 
chroiric  2^oiso7iing,  there  is  sometimes  gi-eat  difficulty  in  assigning  death 
exclusively  to  the  original  action  of  the  poison,  since  the  habits  of  life  of 
the  person,  a  tendency  to  disease,  and  other  circumstances,  may  have 
concurred  either  to  accelerate  or  produce  a  fatal  result.  To  connect  a 
stricture  of  the  gullet,  proving  fatal,  with  the  effects  of  poisoning  by  a 
mineral  acid,  it  would  be  necessary  to  show  that  there  was  no  tendency 
to  this  disease  before  the  acid  was  administered  ;  that  the  symptoms 
appeared  soon  after  the  first  effects  of  the  poison  went  off;  that  the  symp- 
toms continued  to  become  aggravated  until  the  time  of  death  ;  and,  lastly, 
that  there  was  no  other  cause  to  which  death  could  with  any  probability  be 
referred.  These  remarks  apply  equally  to  the  secondary  fatal  effects  of 
any  poison — such,  for  instance,  as  the  salivation  occasionally  induced  by 
corrosive  sublimate,  and  the  exhaustion  and  depression  which  are  caused 
by  tartarated  antimony,  when  the  acute  symptoms  of  poisoning  by  these 
substances  have  passed  away. 

The  characters  of  chronic  poisoning  have  acquired  a  special  interest  for 
the  medical  jurist.  There  is  a  difficulty  about  them  which  no  accuracy  of 
observation  or  judgment  can  surmount.  The  poison  or  poisons,  if 
found  in  the  dead  body  at  all,  must  usually  exist  in  minute  quantities 
only.  This  alone  will  be  sufficient  to  create  a  doubt  whether  death  has 
been  caused  b}^  the  poison,  although  it  is  quite  consistent  with  medical 
experience  that  a  person  may  die  from  chronic  poisoning,  and  little  or 
none  of  the  poison  be  found  in  the  body  after  death.  In  the  case  of  Mrs. 
James  (Reg.  v.  Winslow),  not  more  than  the  tenth  part  of  a  grain  of 
antimony  was  found  in  the  whole  of  the  tissues  of  the  body :  in  the  case 
of  Isabella  Banks  (Reg.  v.  Smethurst,  C.  C.  C,  Aug.,  1859),  the  quantity 
was  greater  than  this,  but  less  than  a  grain  altogether  ;  while  in  the  case 
of  ]\Irs.  Peters,  none  was  found  in  the  body,  although  a  chemist  had  ex- 
tracted a  quantity  of  antimony  as  sulphide  from  the  urine  of  the  deceased 
within  less  than  nine  days  before  her  death.  In  this  case  antimony  had 
also  been  found  in  the  evacuations  during  life,  and  to  the  secret  use  of 
this  mineral  had  been  referred  the  intermittent  irritation  of  the  stomach 
and  bowels,  from  which  deceased  had  suffered.  The  jury  returned  a 
verdict  that  the  deceased  had  died  from  disease,  and  that  death  was  accele- 
rated bv  some  irritant:  Lancet,  18G0,  ii.  p.  119.  On  some  trials  for 
poisoning  (Reg.  v.  Palmer.  C.  C.  C,  185G  ;  Reg.  v.  Chantrelle,  High  Ct. 
of  Just.  Edin.,  May,  18T8)  it  has  been  a  contested  scientific  question 
whether  a  person  can  die  from  poisoning  and  no  trace  of  poison  remain  in 
the  body.  The  evidence  in  Mrs.  Peters's  case  not  only  proves  the  affirma- 
tive, but  goes  to  show  that  antimony  may  act  fatallv  and  be  entirely 
eliminated  from  the  svstem  in  about  a  week:  Med.  Times  and  Gaz., 
18C0,  ii.  pp.  190,  2T1,  317. 


REDNESS    OF    THE    MUCOUS    MEMBRANE.  89 

2.  Evidence  from  the  appearances  in  the  body. — One  of  the  chief  means 
of  determining-  whether  a  person  has  died  from  poison,  is  an  examination 
of  the  body  after  death.  In  relation  to  external  appearances,  there  are 
none  indicative  of  poisoning  upon  which  we  can  safely  rely.  It  was 
formerly  supposed  that  the  bodies  of  persons  who  were  poisoned  putrefied 
more  rapidly  than  those  of  others  who  had  died  from  natural  disease  ;  and 
evidence  for  or  against  poisoning  was  at  one  time  derived  from  the  ex- 
ternal appearance  of  the  body.  This  is  now  known  to  be  an  error  :  the 
bodies  of  persons  poisoned  are  not  more  rapidly  decomposed,  ciJtleris 
jjainbus,  than  those  of  others  who  have  died  a  sudden  and  violent  death 
from  any  cause  whatever. 

In-itant  poison  acts  chiefly  upon  the  stomach  and  intestines,  which  they 
irritate,  inflame,  and  may  corrode.  We  may  likewise  meet  with  all  the 
consequences  of  inflammation,  such  as  softening,  thickening,  ulceration, 
perforation,  or  gangrene.  Sometimes  the  coats  of  the  viscera  are  thickened, 
at  other  times  thinned  and  softened,  by  the  action  of  an  irritant. 

Neurotic  poisons  do  not  commonly  leave  any  well-marked  appearances 
in  the  body.  The  stomach  and  intestines  may  present  no  unnatural 
changes.  There  may  be  greater  or  less  fulness  of  the  vessels  of  the  brain 
and  spinal  marrow,  as  well  as  of  their  membranes ;  but  even  this  is  often 
so  slight  as  to  escape  notice,  unless  attention  be  particularly  directed  to 
these  organs.     Effusion  of  blood  is  rarely  found. 

It  is  important  to  bear  in  mind  that  both  irritants  and  neurotics  may 
destroy  life  without  leaving  any  appreciable  changes  in  the  body.  To 
such  cases  as  these,  the  i-emarks  about  to  be  made  do  not  apply.  The 
proofs  of  poisoning  must,  in  such  exceptional  cases,  be  procured  entirely 
from  other  sources.  Any  evidence  derivable  from  the  appearances  in  the 
body  of  a  person  poisoned  will  be  imperfect  unless  we  are  able  to  dis- 
tinguish them  from  those  analogous  changes  often  met  with  as  the  results 
of  ordinary  disease.  These  are  confined  to  the  mucous  membrane  of  the 
stomach  and  bowels.  They  are  redness,  ulceration,  softening,  and  perfora- 
tion. Each  of  these  conditions  may  depend  upon  disease,  as  well  as  upon 
the  action  of  irritant  poisons. 

Redness. — It  is  a  main  character  of  the  irritants  to  produce,  as  a  result 
of  inflammation,  redness  of  the  mucous  or  lining  membrane  of  the  stomach 
and  small  intestines.  This  redness,  when  first  seen,  is  usually  of  a  deep 
crimson  color,  becoming  brighter  by  exposure  to  air.  It  may  be  diffused 
over  the  whole  mucous  membrane  :  at  other  times  it  is  seen  in  patches, 
dots,  or  lines  (striae)  spread  irregularly  over  the  surface  of  the  stomach. 
It  is  sometimes  met  with  at  the  smaller,  but  more  commonly  at  the  larger, 
end  of  this  organ  ;  and,  again,  we  occasionally  find  the  folds  or  prominences 
only  of  the  mucous  membrane  presenting  this  red  or  inflamed  appear- 
ance. Redness  of  the  mucous  membrane  may,  however,  be  due  to 
gastritis,  active  digestion,  the  use  of  stimulants,  or  disease;  and  in  order 
to  assign  the  true  cause  of  inflammation,  it  will  be  necessary  to  have  an 
account  of  the  symptoms  preceding  death,  or  some  chemical  proof  of  the 
existence  of  irritant  poison  in  the  contents  of  the  stomach  or  in  the 
tissues  of  the  body. 

In  the  healthy  state,  the  mucous  membi'ane  of  the  stomach  is  pale  and 
white,  or  nearly  so,  except  daring  digestion,  when  it  is  slightly  reddened  ; 
and  redness  has  often  remained  in  the  stomachs  of  those  who  have  died 
during  the  performance  of  the  digestive  process.  When  in  contact  with 
the  spleen  or  liver,  after  death,  the  stomach  is  apt  to  acquire  a  deep  livid 
color  from  the  transudation  of  blood  ;  and  it  is  well  knoAvn  that  the 
bowels  acquire  a  somewhat  similar  color  from  the  gravitation  of  blood 


90  ULCERATION. 

whicli  ahvars  takes  place  after  death.  In  sudden  death  from  valvular 
disease  of  the  heart,  the  mucous  membrane  of  the  stomach  is  sometimes 
found  intensely  reddened.  None  of  these  appearances  are  likely  to  be  mis- 
taken for  the  action  of  an  irritant  poison. 

There  is  an  important  class  of  cases  in  ^Yhieh  redness  of  the  mucous 
membrane  of  the  stomach  is  found  after  death,  not  dependent  on  the  action 
of  poison  or  on  any  easily  assignable  cause.  These  cases,  owing  to  their 
being  so  little  known,  and  involved  in  much  obscurity,  deserve  the 
attention  of  a  medical  jurist,  since  the  appearances  closely  resemble  those 
produced  by  irritant  poison.  A  person  may  die  without  suffering  from 
any  symptoms  of  disordered  stomach  ;  but  on  an  inspection  of  the  body, 
a  general  redness  of  the  mucous  membrane  of  this  organ  will  be  found, 
not  distinguishable  from  the  redness  which  is  so  commonly  seen  in 
arsenical  poisoning.  Several  eases  of  this  kind  have  occurred  ;  and  draw- 
ings which  have  been  made  of  the  appearance  presented  by  the  stomach 
are  preserved  in  the  Guy's  Hospital  Museum.  Tidy  is,  however,  of 
opinion  that  there  is  always  ecchymosis  of  the  stomach  after  death  from 
arsenical  poisoning. 

The  redness  of  the  lining  membrane  of  the  stomach,  in  cases  of  poison- 
ing, is  so  speedily  altered  by  putrefaction,  when  circumstances  are  favor- 
able to  this  process,  as  frequently  to  render  it  impossible  for  a  witness  to 
speak  with  any  certainty  upon  its  cause.  Putrefactive  infiltration  of  the 
blood  contained  in  the  adjacent  viscera  and  muscles  will  give  a  reddish 
appearance  to  a  stomach  otherwise  in  a  healthy  condition.  Great  dispute 
has  arisen  respecting  the  length  of  time  during  which  redness  of  the 
stomach  produced  by  an  irritant  Avill  be  recognizable  and  easily  dis- 
tinguishable from  putrefactive  changes.  It  is  sufficient  to  say  that  no 
certain  rule  can  be  laid  down  on  the  subject :  it  must  be  left  to  the  knowl- 
edge and  discretion  of  the  witness.  We  have  distinctly  seen  the  well- 
marked  appearances  of  inflammation  produced  by  arsenic  in  the  stomach  and 
duodenum  in  exhumed  bodies  twenty-eight  days  and  six  months  respec- 
tively after  interment ;  and,  in  another  instance,  the  reddened  state  of  the 
mucous  membrane,  in  a  case  of  arsenical  poisoning,  was  plainly  percepti- 
ble on  removing  a  layer  of  arsenic  nineteen  vionihs  after  interment.  If, 
however,  there  should  be  a  reasonable  doubt  respectiug  the  cause  of  the 
redness,  and  no  poison  is  detected,  it  would  be  unsafe  to  rely  upon  this 
appearance  alone  as  evidence  of  poisoning.     (See  page  70,  ante.) 

UlceraMon. — In  irritant  poisoning  the  stomach  is  occasionally  found 
ulcerated  ;  but  this  is,  comparatively  speaking,  a  rare  occurrence.  In  such 
cases  the  mucous  membrane  is  removed  in  small,  distinct  circular  patches, 
under  the  edges  of  which  the  poison  (often  arsenic)  may  be  found.  Ulcera- 
tion of  the  stomach  is  a  more  common  result  of  disease  than  of  the  action 
of  poison.  As  a  consequence  of  disease,  it  is  very  insidious,  going  on 
often  for  weeks  together  without  giving  any  indication  of  its  existence, 
except  perhaps  slight  gastric  disturbance,  with  occasional  nausea,  vomit- 
ing, and  loss  of  appetite.  In  this  case,  the  ulceration  is  commonly  seen 
in  small,  circumscribed  patches.  It  is  worthy  of  remark,  as  a  means  of 
distinction,  that  ulceration  has  never  been  known  to  take  place  from 
arsenic  or  any  irritant  poison  until  symptoms  indicative  of  irritant  poison- 
ing have  occurred.  In  ulceration  from  disease,  the  mucous  membrane  is 
commonly  reddened  in  the  neighborhood  of  the  ulcer.  In  ulceration  from 
poison,  the  redness  is  generally  diffused  over  other  parts  of  the  stomach 
as  well  as  over  the  duodenum  and  small  intestines.  A  case,  however, 
occurred  in  Guy's  Hospital,  in  which,  with  a  small  circular  patch  of  ulcera- 
tion near  the  cardiac  opening,  the  whole  mucous  membrane  was  red  and 


SOFTENING PERFORATION    OF    THE    STOMACH.  91 

injected  ;  but  this  singular  eondition  of  the  stomach,  so  closely  resembling 
the  effects  of  an  irritant  poison,  was  unaccompanied  by  any  marked 
symptoms  of  irritation  during  life.  The  history  of  a  case  i)revious  to 
death  will  thus  commonly  enable  us  to  determine  to  what  cause  the  ulcera- 
tion found  may  be  due.  Care  must  be  taken  to  distinguish  ulceration  from 
corrosion.  Ulceration  is  a  vital  process:  the  suljstance  of  a  partis 
removed  by  the  absorbents  as  a  result  of  inflammation.  Corrosion,  on 
the  other  hand,  is  a  chemical  action  :  the  parts  are  removed  by  the  im- 
mediate contact  of  the  poison  ;  they  are  decomposed  ;  their  vitality  is 
destroyed,  and  they  combine  with  the  corrosive  matter  itself.  Ulceration 
requires  time  for  its  establishment,  while  corrosion  is  a  very  rapid  effect. 

Softening. — The  coats  of  the  stomach  are  not  unfrequently  found  so 
soft  as  to  yield  and  break  down  under  very  slight  pressure;  and  this  may 
be  the  result  either  of  poisoning,  of  some  spontaneous  morbid  change  in 
its  structure  during  life,  or  of  the  solvent  action  of  the  gastric  juice  after 
death.  As  this  condition  of  the  stomach,  when  caused  by  poison,  is  pro- 
duced by  those  substances  only  which  possess  corrosive  properties,  it  fol- 
lows that,  in  such  cases,  traces  of  their  action  will  be  perceived  in  the 
mouth,  throat,  and  gullet.  In  softening  from  disease,  the  change  will  be 
contined  to  the  stomach  alone,  and  it  is  commonly  found  only  at  the  car- 
diac or  greater  end  of  the  organ.  When  softening  is  really  caused  l)y  an 
irritant  poison,  it  is  generally  attended  by  other  striking  and  unambiguous 
marks  of  its  operation.  Softening  is  not  to  be  regarded  as  a  common 
characteristic  of  poisoning,  and  is  only  an  occasional  appearance.  In- 
stances have  been  met  with  where  the  coats  of  the  stomach  were  consider- 
ably hardened  by  sulphuric  acid,  or,  oftener,  by  carbolic  acid.  Softening 
can  never  be  inferred  to  have  proceeded  from  poison,  unless  other  well- 
marked  changes  are  present,  or  unless  the  poison  is  discovered  in  the 
softened  parts.  The  stomachs  of  infants  have  been  frequently  found 
softened  from  natural  causes  :  such  cases  could  not  be  mistaken  for 
poisoning,  since  the  history  of  them  during  life,  the  want  of  other  ap- 
pearances indicative  of  poisoning,  and  the  total  absence  of  poison  from 
the  viscera,  w^ould  prevent  such  a  suspicion  from  being  entertained. 

Perforation. — The  stomach  may  become  perforated,  either  as  a  result 
of  poisoning  or  of  disease.  Perforation  from  j)oisoning. — This  may 
arise :  1,  from  corrosion  ;  2,  from  ulceration.  The  perforation  by  corro- 
sion  is  by  far  the  most  common  variety  of  perforation  from  poisoning. 
It  is  occasionally  witnessed  when  a  strong  mineral  acid  has  been  taken, 
especially  sulphuric  acid  ;  the  stomach,  in  such  cases,  is  blackened  and  ex- 
tensivel}^  destroyed,  the  aperture  is  large,  the  edges  are  rough  and  irregu- 
lar, and  the  coats  are  easily  lacerated.  The  acid  escapes  into  the  abdo- 
men, and  may  be  detected  there  by  chemical  analysis.  The  perforation 
from  ulceration,  caused  by  irritant  poison  (arsenic),  is  but  littte  known. 
There  are  but  few  instances  on  record.  In  a  great  number  of  poisoned 
subjects  examined  during  many  years  past  at  Guy's  Hospital,  not  a  single 
case  has  occurred.  It  must  then  be  looked  upon  as  a  rare  appearance  in 
cases  of  irritant  poisoning.  Perforation  from  disease. — This  is  by  no 
means  an  unusual  condition.  Many  cases  of  this  disease  will  be  found 
reported  elsew^iere.  (Guy's  Hosp.  Rep.,  ser.  i.,  vol.  iv.,  p.  8.)  It  is  in- 
variably fatal  when  it  proceeds  so  far  that  the  contents  of  the  stomach 
escape  into  the  abdomen  ;  but  sometimes  the  stomach  becomes  glued  to 
the  pancreas  or  other  organs  during  the  ulcerative  process,  and  then  the 
person  may  recover.  Several  instances  of  this  kind  of  adhesion  have 
been  met  with  in  inspections.  The  symptoms  from  perforation  commonly 
attack    a   person    suddenly,  while    apparently    enjoying   perfect    healtL 


92  SPONTANEOUS    PERFORATION    OF    THE    STOMACU. 

Hence  these  cases  may  be  easily  mistaken  for  those  of  irritant  poisoning. 
The  principal  facts  observed  with  regard  to  this  formidable  disease  are  the 
following  : — 1.  It  often  attacks  young  women  from  eighteen  to  twenty- 
three  years  of  age.  2.  The  preceding  illness  is  extremely  slight ;  some- 
times there  is  merely  loss  of  appetite,  or  a  capricious  appetite,  with 
uneasiness  after  eating.  3.  The  attack  commences  with  a  sudden  and 
severe  pain  in  the  abdomen,  generally  soon  after  a  meal.  The  pain 
usually  comes  on  gradually  in  irritant  poisoning,  and  slowl}^  increases  in 
severity  4.  Yomiting,  if  it  exists  at  all,  is  commonly  slight,  and  is 
chiefly  confined  to  what  is  swallowed.  There  is  no  purging  :  the  bowels 
are  generally  constipated.  In  irritant  poisoning  the  vomiting  is  usually 
severe,  and  purging  is  seldom  absent.  5.  The  person  dies  commonly  in 
from  eighteen  to  thirty-six  hours  :  this  is  also  a  usual  period  of  death  in 
the  most  common  form  of  irritant  poisoning,  i.  e.  by  arsenic ;  but  in  no 
case  yet  recorded  has  arsenic  caused  perforation  of  the  stomach  within 
twenty-four  hours,  and  it  appears  probable  that  a  considerable  time  must 
elapse  before  such  an  effect  could  be  produced  by  this  or  any  irritant.  6. 
In  perforation  from  disease  the  symptoms  and  death  are  clearly  referable  to 
peritonitis,  7.  In  the  perforation  from  disease  the  aperture  is  commonly 
of  an  oval  or  rounded  form,  about  half  an  inch  in  diameter,  situated  in  or 
near  the  lesser  curvature  of  the  stomach,  and  the  edges  are  smooth.  The 
outer  margin  of  the  aperture  is  often  blackened,  and  the  aperture  itself  is 
funnel-shaped  from  within  outwards;  i.  e.,  the  mucous  coat  is  the  most 
removed,  and  the  outer  or  peritoneal  coat  the  least.  The  coats  of  the 
stomach,  round  the  edge  of  the  aperture,  are  usually  thickened  for  some 
distance ;  and  when  cut  they  have  almost  a  cartilaginous  hardness. 
These  characters  of  the  aperture  will  not  alone  indicate  whether  it  is  the 
result  of  poisoning  or  disease ;  but  the  absence  of  poison  from  the 
stomach,  with  the  want  of  other  characteristic  marks  of  irritant  poison- 
ing, would  enable  us  to  say  that  disease  was  the  cause.  Besides,  the 
history  of  the  case  during  life  would  materially  assist  us  in  our  judgment. 
The  great  rit^k  on  these  occasions  is  that  the  effects  of  disease  may  be 
mistaken  for  those  of  poisoning;  for  we  are  not  likely  to  mistake  a  per- 
foration caused  by  irritant  poison  for  the  result  of  disease.  Notwith- 
standing the  well-marked  differences  above  described,  it  is  common  to 
meet  with  cases  of  imputed  poisoning  Avhere  death  has  really  occurred 
from  peritonitis  following  perforation.  A  case  of  this  kind  will  be  found 
elsewhere  recorded.  (Guy's  Hosp.  Eep.,  1851,  p.  226.)  In  another  the 
body  was  exhumed  after  several  months'  burial,  and  the  stomach  was 
found  perforated  from  disease  in  the  usual  situation. 

Spontaneous  or  Gelatinized  Perforation. — The  stomach  is  occasionally 
subject  to  a  spontaneous  change,  by  which  its  coats  are  softened,  and  give 
way,  geaerally  at  the  cardiac  or  greater  end  As  the  efiTusion  of  the  con- 
tents of  the  organ  in  such  a  case  never  gives  rise  to  peritoneal  inflammation, 
and  no  symptoms  occur  prior  to  death  to  indicate  the  existence  of  so  ex- 
tensive a  destruction  of  parts,  it  is  presumed  to  be  a  change  in  the  dead 
body,  and  the  coats  of  the  stomach  are  supposed  to  undergo  a  process  of 
solution  or  digestion.  It  is  commonly  attributed  to  the  solvent  action  of 
the  gastric  juice,  the  spleen,  diaphragm,  and  other  viscera  being  some- 
times softened.  Wilkes  states  that  this  post-mortem  or  cadaveric  perfo- 
ration of  the  stomach  is  so  rare  a  condition  that  it  is  not  met  with  once  in 
five  hundred  cases.  In  the  last  two  cases  in  which  it  was  observed  by 
him,  one  patient  had  died  from  albuminuria,  and  the  other  from  head- 
afl'ection  ;  l^nt  in  neither  of  these  could  there  be  found  any  peculiarities 
regarding  their  food,  the  time  of  the  last  meal,  or  the  state  ot  the  bodies 


SPONTANEOUS  PERFORATION  OF  THE  STOMACH.       93 

to  account  for  the  spontaneous  destruction  of  the  coats  of  the  stomach.  In 
January,  1845,  the  author  met  with  an  instance  of  this  i)erforation  in  a 
child  between  two  and  three  years  of  a<xe.  It  was  seized  with  convul- 
sions, became  insensil^le,  and  died  twenty-three  hours  afterwards.  After 
death,  the  g-reater  end  of  the  stomach  was  found  destroyed  to  the  extent 
of  three  inches  ;  and  the  edges  were  softened  and  blaclcened.  There  was 
no  food 'in  the  stomach,  and  nothing  had  passed  into  this  organ  for  thirty- 
two  hours  before  death.  It  was  therefore  impossible  to  ascribe  death  to  the 
perforation  or  the  perforation  to  poison.  (Med.  Gaz.,  vol.  36,  p.  32.)  An 
inspection  of  the  body,  with  a  general  history  of  the  case,  will  commonly 
suffice  to  remove  any  doubt  in  forming  an  opinion  whether  the  extensive 
destruction,  so  commonly  met  with,  has  or  has  not  arisen  from  poison.. 
Thus  in  a  post-mortem  perforation,  the  aperture  is  generally  situated  in  that 
part  of  the  stomach  wiiich  lies  to  the  left  of  the  cardia  ;  it  is  very  large,  of 
an  irregular  form,  and  ragged  and  pulpy  at  the  edges,  which  have  the  appear- 
ance of  being  scraped.  The  mucous  meml)rane  of  the  stomach  is  not  found 
inflamed.  There  is  occasionally  slight  redness,  with  dark  brown  or  almost 
black  lines  (strite)  in  and  near  the  dissolved  coats,  which  have  an  acid 
reaction.  It  can  only  be  confounded  with  perforation  by  the  action  of 
corrosives;  but  the  well-marked  symptoms  during  life,  and  the  detection 
of  the  poison  after  death,  together  with  the  changes  in  the  throat  and 
gullet,  will  at  once  indicate  the  perforation  produced  by  corrosive  poison. 
Favy  has  shown  that  after  death  the  gastric  juice  dissolves  the  stomach. 

[Dr.  Hartshorne  comments  on  the  vital  importance,  in  cases  of  this  kind, 
of  the  post-mortem  being  conducted  by  an  experienced,  thoroughly-trained 
examiner,  of  sufficient  judgment  to  fully  and  distinctly  understand  the  ap- 
pearances hereinbefore  indicated,  and  shows  how  valueless  the  examination 
would  be  if  made  by  ignorant  and  untrained  practitioners.  He  cites  the 
case  of  John  Hendrickson,  Jr.,  convicted  by  this  latter  class  of  evidence, 
as  exposed  by  Dr.  C.  Lee  (Am.  Jour.  Med.  Sci.,  October,  1885,  p.  44T), 
and  insists  that  medical  evidence,  whether  as  to  anatomical  appearances, 
odor  and  color,  form,  or  microscopical  inquiry,  is  and  should,  in  the  nature 
of  things,  be  restricted  to  the  very  few  experts  who  could  be  found  com- 
petent to  give  reliable  evidence  in  these  cases. 

Prof.  Reese  claims  that  Chap.  XL,  supra,  regarding  chemical  a7iah/S'is 
in  establishing  the  proof  of  poisoning,  is  most  important  and  valuable,  and 
says  that  it  is  very  dangerous  in  a  case  of  life  and  death  to  rely  either 
upon  symptoms  or  autopsic  appearances,  or  even  upon  both,  as  affording 
positive  proof  of  poison.  While  unwilling  to  claim  that  the  chemical  evi- 
dence is  always  indispensable  to  prove  the  administration  of  poison  in 
certain  cases  where  chemical  detection  is  impossible,  yet  in  these  excep- 
tional cases  the  other  two  factors — symptoms  and  the  anatomical  lesions — 
as  well  as  the  morr/i  circumstances  of  the  case,  should  be  so  positive  and 
unequivocal  as  to  leave  no  shadow  of  doubt. 

Wharton  and  Stills,  in  commenting  on  this  subject,  sav  :  "These  veri- 
fications (the  symptoms  and  the  autopsy)  once  established,  and  a  harmony 
between  the  lesions  shown  by  the  physician  and  physiologist,  and  the 
substance  discovered  by  chemical  analysis  being  settled,  then  and  only  then 
can  the  conclusion  be  reached  that  death  was  due  to  poison:"  Yol.  II., 
p.  287,  1873.] 


94  .  SULPHURIC    ACID — SYMPTOMS. 


CORROSIVE  AND  IRRITANT  POISONS. 


CHAPTER   VII. 

SULPHURIC  ACID,  OR    OIL    OF  VITRIOL. NITRIC  ACID,  OR  AQUA  FORTIS. — HYDROCHLORICACID, 

OR    SPIRIT    OP     SALT. SYMPTOMS. APPEARANCES    AND    ANALYSIS. — NITRO-HYDKOCHLORIC 

ACID  OR  AQUA  REGIA. 

Sulphuric  Acid,  or  Oil  op  Vitriol. 

Symptoms. — When  this  poison  is  swallowed  in  a  concentrated  form,  the 
symptoms  produced  come  on   either  immediately  or  during  the  act  of 
swallowing.     It  has,  however,  been  taken   in  mistake  for  a  magnesian 
mixture,  without  the  mistake  being  discovered  till  after  the  lapse  of  some 
time.     There  is  violent  burning  pain,  extending  down  the  throat  and 
gullet  to  the  stomach,  and  the  pain  is  often  so  severe  that  the  body  is 
bent.     There  is  an  escape  of  gaseous  and  frothy  matter,  followed  by  retch- 
ing and  vomiting  ;  the   latter  accompanied  by  the  discharge  of  shreds  of 
tough  mucus  and  of  a  liquid  of  a  dark  cofl'ee-ground  color,  mixed  with 
blood.     The  vomited  matters  ma}^  contain  shreds  of  mucous  membrane 
from  the  gullet  and  stomach,  and  even  portions  of  the  muscular  tissue  of 
the  former.     These  may  form  complete  casts  of  some  portion  of  the  gullet 
or  stomach.     The  m.outh  is  excoriated,  the  lining  membrane  and  surface 
of  the  tongue  white,  or  resembling  soaked  parchment ;  and  in  one  instance 
the  appearance   of  the  mouth  was  as  if  it  had  been  smeared  with  white 
paint.     After  a  time  the  membrane  acquires  a  gray  or  brownish  color ; 
the  mouth  is  filled  with  a  thick  viscid  substance  consisting  of  saliva,  mucus, 
and  the  corroded   membrane  ;  this  renders  speaking  and  swallowing  dif- 
ficult.   If  the  poison  has.been  administered  by  a  spoon,  as  in  infants,  or  the 
phial  containing  it  has  been  passed  to  the  back  of  the  throat,  the  mouth 
m.ay  escape  the  chemical  action  of  the  acid,  and  a  child  will  not  always 
scream  under  such  circumstances.     Around  the  lips  and  on  the  neck  may 
be  found  spots  of  a  brown  color  from  the  spilling  of  the  acid  and  its  action 
on  the  skin.     There  is  great  difficulty  of  breathing,  owing  to  the  swelling 
and  excoriation  of  the  throat  and  larynx  ;  and  the  countenance  has  from 
this  cause  a  bluish  or  livid  appearance.     The  least  motion  of  the  abdo- 
minal muscles  is  attended  with  increase  of  pain.     The  stomach  is  so  irri- 
table that  whatever  is  swallowed  is  immediately  ejected,  and  the  vomiting 
is  commonly -violent  and  incessant.     The  matters  ^rsi!  vomited  generally 
contain  the  poison  :  they  are  acid,  and,  if  they  fall  on  a  lime-stone  pave- 
ment, there  is  effervescence;  if  on  colored  articles  of  dress,  the  color  is 
sometimes  altered  to  a  red  or  yellow,  or  it  is  entirely  discharged  and  the 
texture  of  the  stuff  destroyed  ;  on  a  black  cloth  dress,  the  spots  produced 
by  the  concentrated  acid  are  reddish-brown,  and  remain  moist  for  a  con- 
siderable time.     After  a  time  there  is  exhaustion,  accompanied  by  great 
weakness  ;  the  pulse  becomes  quick,   small,  and  feeble  ;  the  skin    cold, 
mottled,  and  covered  with  a  clammy  sweat.     There  is  generally  great 


APPEAKANCES  AFTER  DEATH FATAL  DOSE.         95 

thirst,  with  obstinate  constipation,  and  should  any  evacuations  take  place 
they  are  commonly  either  of  a  dark  Ijruwn  or  of  a  leaden  color,  and  in  some 
instances  almost  black  from  an  admixture  of  altered  blood.  There  are 
sometimes  convulsive  motions  of  the  muscles,  especially  those  of  the  face 
and  lips.  The  countenance,  if  not  livid  from  obstructed  respiration,  is 
pale,  and  expressive  of  g^reat  anxiety  and  intense  sufferin:^.  The  intel- 
lectual faculties  are  quite  clear ;  and  death  usually  takes  place  very 
suddenly,  in  from  eighteen  to  twenty-four  hours  after  the  poison  has  been 
taken.  Sulphate  of  indigo  produces  similar  symptoms.  The  vomited 
matters  are,  however,  bluish-black. 

Appearances  after  Death. — The  appearances  met  with  in  the  body  of  a 
person  who  has  died  from  the  effects  of  this  acid  vary,  according  to 
whether  death  has  taken  place  rapidly  or  slowly.  Supposing  the  case  to 
have  proved  rapidly  fatal,  the  membrane  lining  the  mouth  may  be  found 
white,  softened,  and  corroded.  The  mucous  membrane  of  the  throat  and 
gullet  is  commonly  found  corroded,  having  a  brown-black  or  ash-gray 
color,  and  blood  is  effused  in  ])atches  beneath  it.  The  corroded  membrane 
of  the  gullet  is  occasionally  disposed  in  longitudinal  folds,  portions  of  it 
being  partly  detached.  The  stomach,  if  not  perforated,  is  collapsed  and 
contracted.  On  laying  it  open,  the  contents  are  commonly  found  of  a 
dark  brown  or  black  color  and  of  a  tarry  consistency,  being  formed  in 
great  part  of  mucus  and  altered  blood.  The  contents  may  or  may  not  be 
acid,  according  to  the  time  the  patient  has  survived,  and  the  treatment 
which  has  been  adopted.  On  removing  them,  the  stomach  may  be  seen 
traversed  by  black  lines,  or  the  whole  of  the  mucous  membrane  may  be 
stained  black  or  of  a  dark  brown  color.  On  forcibly  stretching  the  coats, 
the  red  color  indicative  of  inflammation  may  be  sometimes  seen  in  the 
parts  beneath,  or  surrounding  the  blackened  portions. 

When  the  stomach  is  perforated,  the  coats  are  softened,  and  the  edge 
of  the  aperture  is  commonly  black  and  irregular.  In  removing  the 
stomach,  the  opening  is  liable  to  be  made  larger  by  the  mere  weight  of 
the  organ.  The  contents  do  not  always  escape  ;  but,  when  this  happens, 
the  surrounding  parts  are  attacked  by  the  poison.  The  spleen,  the  liver, 
and  the  coats  of  the  aorta  have  been  found  blackened  and  corroded  by  the 
acid,  which  had  escapeil  through  the  perforation.  In  rare  cases  the  lining 
membrane  of  the  aorta  has  been  found  strongly  reddened.  When  a  person 
has  survived  for  eighteen  or  twenty  hours,  traces  of  corrosive  and  inflam- 
matory action  may  be  found  in  the  small  intestines.  In  one  case  the 
mucous  membrane  of  the  ileum  was  corroded.  The  interior  of  the  wind- 
pipe, as  well  as  of  the  bronchial  tubes,  has  also  presented  marks  of -the 
local  action  of  the  acid.  The  acid  has  thus  destroyed  life  without  reach- 
ing the  stomach.  A  remarkable  instance  in  which  the  poison  penetrated 
into  and  destroyed  both  lungs  has  been  reported.  (Med.  Gaz.,  vol.  45,  p. 
1102.)  It  is  important  for  a  medical  witness  to  bear  in  mind  that  the 
mouth,  throat,  and  gullet  are  not  always  found  in  the  state  above  described. 
Ogle  met  with  a  case  in  Avhich  the  tongue  was  but  slightly  affected. 

Fatal  Dose. — The  dangerous  eff'ects  of  sulphuric  acid  appear  to  arise 
rather  fro-m  its  degree  of  concentration  than  from  the  absolute  quantity 
taken.  The  quantity  actually  required  to  prove  fatal  must  depend  on 
many  circumstances.  If  the  stomach  is  full  when  the  poison  is  swal- 
lowed, the  action  of  the  acid  may  be  spent  on  the  food  and  not  on  the 
stomach  ;  and  a  larger  quantity  might  then  be  taken  than  would  suffice 
to  destroy  life  if  the  organ  were  empty.  The  smallest  quantity  which  is 
described  as  having  proved  fatal  was  in  the  following  case :  Half  a  tea- 
spoonful  of  concentrated  sulphuric  acid  was  given  to  a  child  about  a  vear 


96  FATAL    PERIOD ANALYSIS. 

old  bv  mistake  for  castor  oil.  The  usual  symptoms  came  on,  ^vith  great 
disturbance  of  breatbino- ;  and  the  child  died  in  twenty-iour  hours.  The 
quantity  here  taken  could  not  have  exceeded  forty  drops.  (Med.  Gaz.,  vol. 
29,  p.  147.)  It  is,  however,  doubtful  whether  this  small  quantity  would 
have  proved  fatal  to  an  adult.  The  smallest  fatal  dose  which  Christison 
states  he  has  found  recorded  is  one  drachm  ;  it  was  taken  in  mistake  by 
a  young-  man,  and  killed  him  in  seven  days  :  On  Poisons.  Even  when 
diluted,"the  acid  will  rapidly  destroy  lii'e.  A  man  swallowed,  on  an  empty 
stomach,  six  drachms  of  the  strongest  acid  diluted  with  eighteen  drachms 
of  water.  He  suffered  from  the  usual  svmptoms,  and  died  in  two  hours 
and  a  half.   (Med.  Times  and  Gaz.,  1863,' 1,  p.  183.) 

Fatal  Period. — The  average  period  at  which  death  takes  place  in  cases 
of  acute  poisoning  by  sulphuric  acid  is  from  eighteen  to  twenty-four  hours. 
The  shortest  case  recorded  occurred  to  Rapp.  A  man,  aet.  50,  swallowed 
three  ounces  and  a  half  of  concentrated  sulphuric  acid;  he  died  in  three 
quarters  of  an  hour.  (Gaz.  Med.,  Dec.  28,  1850.)  On  the  other  hand,  there 
are  numerous  instances  reported  in  which  the  poison  has  proved  fatal, 
from  secondary  causes,  at  periods  varying  from  one  week  to  several 
months,  and  even  years. 

Chemical  Analysis. — If  the  acid  is  in  a  concentrated  state  it  possesses 
these  properties:  1.  Wood,  sugar,  or  other  organic  matter  plunged  into 
it,  is  speedily  carbonized  or  charred,  either  with  or  without  the  application 
of  heat.  2".  When  boiled  with  wood,  copper-cuttings,  or  mercury,  it 
evolves  fumes  of  dioxide  of  sulphur ;  this  is  immediately  known  by  the 
odor,  as  well  as  by  the  vapor  first  rendering  blue,  and  then  bleaching, 
starch-paper  dipped  in  a  solution  of  iodic  acid.  3.  When  mixed  with  an 
equal  bulk  of  Avater,  great  heat  is  evolved. 

Sulphuric  acid  when  diluted  does  not  carbonize  organic  substances. 
If,  however,  a  glass  rod  be  dipped  in  the  diluted  acid,  and  a  mark  be 
made  with  this  upon  writing-paper,  and  the  paper  be  then  gently  dried 
before  a  fire,  a  black  mark  will  be  left  wherever  the  acid  has  touched  the 
paper.  This  test  is  applicable  to  organic  liquids  containing  sulphuric 
acid.  The  best  reagent  for  its  detection  is  a  solution  of  barium — either 
the  nitrate  or  the  chloride  of  barium.  Having  ascertained  by  test-paper 
that  the  suspected  liquid  is  acid,  and  contains  a  free  mineral  acid  (see 
below),  we  add  to  a  portion  of  it  a  few  drops  of  nitric  acid,  and  then  a 
solution  of  barium  salt.  If  sulphuric  acid  is  present,  a  white  precipitate 
of  sulphate  of  barium  will  fall  down  :  this  is  insoluble  in  all  acids  and 
alkalies.  If  the  precipitate  is  collected,  dried,  and  heated  to  full  redness 
for  some  minutes  in  a  platinum  crucible,  or  in  a  folded  piece  of  platinum 
foil,  with  five  or  six  parts  of  charcoal  powder,  it  will,  if  a  sulphate,  be 
converted  into  sulphide  of  barium.  To  prove  this,  we  add  to  the  calcined 
residue  hydrochloric  acid,  at  the  same  time  suspending  over  it  a  slip  of  filter- 
ing paper  moistened  with  a  solution  of  acetate  of  lead.  If  the  precipitate 
obtained  is  a  sulphate,  the  gas  evolved  will  be  sulphuretted  hydrogen, 
known  by  its  odor,  and  by  its  turning  a  salt  of  lead  of  a  brown  color. 

Cyanide  of  potassium  may  be  used  as  a  reducing  agent  in  place  of 
charcoal,  in  a  proportion  of  "one  part  to  three  parts  of  the  sulphate  of 
barium.  The  mixture  should  be  heated  to  fusion  in  a  reduction-tube. 
On  breaking  the  glass  when  cold,  and  laying  the  incinerated  residue  on 
paper  or  card  wetted  with  a  salt  of  lead,  a  brown  stain  indicative  of 
sulphide  of  lead  is  produced  ;  or  the  residue  may  be  dissolved  in  water, 
and  a  solution  of  acetate  of  lead  added  to  it. 

[A  verv  delicate  test  for  dilute  sulphuric  acid  is  veratria,  which,  when 
introduced  in  small  quantity,  and  evaporated  to  dryness,  produces  a  beau- 
tiful purple  color :  Reese.] 


DIALYSIS.  97 

In  liquids  containing  organic  matter. — If  sulphuric  acid  is  mixed  with 
such  liquids  as  porter,  coffee  or  tea,  the  process  for  its  detection  is  sub- 
stantially the  same,  the  liquid  being  first  rendered  clear  Ijy  filtration. 
The  precipitated  sulphate  of  barium,  if  mixed  with  organic  matter,  may 
be  purified  by  boiling  it  in  strong  nitric  acid;  but  this  is  not  commonly 
necessary,  as  the  reduction  of  the  dried  precipitate  may  be  equally  well 
performed  with  the  impure  as  with  the  pure  sulphate.  Some  liquids, 
such  as  vinegar,  porter,  and  most  wines,  generally  contain  a  soluble  sul- 
phate, but  in  small  proportion;  therefore,  if  there  is  an  abundant  preci|»i- 
tate,  there  can  be  no  doubt,  coeteria  paribus,  that  free  sulphuric  acid  has 
been  added  to  them.  The  liquid  should  invariably  be  tested  for  the  pres- 
ence of  ayree  or  uncombined  mineral  acid.  A  solution  of  ferric  acetate 
is  mixed  with  solution  of  potassium  sulphocyanide,  and  diluted  till  the 
color  is  a  very  pale  red.  A  drop  or  two  of  the  suspected  liquid  dropped 
into  this  solution  will  yield  blood-red  streaks  if  a  free  mineral  acid  be 
present.  An  alcoholic  solution  of  methyl-violet  is  rendered  blue  and  then 
green  when  l-4000th  of  a  free  mineral  or  oxalic  acid  is  present.  Should 
the  liquid  be  thick  and  viscid,  like  gruel,  u  may  be  diluted  with  water, 
and  then  boiled  with  the  addition  of  a  little  acetic  acid.  The  coats  of  the 
stomach  should  be  cut  up  and  boiled  in  distilled  water.  For  the  action 
of  the  barium  test,  it  is  not  necessary  that  the  liquid  should  be  absolutely 
clear,  provided  it  is  not  so  turbid  as  to  interfere  mechanically  with  the 
precipitation  of  the  sulphate  of  barium. 

Dialysis. — When  the  acid  is  mixed  with  milk,  decomposed  blood, 
mucus,  or  other  substances,  rendering  it  thick  and  viscid,  it  may  be 
readily  separated  by  dialysis — a  process  which  is  applicable  to  the  other 
acid  poisons,  such  as  nitric,  hydrochloric,  and  oxalic.  A  portion  of  the  acid 
viscid  liquid  should  be  placecl  in  a  test-tube,  about  five  inches  long,  and  one 
inch  in  diameter,  open  at  both  ends ;  the  neck  being 
securely  covered  with  a  layer  of  thin  bladder  or  parch- 
ment-paper. The  tube  is  then  immersed,  mouth  down- 
wards, in  a  beaker  containing  distilled  water  (Fig  1). 
After  some  hours  the  acid  \vill  pass  through  the 
membrane,  and  may  be  detected  in  the  water  This 
process  may  be  employed  as  a  trial  test  of  the  con- 
tents of  the  stomach  when  they  have  a  strongly  acid 
reaction.     In  thus  testing  for  sulphuric  acid  it  must      ^  ■'  i  ^^ 

be  remembered  that  a  sulphate,  such  as  Epsom  salts,      r       .^'     ,-,ife^y 
may  be  present  in  the  liquid  ;  and  that  an  innocent  ^^^-^jafts^^^^" 

acid,  like  vinegar  or  lemon-juice,  mav  give  the  acid     Beaker  and  tube   for 

..  rn  /  11  "  ii  •  1  the  dialvsis  of  liquid 

reaction.     To  remove  any  fallacy  on  this  ground,  a       poisons." 
portion  of  the  liquid  tested  should  be  evaporated,  and 
the  residue  incinerated,  when  the  alkaline  sulphate,  if  present,  will  be 
obtained  in  the  solid  form. 

It  is  a  medico-legal  fact  of  considerable  importance,  that  the  contents 
of  a  stomach  in  a  case  of  poisoning  by  sulphuric  acid  are  sometimes 
entirely  free  from  any  traces  of  this  poison,  even  when  it  has  been 
swallowed  in  large  quantity.  Casper  relates  three  such  cases  The  acid 
is  not  commonly  found  when  the  person  has  been  under  treatment ;  when 
there  has  been  considerable  vomiting,  aided  by  the  drinking  of  water  or 
other  simple  liquids;  or  when  he  has  survived  several  days. 

Sulphuric  acid  may  be  detected   on  articles  of  clothing  by  a  similar 

process.     The  concentrated  acid  produces  reddish-brown  stains  on  black 

cloth — the    spots   remain    damp,  and   the  fibre  of  the  stuff  is  gradually 

softened  and  corroded.     The  stained  portion  of  cloth  should  be  boiled  in 

T 


9S  NITRIC    ACID  —  SYMPTOMS. 

Avater,  and  the  solution  filtered,  tested  for  free  acid  (see  p.  97,  ante),  and 
then  with  a  salt  of  barium.  If  any  free  acid  is  present,  the  stained  stuff 
and  the  solution  obtained  from  it  will  redden  litmus-paper.  Sometimes 
the  detection  of  the  acid  on  clothing  is  the  only  source  of  chemical  evi- 
dence in  cases  of  poisoning.  It  has  been  thrown  on  the  person  for  the 
purpose  of  producing  bodily  injury  or  injury  to  the  clothes.  In  such 
cases  it  must  be  proved  that  the  substance  is  of  a  corrosive  nature,  but  it 
is  not  necessary  to  show  that  injury  has  been  done  to  the  person. 

The  acid  sulphates,  such  as  alum,  act  as  irritant  poisons  when  giveu 
in  large  doses.  Tardieu,  who  gives  the  details  of  two  cases  of  fatal 
poisoning  by  alum  (L'Empoisonnement,  p.  218),  is  of  opinion  that 
from  half  an  ounce  to  an  ounce  of  the  salt  is  a  fatal  dose  for  an  adult. 
In  1888  Bull  communicated  to  the  editor  a  case  in  which  a  diphtheritic 
child,  set.  3  years,  died  from  the  effects  of  a  teaspoonful  of  alum  given 
in  syrup  as  an  emetic.  The  child  did  not  vomit,  and  died  shortly  after. 
The  mucous  membrane  of  the  stomach  was  red  and  velvety,  as  if  from  the 
effects  of  a  powerful  irritant. 

Nitric  Acid,  or  Aqua  Fortis. 

Symptoms. — When  nitric  acid  is  taken  in  a  concentrated  state,  the 
symptoms  bear  a  close  resemblance  to  those  produced  by  sulphuric  acid. 
They  come  on  immediately,  and  the  swallowing  of  the  acid  is  accompanied 
by  intense  burning  pain  in  the  throat  and  gullet,  extending  downAvards  to 
the  stomach  :  there  are  gaseous  eructations,  resulting  from  the  chemical 
action  of  the  poison,  swelling  of  the  abdomen,  violent  vomiting  of  liquid 
or  solid  matters,  mixed  with  altered  blood  of  a  dark  brown  color,  and 
shreds  of  yellowish-colored  mucus  having  a  strongly  acid  reaction.  The 
abdomen  is  generallv  exquisitely  tender;  but,  in  one  well-marked  case  of 
poisoning  by  this  acid,  the  pain  was  chiefly  confined  to  the  throat:  prob- 
ably the  poison  had  not  reached  the  stomach.  The  mucous  membrane  of 
the  mouth  is  commonly  soft  and  white,  after  a  time  becoming  yellow,  or 
even  brown  ;  the  teeth  are  also  white  or  yellow,  and  the  enamel  is  par- 
tially destroyed  by  the  chemical  action  of  the  acid.  There  is  great  diffi- 
culty of  speaking  and  swallowing,  the  mouth  being  filled  with  viscid 
mucus;  the  power  of  swallowing  is,  indeed,  sometimes  entirely  lost. 
On  opening  the  mouth,  the  tongue  may  be  found  swollen,  and  of  a  citron 
yellow  color ;  the  tonsils  are  also  swollen  and  enlarged.  As  the 
symptoms  progress,  the  pulse  becomes  small,  frequent,  and  irregular — the 
surface  of  the  body  cold,  and  there  are  frequent  rigors  (shivering).  The 
sw^allowing  of  liquids  increases  the  severity  of  the  pain  and  occasions 
vomiting.  There  is  obstinate  constipation.  Death  takes  place  in  from 
eighteen  to  twenty-four  hours,  and  is  sometimes  preceded  by  a  kind  of 
stupor,  from  which  the  patient  is  easily  roused.  The  intellectual  faculties 
commonly  remain  clear  until  the  last.  Death  may  occur  from  pneumonia, 
the  fumes  of  the  acid  having  gained  access  to  the  lungs. 

The  vapor  of  this  acid  is  destructive  to  life.  In  1854  Mr.  Haywood, 
an  analytical  chemist  of  Sheffield,  lost  his  life  under  the  following  circum- 
stances. He  was  pouring  a  mixture  of  nitric  and  sulphuric  acids  from  a 
carboy  containing  about  sixty  pounds,  when  by  some  accident  the  vessel 
was  broken.  For  a  few  minutes  he  inhaled  the  fumes  of  the  mixed  acids, 
l)ut  it  does  not  appear  that  any  of  the  liquid  fell  over  him.  Three  hours 
after  the  accident  he  was  sitting  up  and  appeared  to  be  in  moderately  good 
health.  He  was  then  seen  by  a  medical  man,  and  complained  merely  of 
some  cuts  about  bis  hands.      He  coughed  violently.     In  three  hours  more 


NITRIC    ACIU APPEARANCES    AFTER    DEATH.  99 

there  was  a  difficulty  of  breathinji-,  with  increase  of  the  cough.  There 
was  a  sense  of  tightness  at  the  lower  jiart  of  the  throat,  and  the  pulse  was 
hard.  At  times  he  said  he  could  scarcely  breathe.  He  died  eleven  hours 
after  the  accident.  On  inspection  there  was  congestion  of  the  windpipe 
and  bronchial  tubes,  with  effusion  of  blood  in  the  latter.  The  heart  was 
flaccid,  and  contained  but  little  blood;  and  the  lining  membrane  of  the 
heart  and  aorta  was  inflamed.  The  blood  gave  a  slightly  acid  reaction  to 
test-paper.  The  windpipe  was  not  examined.  It  is  very  probable  the 
seat  of  mischief  was  in  this  organ,  and  that  the  deceased  died  from  in- 
flammatory effusion,  and  svvelliiiji'  of  the  parts  about  the  opening  of  tlie 
windpipe.  (Lancet,  1854,  i.  p.  4l!0.)  A  similar  accident  occurred  to  Mr. 
Stewart  and  one  of  the  janitors  of  an  educational  institution  in  Edin- 
burgh, in  1863.  They  both  died  from  the  cfiects  of  the  acid  vapor, 
(Chem.  News,  1863,  p.  132.)  On  Sept.  23,  1890,  during  attempts  to  ex- 
tinguish a  fire  at  some  chemical  stores,  a  bottle  of  nitric  acid  was  broken. 
The  action  of  the  acid  upon  surrounding  articles  gave  rise  to  abundant 
evolution  of  nitrous  fumes,  and  two  of  the  fire-brigade  officers  were  so 
affected  by  their  inhalation  that  they  died  the  same  day.  (Pharm.  Jour., 
1890-1,  p.  252.) 

The  fumes  from  batteries  charged  with  nitric  acid  are  often  productive 
of  serious  results  ;  and  the  editor  has  met  with  alarming  illness  arising 
from  the  inhalation  of  the  nitrous  fumes  given  off  during  the  working  of 
such  batteries  in  an  ill-ventilated  room. 

Appearances  after  Death. — Supposing  death  to  have  taken  place  rapidly 
from  the  liquid  acid,  the  following  appearances  may  be  met  with  :  The 
skin  of  the  mouth  and  lips  will  present  various  shades  of  color,  from 
orange-yellow  to  brown.  Yellow  spots  produced  by  the  spilling  of  the 
acid  may  be  found  about  the  hands  and  neck.  The  membrane  lining  the 
mouth  is  sometimes  white — more  commonly  of  a  yellow  color  ;  ancl  the 
teeth  are  white  or  yellowish  in  color.  The  throat  and  windpipe  are  much 
inflamed.  The  lining  membrane  of  the  gullet  is  softened,  of  a  yellow  or 
brown  color,  and  easily  detached,  often  in  long  shreds.  The  windpipe  is 
congested,  and  the  lungs  also.  The  most  strongly  marked  changes  are 
seen  in  the  stomach.  When  not  perforated,  this  organ  may  be  found  dis- 
tended with  gas,  its  mucous  membrane  partially  inflamed  and  covered 
with  patches  of  a  yellow,  brown,  or  green  color,  or  it  may  be  even  black. 
Its  coats  may  be  so  much  softened  as  to  break  down  under  the  slightest 
pressure.  Similar  changes  are  found  in  the  duodenum  ;  but  in  some  cases 
the  small  intestines  have  presented  no  other  appearance  than  that  of  a 
slight  redness.  It  might  be  supposed  that  the  stomach  would  be  in 
general  perforated  by  this  corrosive  liquid ;  but  perforation  has  not  been 
often  observed.  In  a  case  of  the  editor's  there  was  a  small  aperture  in 
the  anterior  wall  of  the  stomach,  around  which  the  peritoneum  was  ecchy- 
mosed  ;  but  no  lymph  was  exuded  around  the  opening.  It  is  probable 
that  the  rupture  had  taken  place  about  the  time  of  death,  which  super- 
vened seventeen  hours  after  the  acid  was  taken.  (Guy's  Hosp.  Rep., 
1872,  xvii.  p.  223.)  In  a  case  which  proved  fatal  after  the  long  period  of 
six  months,  there  was,  at  the  intestinal  end  of  the  stomach,  a  distinct 
cicatrix  with  puckering  and  hardening  of  the  surrounding  mucous  mem- 
brane, causing  a  slight  contraction  of  the  intestinal  orifice.  The  only 
other  appearance  consisted  in  some  dark  longitudinal  lines  on  the  posterior 
surface  of  the  lining  membrane  of  the  gullet.  These  had  probably 
been  caused  by  the  acid.     (Lancet,  1860,  ii.  p.  510.) 

The  smallest  quantity  of  this  acid  which  is  reported  to  have  destroyed 
life,  is  about  two  drachms  in  the  case  of  a  boy,  aged  thirteen,  who  died  in 


100  FATAL    DOSE CHEMICAL    A^TALYSIS. 

thirty-six  hours.  Death  commonly  takes  place  within  twenty-four  hours.' 
Soberheim  relates  a  ca^-c  of  poisoning  by  nitric  acid,  which  proved  fatal 
in  one  huur  and  three-quarters.  This  is  believed  to  be  the  most  rapidly 
fatal  instance  on  record  where  the  acid  acted  in  the  ordinary  manner. 
The  usual  well-marked  effects  were  found  in  the  gullet,  stomach,  and 
small  intestines.  In  infants,  life  may  be  destroyed  by  this  poison  in  a  few 
minutes,  should  it  happen  to  reach  the  larynx.  The  longest  case  is, 
perhaps,  that  recorded  by  Tartra,  where  a  woman  died  from  exhaustion, 
produced  by  the  secondary  effects  of  the  acid  eight  months  after  having- 
swallowed  it. 

Chemical  Analysis. — In  the  simple  state. — This  acid  may  be  met  Avith 
either  concentrated  or  diluted.  The  concentrated  acid  varies  in  color 
from  a  deep  orange-red  to  a  light  straw-yellow.     It  may  be  recognized  : 

1.  By  evolving  acid  fumes  when  exposed  to  the  air  or  when  heated.  2. 
By  its  staining  organic  matter  yellow  or  brown,  the  color  being  heightened 
and  turned  to  an  orange-red  by  contact  with  the  caustic  alkalies.  3.  When 
mixed  with  copper-cuttings,  it  is  rapidly  decomposed,  deep  red  acid  vapors 
are  given  off,  and  a  greenish-colored  solution  of  nitrate  of  copper  is  fornud. 
Tin  or  mercury  may  be  substituted  for  copper  in  this  experiment.  4.  The 
addition  of  gold-leaf  and  a  few  drops  of  hydrochloric  acid:  if  nitric  acid 
is  present,  the  gold  will  be  dissolved  on  warming  the  mixture.  Common 
aqua  fortis  (nitric  acid)  sometimes  contains,  as  impurity,  a  sufficiency  of 
hydrochloric  acid  to  dissolve  gold-leaf.  It  strikes  a  deep  brown  color 
with  a  solution  of  ferrous  sulphate.  In  the  diluted  state. — This  acid  is 
not  precipitated  like  sulphuric  by  any  common  reagent,  since  all  its  saline 
combinations  are  soluble  in  water.  1.  The  liquid  has  a  highly  acid  reac- 
tion, and  (if  not  too  diluted),  on  boiling  it  with  some  copper  turnings,  red 
fumes  are  given  off,  the  liquid  acquiring  at  the   same  time  a  blue  color. 

2.  A  streak  made  on  white  paper  with  the  diluted  acid  does  not  car])onize 
it  when  heated;  but  a  scarcely  visible  yellow  stain  is  left.  3.  The  liquid 
is  neither  precipitated  by  nitrate  of  barium  nor  by  nitrate  of  silver.  These 
last  two  experiments  give  merely  negative  results  ;  they  serve  to  show 
that  sulphuric  and  hydrochloric  acids  are  absent.  4.  The  liquid  is  mixed 
with  an  equal  bulk  of  pure  sulphuric  acid,  partially  cooled,  and  then  a 
solution  of  ferrous  sulphate  is  gently  poured  on  to  the  surface  of  the 
mixture  :  a  deep  brown  ring  forms  at  the  junction  of  the  two  liquids  if 
nitric  acid  or  a  nitrate  is  present. 

In  order  to  detect  nitric  acid  when  mixed  with  water  or  other  liquids, 
the  liquid  should  be  first  tested  with  litmus-paper,  and  also  with  ferric 
acetate  and  potassium  sulphocyanate,  or  by  means  of  methyl-violet,  for 
the  presence  of  a  free  mineral  acid  (see  p.  97,  ante).  Two  separate  por- 
tions should  then  be  carefully  neutralized — the  one  with  potash,  the  other 
with  soda,  and  then  each  slowly  evaporated  to  obtain  crystals.  If  the 
liquid  contains  nitric  acid,  these  crystals  will  have  the  following  charac- 
ters:  1.  Those  of  nitrate  of  potassium  will  appear  in  the  form  of  long 
fluted  prisms,  which  neither  effloresce  nor  deliquesce  on  exposure  to  air. 
Those  of  nitrate  of  sodium  have  a  rhombic  form  and  closely  simulate  the 
appearance  of  the  cubic  crystals  of  common  salt.  One  drop  of  the  solution, 
evaporated  spontaneously  on  glass,  will  suffice  to  yield  distinct  and  well-  ' 
formed  crystals.  2.  When  moi.stened  with  strong  sulphuric  acid,  the 
powdered  crystals  of  either  salt  slowly  evolve  a  colorless  acid  vapor.  By 
tliis  test  the  nitrate  is  known  from  every  other  deflagrating  salt.  3.  A 
])ortion  of  the  powdered  crystals  should  be  placed  in  a  small  tube  and 
mixed  wMth  an  equal  bulk  of  fine  copper  filings.  The  mass  is  then  to  be 
moistened  with  water,  and  a  few  drops  of  strong  sulphuric  acid  added. 


NITRIC    ACID    IN    ORGANIC    LIQUIDS.  101 

Either  with  or  without  the  application  of  a  gentle  heat,  decomposition 
immediately  ensues,  by  which  red  nitrous  fumes  are  evolved,  recognizable 
by  their  color,  odor,  and  acid  reaction.  In  operating  on  a  small  quantity 
of  nitrate  free  from  chloride,  the  crystals  may  be  placed  in  a  flask  and 
aiixed  with  one  or  two  drops  of  concentrated  sulphuric  acid  and  a  few 
copper  filings.  Place  in  the  neck  of  the  flask  a  slip  of  damp  blue  litmus- 
paper,  and  a  slip  of  starch-paper  moistened  with  a  solution  of  iodide  of 
potassium.  After  a  longer  or  shorter  interval  the  litmus  will  be  reddened, 
and  the  starch-paper  will  assume  a  blue-black  color.  If  the  nitrate  should 
be  mi.ved  with  much  chloride,  then  the  power  of  dissolving  gold-leaf  on 
boiling  the  dry  salt  with  strong  hydrochloric  acid  furnishes  the  best  means 
of  detection.  4.  We  add  to  the  crystals  a  small  portion  of  gold-leaf  and 
hydrochloric  acid;  then  boil  for  a  few  minutes.  If  nitric  acid  or  a  nitrate 
is  present,  the  gold  will  either  partly  or  entirely  disappear.  Its  partial 
solution  will  be  indicated  by  a  dark-purple  or  brown  color  on  the  addition 
of  stannous  chloride  to  the  liquid  after  boiling. 

In  Liqvids  containing  Organic  Matter. — Nitric  acid  may  be  adminis- 
tered in  such  liquids  as  tea,  vinegar,  or  porter.  In  this  case,  besides  the 
acid  reaction,  there  will  be  a  peculiar  smell  produced  by  the  strong  acid, 
Avhen  mixed  with  organic  substances.  The  application  of  the  usual  tests 
may  be  here  counteracted:  thus,  unless  the  quantity  of  nitric  acid  in  the 
liquid  is  considerable,  the  orange-red  nitrous  acid  fumes  are  not  evolved 
on  boiling  it  with  co[)per  cuttings. 

The  action  on  gold-leaf  will  enable  a  chemist  to  detect  nitric  acid  in 
coffee,  tea,  and  similar  ori>-a,nic  liquids,  even  when  the  proportion  of  acid 
is  small.  Boil  a  fragment  of  gold-leaf  in  pure  hydrochloric  acid,  and  add 
while  boiling  a  few  drops  of  the  suspected  organic  liquid  to  the  mixture. 
If  the  acid  is  present,  the  gold  will  be  dissolved.  When  the  acid  liquid  is 
thick  and  turbid,  a  portion  of  it  should  be  placed  in  a  tube  and  submitted 
to  the  process  of  dialysis  (see  p.  97,  ante).  Vomited  matters,  as  well  as 
the  contents  and  coats  of  the  stomach  (cut  up),  should  be  boiled  in  water, 
and  filtered.  If  not  cleared  by  filtration,  they  may  be  submitted  to 
dialysis,  and  the  acid  water  obtained  carefully  neutralized  with  potash  or 
soda  and  concentrated.  If  by  filtration  we  succeed  in  procuring  a  clear 
acid  liquid,  the  color  is  of  no  importance.  A  few  drops  of  the  neutralized 
and  concentrated  liquid  may  be  evaporated  on  a  glass  slide,  and  the 
crystals  thus  obtained  examined  microscopically  and  compared  with  those 
of  nitrate  of  potassium  and  of  sodium.  Paper  dipped  into  the  concentrated 
liquid  and  dfied  burns  with  deflagration  like  touch-paper.  The  crystals 
obtained  by  evaporating  the  neutralized  liquid  are  generally  colored  with 
organic  matter,  but  they  fuse  into  a  white  mass  when  heated  in  a  platinum 
capsule.  The  pure  nitrate  thus  obtained  may  be  tested  as  above  described. 
The  organic  matter  in  the  crystals  does  not  interfere  with  the  results  of 
the  copper  and  gold  tests. 

When  either  nitric  acid,  or  the  nitrate  into  which  it  has  been  con- 
verted, is  mixed  with  common  salt,  the  copper  test  cannot  be  employed. 
The  gold  test  will  in  such  a  case  furnish  the  best  evidence.  Hydrochloric 
acid  with  a  small  portion  of  gold-leaf  may  be  added  to  the  dried  residue, 
and  the  mixture  boiled.  If  nitric  acid  or  a  nitrate  is  present,  even  in 
minute  proportion,  some  portion  of  the  gold  will  be  dissolved — a  fact 
demonstrable  by  the  addition  of  stannous  chloride. 

Nitric  acid  ma}-  be  detected  in  stains  on  clothing,  if  recent,  by  simply 
boiling  the  stained  cloth  in  water.  An  acid  liquid  will  be  obtained,  unle.-^s 
the  stains  are  of  old  date  or  the  stuff  has  been  washed.  This  liquid,  when 
concentrated,   may   be  dealt   with   in  the  manner  already  described  for 


102  HYDROCHLORTC    OR    MURIATIC    ACID. 

organic  liquids.  The  stnins  from  this  acid  on  black  and  blue  cloth  are  of 
a  yellow  or  brownish-yellow  color  and  are  indelible.  When  long  exposed 
they  become  dry,  but  the  cloth  is  easily  torn.  A  simple  method  of  detect- 
ing the  acid  is  to  boil  at  once  a  piece  of  the  stained  cloth  with  a  fragment 
of  gold-leaf  and  hydrochloric  acid.  If  nitric  acid  is  present  in  the  stain,  a 
portion  of  the  gold  will  be  dissolved. 

In  1889,  a  man  was  convicted  of  the  raui'der  of  a  woman  by  pouring  nitric 
acid  down  her  throat  v.-hilst  in  bed  (Reg.  v.  Lipski,  C.  C.  C.,  July,  1888). 
In  reality  a  mixture  of  acids,  containing  more  sulphuric  than  nitric,  was 
employed.  Such  a  mixture  does  not  char  cellulose  (wood  and  cotton) 
like  sulphuric  acid,  but  converts  it  into  nitro-cellulose,  which  substance 
Avas  found  by  the  editor  in  th.e  stains  on  the  deceased  woman's  linen, 
and  also  in  wood  cut  from  the  floor  of  the  room  in  which  the  murder  was 
committed. 

Hydrochloric  Acid.     Muriatic  Acid. 

This  acid,  which  is  also  called  muriatic  acid,  and  is  popularly  known 
under  the  name  of  spirit  of  salt,  is  often  taken  as  a  poison.  In  the  cases 
Avhich  have  hitherto  been  observed,  the  aijmploms  and  appearances  have 
been  similar  to  those  caused  by  nitric  acid.  A  woman,  eet.  G3,  swallowed 
half  an  ounce  of  concentrated  hydrochloric  acid.  She  was  received  into 
the  hospital  in  three-quarters  of  an  hour.  The  prominent  symptoms  were 
burning  pain  in  the  throat  and  stomach,  feeble  pulse,  cold,  clammy  skin, 
retching,  and  vomiting  of  a  brown  matter  streaked  with  blood  and  con- 
taining shreds  of  membrane.  There  was  great  exhaustion.  The  throat 
became  swollen,  the  patient  lost  the  power  of  swallowing,  and  died  in 
eighteen  hours.  She  retained  her  senses  until  the  last.  The  ajipearances 
in  the  body  were  as  follows:  The  mucous  membrane  of  the  mouth  and 
throat  was  white,  softened,  and  destroyed  in  many  places  by  the  corrosive 
action  of  the  acid.  The  mucous  membrane  of  the  gullet  was  red  and  in- 
flamed. The  back  part  of  the  stomach  near  the  pylorus  Avas  dark-colored, 
stripped  of  its  mucous  membrane  (which  was  generally  softened),  and 
marked  with  black  lines.  It  was  not  perforated  (Lancet,  1859,  ii.  p.  59). 
In  this  case  the  smallest  quantity  of  hydrochloric  acid  was  taken  which 
has  as  yet  been  known  to  prove  fatal. 

In  1885,  a  man,  aet.  37,  was  admitted  into  Guy's  Hospital  after  swallow- 
ing, for  suicidal  purposes,  a  fluidounce  of  strong  hydrochloric  acid,  in 
which  he  had  dissolved  a  dram  of  oxalic  acid.  The  ordinary  antidotes 
Avere  employed,  and  he  progressed  favorably  till  the  tenth  day,  AA"hen  he 
died  rather  suddenly.  On  post-mortem  examination  the  editor  found  a 
membranous  exudation  and  minute  ulcers  at  the  back  of  the  pharynx. 
The  mucous  membrane  of  the  gullet  Avas  white,  thickened,  and  interspersed 
Avith  small  extravasations  of  blood.  The  stomach  contained  remains  of 
food  of  the  ordinary  acidity.  The  mucous  membrane  was  Avhite  and 
mammillated.  Towards  the  pyloric  or  intestinal  end  there  M-ere  small 
ulcers  with  open  bloodvessels,  from  the  mouths  of  which  extended  con- 
siderable extravasations  of  blood  blackened  by  the  action  of  the  acids  of 
the  stomach.  Between  the  ulcer.s  the  surface  was  raAV  and  hemorrhagic. 
The  hemorrhage  extended  into  the  duodenum,  but  not  beyond. 

Chemical  AnahjaiH. — In  a  concentrated  state,  hydrochloric  acid  evolves 
copious  fumes.  The  pure  acid  is  nearly  colorless;  the  commercial  acid  is 
of  a  lemon-yelloAA'  color,  and  frequently  contains  iron,  arsenic,  common 
salt,  and  other  impuriti-es.  When  boiled  Avith  a  small  quantity  of  peroxide 
of  manganese,  chlorine  is  evolved.     It  does  not  dissolve  gold-leaf  until  a 


OXALIC    ACID.  103 

few  drops  of  nitvic  acid,  have  been  added  to  it,  and  the  mixture  is  heated. 
In  the  diluted  state,  it  may  be  recognized  by  the  dense  white  precipitate 
which  it  gives  when  a  solution  of  nitrate  of  silver  is  added  to  it.  This 
precipitate  is  insoluble  in  nitric  acid,  but  soluble  in  ammonia  ;  it  becomes 
purple  when  exposed  to  light;  and  when  heated  it' melts  without  decom- 
position, forming  a  yellowish-colored  solid  in  cooling.  If  the  acid  is  con- 
tained in  organic  liquids- in  moderate  quantity,  it  admits  of  separation  by 
distillation  to  dryness.  In  this  case'  any  chlorides  present  are  left  in  the 
retort.  It  may  also  be  procured  by  dialysis  in  a  40ure  enough  state  for 
testing  (see  p.  97,  ante).  In  all  cases  the  presence  of  a  free  mineral  acid 
must  be  ascertained  (see  p.  97,  ante). 

Hydrochloric  acid,  in  small,  quantity,  as  well  as  alkaline  chlorides,  is  a 
natural  constituent  of  the  fluids  of  the  stomach  and  bowels.  The  presence 
of  local  chemical  changes  in  the  throat  and  stomach  would  show  whether 
the  acid  had  been  taken  as  a  poison.  If  the  acid  is  found  only  in  minute 
quantity,  no  inference  of  poisoning  can  be  drawn,  unless  there  are  distinct 
marks  of  its  chemical  action  upon  the  throat  and  stomach.  It  darkens 
the  blood  like  sulphuric  acid,  although  it  has  not  the  same  degree  of  car- 
bonizing action  on  organic  matter.  The  stains  produced  by  this  acid  on 
black  cloth  are  generally  of  a  reddish  color.  As  the  acid  is  volatile,  it 
may  disappear  from  the  stuff.  If  recent,  the  acid  may  be  separated  by 
boiling  the  stuff"  in  water  and  applying  the  silver  test,  and  the  tests  for 
a  free  mineral  acid  (see  p.  97,  ante).  An  unstained  portion  of  cloth  should 
be  similarly  tested  for  the  sake  of  comparison. 

[Nitro-Hydrochloric  Acid.     (Aqua  Regia.) 

The  general  symptoms,  eff'ects,  and  post-mortem  appearances  resemble 
those  of  the  preceding  acid.  The  test  is  its  solvent  power  over  gold.  Its 
chlorine  can  be  detected  by  the  odor  evolved  and  also  by  nitrate  of  silver; 
its  nitric  acid,  by  the  action  on  copper  in  the  cold.     (Reese. )J 


CHAPTER   VIII. 

OXALIC  ACID. SYMPTOMS  AND  APPEARANCES. CHEMICAL  ANALYSIS. — DIALYSIS  OF  ORGANIC 

LIQUIDS. ACID  OXALATE  OP  POTASSIUM,   OR  SALT  OF  SOREEL. VEGETABLE    ACIDS. 

Oxalic  Acid. 

Symptoms. — If  this  poison  is  taken  in  a  large  dose,  i.e.  from  half  an  ounce 
to  an  ounce  of  the  crystals,  dissolved  in  water,  a  hot,  burning,  acid  taste  is 
experienced  during  the  act  of  swallowing  the  poison.  This  is  accompanied 
by  a  similar  sensation  extending  down  the  gullet  to  the  stomach.  There 
is  sometimes  a  sense  of  constriction  or  suffocation  :  the  countenance  is 
livid,  and  the  surface  of  the  skin  soon  becomes  cold  and  clammy.  Vomit- 
ing occurs  either  immediately  or  within  a  few  minutes.  Should  the 
poison  be  much  diluted,  there  is  merely  a  sensation  of  strong  acidity,  and 
vomiting  may  not  occur  until  after  a  quarter  of  an  hour  or  twenty  minutes. 
In  some  cases  there  has  been  little  or  no  vomiting,  while  in  others  this 
symptom  has  been  incessant  until  death.     In  one  case,  in  which  an  ounce 


101  APPEARANCES  AFTER  DEATH. 

of  the  acid  was  swallowed,  the  vomiting  and  pain  in  the  stomach  continued 
until  the  fifth   day,  when  the   man   died  suddenly  (Lancet,   1860,    ii.  p. 
509)  ;  but  in  another,  in  which  the  poison  was  much  diluted,  vomiting  did 
not    occur   for  seven   hours.       (Christison.)     The    vomited   matters   are 
highly  acid,   have  a  greenish-brown  or  almost  black  color,  and  consist 
chiefly  of  mucus  and  altered  blood.     The  patient  complains  of  great  pain 
and  tenderness  in  the  aljdomen,  with  a  burning  sensation  in  the  stomach. 
There  ma}^  be  convulsions.     There  is  in  general  an  entire  prostration  of 
strength,  so  that  if  the  person  is  in   the  errect  position  he  falls  ;  there  is 
likewise   unconsciousness  of  surrounding   objects,  and  a  kind  of  stupor, 
from    which,    however,   the    patient    may    be  without   difficulty    roused. 
Owing  to  the  severity  of  the  pain,  the  legs  are  sometimes  drawn  up  to- 
wards the  abdomen,  or  the  patient  rolls  about  on  the  floor  or  bed.     The 
pulse  is   small,    irregular,    and  scarcely  perceptible ;   the    skin    cold   and 
clammy;   and  there  is  a  sensation  of  numbness  in  the  limbs.     The  breath- 
ing is  spasmodic,  the  inspirations  being  deep,  and  a  long  interval  elapses 
between  them.     Should  the  patient  survive  the  first  effects  of  the  poison, 
the  following  symptoms  may  appear:  soreness  of  the  mouth,  constriction 
and  burning  pain  in   the  throat,  pain   in  swallowing,  tenderness  in  the 
abdomen,  and  irritability  of  the  stomach,  so  that  there  is  frequent  vomit- 
ing, accompanied   by   purging.       The   tongue   is  swollen,   and   there    is 
great  thirst.     Sometimes  there    is  aphonia,   or  the  patient   speaks  in  a 
feeble  punchinello  voice.     The  following  case  is  exceptional,  from  the  fact 
that  the  .symptoms  throughout  were  chiefly  referable  to  the  brain.     A  man 
took  what  was  supposed  to  be  a  black  draught,  but  it  contained  oxalic  acid 
instead  of  Epsom  salts.     Two  hours  afterwards  he  was  found  in  a  state 
of  complete  coma,  but  the  symptoms  set  in  a  quarter  of  an  hour  after  he 
had  taken  the  draught.     The  man  died  in  five  hours,  without  recovering 
his  consciousness.     The  only  marked  appearance  on  inspection  was  intense 
congestion  of  the  brain.     (Lancet,    1872,  ii.  p.  41.)     Oxalic  acid  injected 
into  the  circulation   of  animals   acts  as  a  cardiac  poison ;  and  this  is  in 
accordance  with  its  well-knoAvn   rapidly-fatal  effects  on  man.     Christison 
says  :   "  If  a  person,  immediately  after  swallowing  a  solution  of  a  crystal- 
line salt,  which  tasted  purely  and  strongly  acid,  is  attacked  with  burning 
in  the  throat,  then  with  burning  in  the  stomach,  vomiting,  particularly  of 
bloody  matter,  imperceptible  pulse,  and  excessive  languor,  and  dies  in  half 
an  hour,  or,  still  more,  in  twenty,  fifteen,  or  ten  minutes,  I  do  not  know 
any  fallacy  which  can  interfere  with  the  conclusion  that  oxalic  acid  was 
the  cause  of  death.     No  parallel  disease  begins  so  abruptly  and  termin- 
ates so  soon  ;  and  no  other  cry.stalline  poison  has  the  same  effect."  Ringer 
asserts  that  soluble  oxalates  precipitate  calcium  from  the  blood  as  insoluble 
oxalate  of  calcium  ;   and  as  soluble  calcium  salts  in  the  blood  are  requisite 
for  the  maintenance  of  the  muscular   contractility,  oxalates  may  kill  by 
destroying  the  cardiac  muscular  contractility.    (Practitioner,  1885,  xxxiv. 
p.  81.) 

Appearances  after  Death. — The  mucous  membrane  of  the  tongue,  mouth, 
throat,  and  gullet  is  softened,  and  commonly  white  as  if  bleached  ;  but  it 
is  sometimes  coated  with  a  portion  of  the  brown  mucous  matter  dis- 
charged from  the  stomach.  This  latter  organ  contains  a  dark  brown 
mucous  liquid,  often  acid,  and  having  an  almost  gelatinous  consistency. 
On  removing  the  contents,  the  mucous  membrane  will  be  seen  pale  and 
soft(^ned,  without  always  presenting  marks  of  inflammation  or  abrasion, 
if  death  has  taken  place  rapidly.  The  mucous  membrane  is  soft  and 
brittle,  easily  raised  by  the  scalpel,  and  presents  the  appearance  which  we 
might  suppose  it  would  assume  after  having  been  for  some  time  boiled  in 


FATAL    DOSE.  105 

water.  The  small  vessels  are  seen  ramifying  over  the  surface,  and  filled 
with  dark-colored  blood  apparently  solidified  within  them.  The  lining 
membrane  of  the  gullet  presents  the  same  characters,  and  has  often  a 
worm-eaten  appearance.  It  is  pale,  and  appears  as  if  it  had  been  boiled 
in  water,  or  digested  in  alcohol;  it  has  been  found  s  .rongly  raised  in 
longitudinal  folds,  interrupted  by  patches  where  the  membrane  has  be- 
come abraded.  In  a  case  which  was  fatal  in  eight  hours,  the  tongue  was 
covered  with  white  specks;  the  gullet  was  not  inflamed,  but  the  stomach 
was  extensively  destroyed  and  had  a  gangrenous  appearance.  Portions 
of  the  mucous  membrane  were  detached,  exposing  the  muscular  coat. 
With  respect  to  the  intestines,  the  upper  portion  may  be  found  inflamed; 
but,  unless  the  case  is  protracted,  the  appearances  in  the  bowels  are  not 
strongly  marked. 

In  a  well-marked  instance  of  poisoning  by  this  acid,  recorded  by 
Hildebrand,  the  mucous  membrane  of  the  stomach  and  duodenum  was 
much  reddened,  although  the  patient,  a  girl  of  eighteen,  died  in  three- 
quarters  of  an  hour  after  taking  one  ounce  of  the  acid,  by  mistake  for 
Epsom  salts.  (Casper's  Vierteljahrsschr.,  1853,  p.  256.)  In  a  case 
of  poisoning,  in  which  two  ounces  of  the  acid  had  been  taken,  and 
death  was  rapid,  the  coats  of  the  stomach  pi'esented  the  almost  black 
appearance  produced  by  sulphuric  acid,  owing  to  the  color  of  the  altered 
blood  spread  over  them.  In  protracted  cases,  the  gullet,  stomach,  and 
intestines  have  been  found  more  or  less  congested  or  inflamed.  In  the 
case  already  cited,  in  which  an  ounce  was  swallowed,  and  death  occurred 
on  the  fifth  day,  the  stomach  was  slightly  congested,  and  contiilned  a 
bloody  fluid,  but  the  mucous  membrane  was  entire.  (Lancet,  1860,  ii.  p. 
509.) 

The  glairy  contents  of  the  stomach  do  not  always  indicate  strong 
acidity  until  after  they  have  been  boiled  in  water.  Oxalic  acid  does  not 
appear  to  have  so  strongly  corrosive  an  action  on  the  stomach  as  that 
possessed  by  the  mineral  acids.  It  is,  therefore,  rare  to  hear  of  the  coats 
of  the  organ  being  perforated  by  it;  but  the  acid,  when  in  a  concentrated 
state,  renders  the  mucous  coat  soft  and  brittle,  and  perforation  of  the 
coats  may  occasionally  occur  either  during  life  or  after  death,  as  a  result 
of  its  chemical  action.  Wood  has  recorded  the  case  of  a  woman,  vet.  27, 
found  dead,  whose  death  had  been  obviously  caused  by  oxalic  acid;  but 
the  quantity  taken,  and  the  duration  of  the  case,  were  unknown.  The 
stomach  presented,  at  its  upper  and  fore  part  near  the  cardiac  opening,  an 
irregular  aperture  of  a  size  to  admit  the  point  of  the  finger. 

Fatal  Dose. — The  smallest  quantity  of  this  poison  which  has  been 
known  to  destroy  life  is  60  grains.  A  boy,  set.  16,  took  that  quantity, 
as  he  said,  of  the  poison  in  a  solid  form,  and  was  found  in  about  an  hour 
insensible,  pulseless,  and  his  jaws  spasmodically  closed.  He  had  vomited 
some  bloody  matter;  his  tongue  and  lips  were  unusually  pale,  but  there 
was  no  excoriation.  He  died  in  eight  hours.  (Lancet,  1855,  ii.  p.  521.) 
■  Tardieu  (L'Empoisonnement,  p.  253)  speaks  of  a  fatal  case  in  a  young 
man,  set.  16,  from  a  dose  of  30  grains  (2  grammes),  but  it  is  doubtful, 
since  he  gives  no  details,  whether  this  is  not  the  English  case  just  now 
mentioned.  Two  cases  occurred  at  Guy's  Hospital,  in  each  of  which  half 
an  ounce  of  oxalic  acid  had  been  swallowed.  Active  treatment  was 
adopted,  and  both  patients  recovered.  When  the  dose  of  oxalic  acid  is 
half  an  ounce  and  upwards,  death  commonly  takes  place  within  an  hour  ; 
but  there  are  numerous  exceptions  to  this  rapidity  of  action.  Christison 
mentions  an  instance  in  which  an  ounce  of  oxalic  acid  killed  a  girl  in 
thirty  minutes;  and  another  in  which  the  same  quantity  destroyed  life 


106  CHEMICAL  ANALYSIS  —  TESTS. 

in  ten  minutes;  but  in  a  third  case  death  did  not  occur  until  the  fifth  day. 
The  editor  has  met  with  cases  of  death  in  fifteen  and  twenty  minutes 
respectively.  Ogilvy  has  reported  a  case  of  poisoning-  by  oxalic  acid  in 
Avhich  it  is  probable  that  death  took  place  within  three  minutes  after  the 
poison  had  been  swallowed.  The  quantity  of  the  acid  taken  could  not  be 
determined. 

Chemical  Analysis. — In  the  simple  state. — This  acid  may  be  met 
with,  either  as  a  solid  or  in  solution  in  water.  Solid  oxalic  acid 
crystallizes  in  long  slender  prisms,  which,  when  perfect,  are  four-sided 
(Fig.  2).  In  this  respect  it  differs  from  other  common  acids,  mineral  and 
vegetable.  The  crystals  are  unchangeable  in  air,  and  to  the  eye  are 
precise]}^  like  those  of  Epsom  salts  and  white  vitriol ;  they  are  soluble  in 
water   and   alcohol,  forming  strongly  acid   solutions.     When  heated  on 

platinum-foil  they  melt,  and  are  entirely  dis- 
Fig.  2.  sipated    without    blackening.     Heated    in    a 

close  tube  they  melt,  and  a  white  crystalline 
sublimate  forms  in  the  cold  part  of  the  tube. 
There  should  be  no  residue  whatever  if  the 
acid  is  pure,  but  the  commercial  acid  gener- 
ally leaves  a  slight  residue  of  fixed  impurity. 
By  this  effect  of  heat,  oxalic  acid  is  easily 
distinguished  from  those  crystalline  salts  for 
which  it  has  been  sometimes  fatally  mistaken, 
namely,  the  sulphates  of  magnesium  and 
zinc :  these  leave  white  residues.  A  tea- 
spoonful  of  oxalic  acid  in  small  crystals 
weighs  seventy-six  grains,  and  half  an  ounce 
Crystals  of  axa^icAcki,magDified  ^^  ^^^  crystals  is  equivalent  to  three  tea- 
spoonfuls. 
Tests. — 1.  Nitrate  of  silver. — When  added  to  a  solution  of  oxalic  acid, 
it  produces  an  abundant  white  precipitate  of  oxalate  of  silver.  A 
solution  containing  so  small  a  quantity  of  oxalic  acid  as  not  to  redden 
litmus-paper,  is  affected  by  this  test ;  but  when  the  quantity  of  poison  is 
small,  it  is  advisable  to  concentrate  the  liquid  by  evaporation  before 
applying  the  test.  The  oxalate  of  silver  is  identified  by  the  following 
properties:  It  is  completely  dissolved  by  cold  nitric  acid.  If  collected 
on  a  filter,  thoroughly  dried,  and  heated  on  platinum-foil,  it  is  dissipated 
in  a  white  vapor  with  a  slight  detonation,  and  a  residue  of  silver  is  left. 
When  the  oxalate  is  in  small  quantity,  this  detonation  may  be  observed 
in  detached  particles  on  burning  the  filter  previously  well  dried.  2. 
Sulphate  of  calcium.  A  solution  of  oxalic  acid  is  precipitated  white  by 
lime-water  and  all  the  salts  of  calcium.  Lime-water  is  itself  objectionable 
as  a  test,  because  it  is  precipitated  white  by  several  other  acids.  The  salt 
of  calcium,  which,  as  a  test,  is  open  to  the  least  objection,  is  the  sulphate. 
As  this  is  not  a  very  soluble  salt,  its  solution  must  be  added  in  rather 
large  quantity  to  the  suspected  acid  poisonous  liquid  previously  concen- 
trated. A  white  precipitate  of  oxalate  of  calcium  is  slowly  formed.  This 
precipitate  should  possess  the  following  properties:  1.  It  ought  to  be 
immediately  dissolved  by  nitric  or  hydrochloric  acid.  2.  It  ought  not  to 
be  dissolved  by  acetic  or  any  other  vegetable  acid,  or  by  ammonia. 

In  organic  'liquids. — The  process  is  the  same,  whether  it  is  applied  to 
liquids  in  which  the  poison  is  administered,  or  to  the  matters  vomited,  or, 
lastly,  to  the  contents  of  the  stomach.  Should  the  liquid  be  very  acid, 
we  must  filter  it  to  separate  any  insoluble  matters;  should  it  not  be 
strongly  acid,  the  whole  may  be  boiled  if  necessary  with  distilled  water, 


OXALIC    ACID,    ITS    DETECTION.  107 

filtered,  and  concentrated  by  evaporation.  To  the  filtered  liciuid,  acidu- 
lated with  acetic  acid,  acelale  of  lead  should  be  added  until  there  is  no 
further  precipitation ;  and  the  white  i)recipitate  formed,  collected  and 
washed.  If  any  oxalic  acid  was  present  in  the  li(|uid,  it  will  exist  in  this 
precipitate  as  oxalate  of  lead.  Diffuse  the  precipitate  in  water,  and  pass 
into  the  liquid  a  current  of  sulphuretted  hydrogen  gas  for  about  half  an 
hour,  taking-  care  that  the  gas  comes  in  contact  with  every  portion  of  the 
precipitate.  Black  sulphide  of  lead  will  be  thrown  down,  and  with  it 
commonly  the  greater  part  of  the  organic  matter  mixed  with  the  oxalate 
of  lead.  Filter,  to  separate  the  sulphide  of  lead;  the  filtered  liquid  may 
be  clear  and  highly  acid.  Concentrate  by  evaporation,  Avhen  the  sul- 
phuretted hydrogen  dissolved  in  the  liquid  is  thereby  expelled,  and  oxalic 
acid  may  be  ultimately  obtained  crystallized  by  slow  evaporation  in  a 
watch-glass,  or  on  a  glass  slide  for  microscopical  observation.  If  crystals 
are  obtained,  they  must  be  dissolved  in  water  and  tested  in  the  manner' 
above  directed.  As  oxalic  acid  is  very  soluble  in  alcohol,  this  liquid  may 
be  occasionally  employed  for  separating  it  from  the  contents  of  the 
stomach  and  from  many  organic  compounds.  Crystals  may  be  obtained 
from  the  alcoholic  solution,  and  these  may  be  purified  and  tested  by  the 
methods  already  described.  Owing  to  the  effect  of  early  vomiting  and 
treatment,  it  is  not  usual  to  find  much  oxalic  acid  in  the  contents  of  the 
stomach.  From  milk,  gruel,  coffee,  blood,  mucus,  and  other  viscid  liquids, 
oxalic  acid  is  readily  separated  by  the  process  of  dialysis,  as  described 
under  sulphuric  acid  (see  p.  97,  ante).  The  liquid  should  be  first  boiled — ■ 
the  coats  of  the  stomach  (cut  up)  being  included,  if  necessary.  The  dis- 
tilled water  placed  on  the  outside  of  the  tube  will  receive  the  acid.  This 
may  be  concentrated  by  evaporation.  Prismatic  crj^stals  may  thus  be 
procured,  and  the  silver  and  sulphate  of  calcium  tests  may  be  applied. 

The  presence  of  oxalic  acid  in  an  organic  liquid  may  be  detected  by 
another  dialytic  method.     Place  a  portion  of  the  liquid  containing  the 
poison  in  a  beaker,  and  insert  in  this  a  tube 
secured  with  skin  or  parchment-paper  con-  Fig-  3. 

taining  a  solution  of  sulphate  of  calcium. 
The  oxalic  acid  will  penetrate  the  mem- 
brane, and  will  form  inside  the  mouth  of 
the  latter  a  deposit  of  crystals  of  oxalate  of 
calcium,  known  by  their  octahedral  form 
(Fig.  3). 

Sometimes  the  chemical  evidence  may 
depend  on  stains  on  articles  of  clothing. 
Oxalic  acid  discharges  the  color  of  some 
dyes,  and  slowly  reddens  others ;  but  un- 
less the  stuff  has  been  washed  the  acid 
remains  in  the  fabric,   and  may  there  be 

detected.       It    does   not    corrode    or    destroy      crystals  of  Calcium  oxalate  obtained 

the  stuff  like  mineral  acids.     In   Pveg.  v.       by  dialysis  of  coitee  containing  Ox- 

-»r        •     / /-(    /-I     /-x      TA         -ioo/>\   -1.  1  ahc  Acid,  magnified  3o0  diameters. 

Morns  (C.  C.  C,  Dec.  1880)  it  was  proved 

that  the  prisoner  had  attempted  to  administer  a  liquid  poison  forcibly  to 
her  daughter,  a  girl  aged  six  years.  It  was  sour  in  taste,  made  the  girl's 
lips  smart,  and  caused  vomiting.  There  was  dryness  of  the  lips  and  in- 
flammation of  the  lining  membrane  of  the  mouth.  ]S'o  portion  of  the 
substance  administered  could  be  procured,  but  a  crystalline  deposit  of 
oxalic  acid  was  obtained  from  some  stains  ou  the  dress  of  the  child.  The 
woman  was  convicted. 


108  SALT    OF    SORREL VEGETABLE    ACIDS. 

[Oxalic  acid  cannot  be  detected  in  the  blood  ;  and  if  injected  into  a 
vessel  it  is  so  readily  decomposed  that  it  cannot  he  recog-nized  even  after  a 
i'ew  minutes.     (Wharton  ifc  Stille,  Med.  Jur.,  1873,  p.  329.)] 

Acid  Oxalate  of  Potassium,  or  Salt  of  Sorrel. — Symptows  o.nd 
Effects. — This  poisonous  salt  is  much  used  for  the  purpose  of  bleaching- 
straw  and  removing  ink-stains,  and  is  sold  for  this  purpose  under  the 
name  of  essential  salts  of  lemons.  Its  poisonous  properties  are  not  gen- 
erally known,  or  no  doubt  it  would  be  frequently  substituted  for  oxalic 
acid.  Out  of  four  cases  of  poisoning  b}^  this  substance,  three  proved  fatal, 
"while  in  the  other  the  patient  recovered.  In  the  case  of  recovery,  a  young 
lady,  aged  twenty,  swallowed  an  ounce  of  the  salt  dissolved  in  warm 
water.  She  was  not  seen  ior  an  hour  and  a  half,  and  was  then  found  on 
the  floor,  faint  and  exhausted,  having  previously  vomited  considerablv. 
There  was  great  depression,  the  skin  cold  and  clammy,  the  pulse  feeble, 
and  there  was  a  scalding  sensation  in  the  throat  and  stomach.  There  was 
also  continued  shivering.  Proper  medical  treatment  was  adopted,  and 
she  recovered  in  two  days,  still  suffering  from  debilit}'  and  great  irritation 
of  the  stomach.  During  the  state  of  depression,  it  was  remarked  that  the 
eyes  Avere  much  injected  and  the  pupils  dilated.  There  was  also  great 
dimness  of  vision.   (Med.  Gaz.,  vol.  27,  p.  480.) 

This  salt  destro3'S  life  almost  as  rapidly  as  oxalic  acid  itself;  and  in  the 
symptoms  which  it  produces  it  closely  resembles  that  poison.  In  one 
case,  half  an  ounce  killed  an  adult  in  so  short  a  time  as  eight  minutes; 
but  probably  the  fatal  effects  were  in  this  instance  accelerated  by  the  de- 
ijilitated  state  of  the  person  who  took  it.  In  another  case  death  took  place 
in  ten  minutes.  (Ann.  d'Hyg.,  1850,  vol.  1,  p.  162.)  In  some  instances 
this  poisonous  substance  has  been  supplied  b}^  mistake  for  cream  of  tartar, 
and  has  thus  caused  death. 

Chemical  Analysis. — It  is  not  very  soluble  in  cold  water,  but  its  solu- 
tion may  be  readily  mistaken  for  that  of  oxalic  acid.  The  tests  for  oxalic 
acid  may  be  ap])licd  for  the  detection  of  it  in  this  salt.  When  a  portion  is 
heated,  carbonate  of  potassium  is  left. 

Vegetable  Acids. 

The  vegetable  acids,  such  as  the  acetic,  tartaric,  and  citric,  are  capable 
of  acting  as  poisons.  The  editor  has  met  with  alarming  laryngeal  sj^mp- 
toms,  besides  the  local  corrosive  action,  produced  by  the  swallowing  of 
acetic  acid.  Bayard  and  Devergie  have  recorded  a  fatal  case  of  poisoning 
with  tartaric  acid.  (Ann.  d'Hyg.,  xlvi.  p.  433.)  In  1877  a  Avoman,  set.  50, 
died  in  Sheffield  from  taking  a  quantity  of  aromatic  vinegar. 


ALKALINE    POISONING.  109 


CHAPTER    IX. 

ALKALIES     AND    ALKALIXE    SALTS. rOTASII,  SODA,  AND    AMMOXIA. XITKATE  AND  SULPHATE 

OF    POTASSIUM. S.\LTS    OF    BAKIUM. 

Potash  and  Soda. 

Symploms. — The  symptom.s  produced  by  potash  and  soda,  when  taken 
in  large  doses,  are  similar,  so  that  one  description  will  serve  for  both. 
The  most  common  form  in  which  these  poisons  are  met  with  is  in  the 
state  of  pearlash  (carbonate  of  potassium)  and  soap-leys  (caustic  soda). 
The  person  experiences,  during  the  act  of  swallowing,  an  acrid,  caustic 
taste,  owing  to  the  alkaline  liquid,  if  sufficiently  concentrated,  excoriating 
the  mucous  membrane.  There  is  a  persistent  sensation  of  burning  heat 
in  the  throat,  extending  downwards  to  the  stomach.  Vomiting  is  not 
always  observed  ;  but  when  it  does  occur,  the  vomited  matters  are  some- 
times mixed  with  blood  of  a  dark  brown  color  and  with  detached  portions 
or  flakes  of  mucous  membrane — this  effect  depending  on  the  degree  of 
causticity  in  the  liquid  swallowed.  The  surface  is  cold  and  clammy,  and 
there  is  purging  with  severe  pain  in  the  abdomen,  resembling  colic.  The 
pulse  is  quick  and  feeble.  In  the  course  of  a  short  time,  the  lips,  tongue, 
and  throat  become  swollen,  soft,  and  red.  Other  symptoms  of  a  more 
serious  kind  sometimes  show  themselves  In  1877,  a  cook  in  a  girls' 
boarding-school  put  four  ounces  of  washing  soda  (crude  carbonate)  into 
the  tea  supplied  to  the  pupils.  They  suffered  from  severe  colicky-griping 
pains  and  purging,  continuing  for  several  days,  with  loss  of  appetite,  and 
general  feeling  of  weakness.  One  girl,  ajt.  16,  who  had  partaken  freely 
of  the  tea,  in  addition  to  these  symptoms,  suffered  severely  on  the  fifth 
day  from  purpura.  There  was  h^matemesis,  with  profuse  bleeding  from 
every  mucous  surface,  and  spots  of  ecchymosis  on  all  parts  of  the  skin. 
She  had  a  tedious  and  very  difficult  recovery.  It  was  calculated  that  she 
had  taken  about  two  drachms  of  soda.  The  most  rapidly-fatal  case  of 
alkaline  poisoning  reported  is  that  of  a  boy,  who  died  in  three  hours  after 
swallowing  three  ounces  of    a  strong  solution  of  carbonate  of   potassium. 

A-ppearances  after  Death. — la  recent  cases  there  are  marks  of  the  local 
action  of  the  poison  on  the  mucous  membrane  of  the  mouth,  throat,  and 
gullet.  This  membrane  has  been  found  softened,  detached,  and  inflamed 
in  patches  of  a  deep  chocolate  color — sometimes  almost  black.  A  similar 
appearance  has  been  met  with  in  the  mucous  membrane  of  the  larvnx  and 
windpipe.  The  stomach  has  had  its  mucous  surface  destroyed  in  patches, 
and  there  has  been  partial  inflammation.  In  one  instance,  as  the  result  of 
the  action  of  soda,  it  was  puckered,  hardened,  and  blackened.  The  qimn- 
titij  of  these  alkaline  poisons  required  to  destroy  life  is  unknown.  The 
fatal  effects  depend  rather  on  the  degree  of  concentration  of  the  liquid 
than  on  the  absolute  quantity  of  alkali  present. 

Chemical  Analysis. — When  potash  or  soda,  or  the  carbonate  of  either 
alkali,  is  contained  in  a  poisonous  proportion  in  any  organic  liquid,  it  will 
be  observed  that  the  liquid  has  not  only  a  strongly  alkaline  reaction, 
but  is  soapy  to  the  feel,  frothy  when  shaken,  and  has  a  peculiar  odor. 
The  alkali  may  be  obtained  in  the  state  of  carbonate  or  otherwise  by 


110  AMMONIA. 

simply  evaporating  the  suspected  liquid  and  incinerating  the  residue  in  a 
silver  or  porcelain  vessel.  The  presence  of  potash  or  soda  may  be  easily 
determined  by  the  appropriate  tests  for  these  alkalies.  Potash  gives  a 
violet  and  soda  an  inteuseh'  yellow  color  to  a  colorless  gas-flame. 

Ammonia. 

The  vapor  of  strong  ammonia  is  poisonous.  Several  severe  cases  have 
been  seen  by  the  editor.  It  may  destroy  life  by  producing  inflammation 
of  the  larynx  or  of  the  lungs  and  air-passages.  It  is  often  employed  in- 
judiciously to  rouse  persons  from  a  fit.  A  case  is  on  record  of  an  epileptic 
having  died  with  the  symptoms  of  croup,  two  days  after  the  application 
of  the  vapor  of  strong  ammonia  to  the  nostrils,  in  order  to  rouse  him  from 
a  fit. 

SymjptOms  and  Appearances. — The  strong  solution  of  ammonia  pro- 
duces, when  swallowed,  symptoms  similar  to  those  described  in  speaking 
of  potash,  but,  as  it  is  much  more  irritating,  it  causes  a  choking  sensation, 
followed  by  intense  heat  and  burning  pain  in  the  throat,  gullet,  and 
stomach. 

Serious  injury  to  the  organs  of  respiration  is  one  of  the  results  of 
the  action  of  this  poison.  A  man  liable  to  attacks  of  fainting,  died 
in  three  days  after  swallowing  a  quantity  of  a  liquid  administered  to 
him  by  his  son.  This  liquid,  which  was  at  the  time  believed  to  be  sal 
volatile,  was  in  fact  a  strong  solution  of  ammonia.  The  deceased  com- 
plained immediately  of  a  sensation  of  choking  and  strangling  in  the 
act  of  vomiting.  Symptoms  of  difficulty  of  breathing  set  in,  with  other 
signs  of  irritation  in  the  throat  and  stomach.  The  mucous  membrane  of 
the  mouth  and  throat  Avas  corroded  and  dissolved ;  and  it  was  evident 
that  the  liquid  had  caused  great  local  irritation.  The  difficulty  of  breath- 
ing was  such  as  to  threaten  suffocation,  and  at  one  time  it  was  thought 
tracheotomy  must  be  resorted  to.  The  state  of  the  patient,  however, 
precluded  performance  of  the  operation,  and  he  died  on  the  third 
day.  On  inspection,  the  viscera  presented  strong  marks  of  cor- 
rosion. The  covering  of  the  tongue  was  softened,  and  had  peeled  off ; 
the  lining  membrane  of  the  air-passages  was  softened  and  covered 
v.'ith  layers  of  false  membrane,  the  result  of  inflammation  ;  and  the 
larger  bronchial  tubes  were  completely  obstructed  by  casts  of  cylinders 
of  this  membrane.  The  lining  membrane  of  the  gullet  was  softened, 
and  at  the  lower  part,  near  its  junction  with  the  stomach,  the  tube 
was  completely  dissolved  and  destroyed.  There  was  an  aperture  in  the 
anterior  wall  of  the  stomach,  about  an  inch  and  a  half  in  diameter  :  the 
edges  were  soft,  ragged,  and  blackened,  presenting  an  appearance  of 
solution.  The  contents  of  the  stomach  had  escaped.  On  the  inside,  the 
vessels  were  injected  with  dark-colored  blood,  and  there  were  numerous 
small  effusions  of  blood  in  various  parts  of  the  mucous  membrane. 
The  coats  were  thinned  and  softened  at  the  seat  of  the  aperture.  The 
l)lackened  and  congested  appearance  of  the  lining  membrane  somewhat 
resemljled  that  which  is  seen  in  poisoning  with  sulphuric  or  oxalic  acid. 
The  mucous  matter  on  the  coats  of  the  stomach  was  feebly  acid.  No 
poison  of  any  kind  was  found  in  the  layer  of  mucus  or  in  the  coats.  There 
was  not  in  any  part  the  slighest  trace  of  ammonia,  the  poison  which  had 
caused  the  mischief.  The  deceased  had  lived  three  days  ;  remedies  had 
been  used,  and  every  trace  of  ammonia  had  disappeared.  The  immediate 
cause  of  death  was  obstruction  of  the  air-tubes,  as  a  result  of  inflammation 
caused  by  the  local  irritant  action  of  the  liquid ;  it  was  quite  obvious  that 


NITRATE    OF    POTASSIUM.  Ill 

a  quantity  had  entered  the  windpipe.  The  perforation  of  the  stomach  had 
probably  taken  place  shortly  before  death,  or  was,  perhaps,  jjost-mortem, 
as  there  were  no  marks  of  ])eritonitis.  The  injury  to  the  stomach  and 
gullet  would  have  been  sullicient  to  cause  death,  even  supposing  that  the 
liquid  had  not  penetrated  into  the  lungs.  A  child,  about  two  years  old, 
swallowed  a  teaspoonful  of  strong  solution  of  ammonia.  It  fell  to  the 
floor  breathing  hurriedly,  and  became  blue  in  the  face.  An  hour  after- 
wards there  were  white  patches  on  the  tongue  and  cheeks,  with  conges- 
tion of  the  tonsils  and  pharynx.  There  was  frequent  vomiting,  but  no 
blood  in  the  vomits.  Pulse,  ItJl;  temperature,  102.8°  T.  The  child  died 
the  next  dav.  It  was  unconscious,  and  there  were  convulsions  at  intervals. 
(Med.  Time"s  and  Gaz.,  1878,  i.  p.  35.) 

Solution  of  ammonia  applied  to  the  skin  acts  as  a  corrosive,  and  may 
inflame  or  cause  the  destruction  of  the  parts  which  it  touches.  A  man 
was  convicted  (Reg.  v.  Gavan,  Stafford  Sum.  Ass.,  1873)  of  throwing  a 
liniment,  containing  a  strong  solution  of  ammonia,  over  the  prosecutrix, 
Avith  intent  to  injure  her.  The  liquid  was  thrown  in  her  face,  and  some 
portion  reached  the  eyes ;  but  she  recovered  from  the  effects.  A  weak  so- 
lution acts  as  an  irritant  to  the  skin,  while  a  strong  solution  causes 
vesication  and  a  destruction  of  the  part. 

Carbonate  of  Ammo tii urn. — The  concentrated  solution  of  this  salt  (sal 
volatile)  is  probably  more  active  as  a  poison  than  is  commonly  supposed. 
A  man,  in  a  fit  of  passion,  swallowed  about  five  fluid  drachms  of  a  solution 
of  sal  volatile.  In  ten  minutes  he  was  seized  with  stupor  and  insensibility  ; 
but,  upon  the  application  of  stimulant  remedies,  he  recovered.  He 
suffered  for  some  time  afterwards  from  severe  irritation  about  the  throat 
and  gullet. 

A  female,  set.  19,  while  in  a  state  of  unconsciousness,  was  made  to 
swallow  a  quantity  of  hartshorn.  She  immediately  felt  a  severe  pain  in 
the  stomach,  and  about  an  hour  afterwards  she  vomited  some  blood. 
This  vomiting  of  blood  continued  for  several  days.  These  symptoms 
were  follow^ed  by  great  irritability  of  the  stomach  and  the  constant  re- 
jection of  food.  There  was  obstinate  constipation  of  the  bowels,  with 
emaciation  and  loss  of  strength.  She  died  in  about  three  months  from  the 
time  at  which  she  had  swallowed  the  alkaline  poison.  On  inspection,  the 
gullet  was  found  healthy  ;  but  the  orifice,  at  its  junction  with  the  stomach, 
was  slightly  contracted.  The  intestinal  opening  (pylorus)  was  contracted 
to  the  size  of  a  crow-quill,  and  the  coats  were  thickened.  On  the  posterior 
■wall  of  the  stomach  there  was  a  dense  cicatrix  of  the  size  of  a  half-crown, 
and  from  this  point  fibrous  bands  ramified  in  various  directions.  The 
duodenum  and  other  parts  of  the  intestinal  canal  were  healthy.  (Med.  Times 
and  Gaz.,  1853,  ii.  p.  554.) 

Chemical  Analysis. — Ammonia  is  distinguished  from  potash  and  soda 
by  its  pungent  odor  and  entire  volatility.  Carbonate  of  ammonium 
may  be  knov/n  from  other  salts  by  its  alkaline  reaction,  its  odor,  and  its 
volatility  as  a  solid  ;  and  from  pure  ammonia  by  its  effervescing  on  the 
addition  of  an  acid. 

Nitrate  op  Potash.     Nitre.     Saltpetre. 

Symptoms  and  Appearances. — This  well-known  salt  has  on  several 
occasions  destroyed  life  when  taken  in  large  doses.  A  man  swallowed 
by  mistake  for  Epsom  salts  an  ounce  of  nitre  mixed  with  water.  It  pro- 
duced vomiting  with  severe  pain,  but  no  purging.  There  was  coldness  of 
the  surface  and  lividity  of  the  face.     Death  took  place  in  three  hours.    On 


112        CHLORATE  AND  SULPHATE  OF  POTASSIUM. 

inspection  the  mucous  membrane  of  the  stomach  was  found  highly  in- 
flamed, especially  toward  the  middle  of  the  greater  curvature,  where  for 
several  inches  it  resembled  scarlet  cloth.  The  pylorus  and  duodenum 
were  of  a  deep  crimson  color.  The  peritoneal  surface  was  reddened, 
especially  over  the  stomach,  the  vessels  having  a  vermilion  color,  as  if  they 
had  beeu  injected.  The  heart  and  lungs  were  healthy,  the  blood  was  fluid, 
and  more  florid  than  natural.  The  other  organs  presented  no  unusual 
appearances.  No  analysis  was  made  of  the  contents  of  the  stomach,  but 
that  the  nitre  was  the  cause  of  death  no  doubt  could  be  entertained,  and 
a  verdict  was  returned  accordingly  at  the  coroner's  inquest.  Another 
man  took  an  ounce  of  saltpetre  in  mistake  for  Epsom  salts.  Pain  came 
on  immediately,  with  profuse  perspiration.  He  felt  sick,  but  did  not 
vomit  till  more  than  four  hours  had  elapsed.  "When  seen,  between 
six  and  seven  hours  after  taking  the  nitre,  his  pulse  was  56  and  full.  The 
tongue  was  white,  moist,  and  tremulous.  Micturition  was  frequent  for 
the  first  three  hours.  He  recovered.  (Brit.  Med.  Jour.,  1882,  i.  p.  304.) 
Two  cases  are  recorded  of  recovery  after  the  administration  of  two  ounces 
of  saltpetre.   (Brit.  Med.  Jour.,  1877,  ii.  p.  520;  1882,  i.  p.  500.) 

Analysis. — For  the  chemical  properties  and  methods  of  detecting  this 
salt,  see  pp.  100,  101. 

Chlorate  op  Potassium.     Chlorate  or  Potash. 

Chlorate  of  potassium  given  in  large  doses  acts  as  a  poison,  producing 
severe  vomiting,  profuse  purging,  intense  difficulty  of  breathing,  lividity 
of  the  countenance,  and  profound  depression  of  the  heart's  action. 
After  death,  the  blood  is  found  of  a  chocolate  color,  its  pigment  being  de- 
stroyed.  (Das  Chlorsaure  Kali,  by  Yon  Mering,  p.  142.) 

Sulphate  or  Potassium.     Sulphate  of  Potash. 

Symptoms  and  Appearances. — The  question  whether  this  should  be  re- 
garded as  an  irritant  poisonous  salt  or  not  was  much  debated  among 
members  of  the  profession,  in  reference  to  a  case  which  was  tried  in  1843  : 
Reg.  V.  Haynes,  C.  C.  C.  The  accused  had  given  to  the  deceased,  the 
night  before  her  death,  two  ounces  of  sulphate  of  potassium  dissolved  in 
water  ;  and  it  was  alleged  that,  a  fortnight  previously  to  this,  she  had 
taken  in  divided  doses  as  much  as  a  quarter  of  a  pound  of  the  salt.  The 
■woman  thought  she  was  pregnant,  but  this  was  disproved  by  an  exami- 
nation of  the  body  ;  and  it  was  charged  that  the  prisoner  had  given  her 
the  salt  with  the  intention  of  causing  a  miscarriage.  After  the  last  dose, 
she  was  seized  with  sickness,  and  died  within  a  very  short  time.  The 
stomach  was  found  empty,  but  highly  inflamed ;  and  there  was  blood 
eftused  on  the  brain.  One  medical  witness  referred  death  to  the  action  of 
the  sulphate  as  an  irritant  poison  ;  another  attributed  it  to  apoplexy  as  an 
indirect  result  of  the  violent  vomiting  caused  by  it.  The  prisoner  was 
acquitted  of  the  charge  of  murder,  but  was  subsequently  found  guilty  of 
administering  the  substance  with  intent  to  procure  abortion.  Both  of  the 
witnesses  admitted  that,  in  small  doses,  the  salt  was  innocent ;  but  that 
in  the  dose  of  two  ounces  it  might  produce  dangerous  eflects.  Several 
other  fatal  cases  are  recorded.   (Ann.  d'Hyg.,  Avril,  1842.) 

There  is  no  doubt  that  the  most  simple  purgative  salts  may,  under 
certain  circumstances,  and  when  given  in  large  doses,  destroy  life.  A  case 
is  elsewhere  related  in  which  Epsom  salts  caused  death,  and  gave  rise  to 
a  criminal  charge  in  this  country.  (On  Poisons,  2d  edit.  p.  4.)     In  May, 


POISONING    WITH    SALTS    OF    BARIUM.  113 

1875,  a  woman,  tet.  27,  died  in  a  few  hours  from  the  effects  of  two  ounces 
of  Epsom  salts  taken  at  once.  (Pharm.  Jour.,  June  12,  1875,  p.  1001.)  It 
is  said  that  sulphate  of  potassium  has  in  some  cases  caused  vomiting  and 
other  serious  symptoms,  from  its  containing  as  impurity  sulphate  of  zinc. 
This,  if  present,  would  be  easily  discovered  by  the  appropriate  tests  for 

zinc  (see  p.  159, 250s^)- 

Sulphate  of  potassium  may  be  easily  indentified.  It  is  in  hard,  dry 
crvstals,  soluble  in  water,  forming  a  neutral  solution,  in  which  potassium 
find  sulphuric  acid  may  be  discovered  by  the  appropriate  tests  (see  pp.  97, 
109). 

Salts  op  Barium. 

Chloride  of  Barium. — Symptoms. — A  woman,  ret.  22,  took  by  mistake 
for  Epsom  salts,  less  than  a  teaspoonful  (100  grains)  of  the  chloride.  In 
half  an  hour  there  was  a  feeling  of  deadly  sickness,  with  sharp  burning 
pains  in  the  stomach  and  bowels.  Vomiting  and  purging  set  in  violently, 
the  purging  being  attended  with  straining.  'An  hour  and  a  half  after  she 
had  taken  the  poison  the  following  symptoms  were  observed:  The  face 
was  pale  and  anxious,  the  eyes  deeply  sunk,  the  surface  cold,  the  heart's 
action  feeble,  the  pulse  scarcely  perceptible,  the  tongue  natural  and  warm, 
loss  of  muscular  power,  sensation  and  intelligence  unaffected,  the  pupils 
natural.  Fluids  taken  were  instantly  rejected,  together  with  a  ropj- 
mucus.  There  was  pain  in  the  stomach,  ringing  in  the  ears,  twitching  of 
the  face,  and  twisting  of  the  legs  and  arms.  In  eight  hours  and  a  half 
the  symptoms  had  abated,  but  in  about  fourteen  hours  the  purging  had 
returned,  and  the  symptoms  were  much  worse.  There  Avas  a  loss  of 
voluntary  muscular  power.  The  breathing  was  slow  and  labored,  and 
indicated  effusion  in  the  bronchial  tubes,  but  the  Avoman  was  sensible. 
In  fifteen  hours  she  was  convulsed,  and  these  convulsions  continued  iu 
paroxysms  for  two  hours,  when  she  died,  seventeen  hours  after  taking 
the  poison.  During  the  fits  she  had  several  watery  evacuations,  and  con- 
sciousness was  lost.  There  was  no  post-mortem  examination.  (Lancet, 
1859,  1,  p.  211.) 

Another  instance  of  death  from  chloride  of  barium  is  reported  (Pharm. 
Jour.,  Aug.  10,  1872,  p.  117)  ;  but  no  account  is  given  of  the  dose  taken, 
or  of  the  symptoms  and  appearances.  Kennedy  states  that,  in  using  this 
compound  as  a  medicine,  he  has  found  that  few  persons  are  able  to  bear 
the  eighth  of  a  grain  ;  that  it  is  analogous  to  corrosive  sublimate ;  and 
that  an  overdose  will  produce  similar  effects.  He  has  used  it  for  many 
years,  and  he  finds  the  proper  dose  is  from  the  twelfth  to  the  sixteenth 
part  of  a  grain  ;  but  he  cites  no  instance  of  its  acting  as  a  poison  in  a  dose 
of  one  or  two  grains.     (Lancet,  1873,  ii.  p.  28.) 

Chevallier  met  with  a  case  in  which  acetate  ofharium  had  been  sup- 
plied in  a  medicine  in  place  of  sulphovinate  of  sodium.  It  caused  the 
death  of  the  patient,  and  produced  serious  symptoms  in  the  druggist,  who 
had  swallowed  a  portion  of  the  medicine,  in  order  to  show  that  there  had 
been  no  mistake  in  its  preparation.  (Ann.  d'Hyg.,  1873,  1,  p.  395.) 
Nitrate  of  barium  acts  like  the  chloride.  The  chlorate,  used  in  pyrotechny, 
has  acted  as  a  poison. 

Garhonate  ofharium  is  said  to  have  destroyed  life  in  two  eases,  in  each 
of  which  only  sixty  grains  were  taken  ;  but  the  following  cases  show  that 
this  compound  is  not  so  poisonous  as  the  chloride :  A  young  woman 
swallowed  half  a  teacupful  of  the  powdered  carbonate,  mixed  with  water, 
at  a  time  when  she  bad  been  fasting  twenty-four  hours.  There  was  no 
particular  taste.     In  two  hours  she  experienced  dimness  of  sight,  double 


114  POISONING    WITH    PHOSPHORUS. 

vision,  ringing  in  the  ears,  pain  in  the  head  and  throbbing  in  the  temples, 
with  a  sensation  of  distention  and  weight  at  the  pit  of  the  stomach.  There 
was  also  palpitation  of  the  heart.  After  a  time  she  complained  of  pain  in 
the  legs  and  knees,  and  cramps  in  the  calves.  She  twice  vomited  a  fluid 
like  chalk  and  water.  The  skin  was  hot  and  dry,  the  pulse  frequent,  full, 
and  hard.  These  symptoms  gradually  abated,  and  she  recovered,  although 
the  pain  in  the  head  and  stomach  continued  for  a  long  time.  (Med.  Gaz., 
xiv.  p.  448  )  A  woman  took  a  mixture  of  the  carbonate  and  sugar  in 
repeated  doses,  but  in  unknown  quantity.  She  died  on  the  second  day, 
having  suffered  from  vomiting,  purging,  pain,  and  other  symptoms  of 
irritation.  On  inspection,  the  mucous  membrane  of  the  stomach  and  in- 
testines was  inflamed.  The  carbonate  was  found  in  the  stomach. 
(Brit.  Med.  Jour.,  1877,  i.  p.  888.)  This  salt  is  used  as  a  poison  for  rats 
and  mice. 

Analysis. — Chloride  of  barium  crystallizes  in  plates,  and  is  soluble  in 
water.  1.  The  solution  yields  a  white  precipitate  with  sulphuric  acid  or 
an  alkaline  sulphate.  This  precipitate  is  insoluble  in  nitric  acid.  2.  The 
powdered  salt,  burnt  on  platinum  wire  in  a  smokeless  flame,  imparts  to  it 
a  greenish-yellow  color.  3.  Chlorine  may  be  detected  in  it  by  a  solution 
of  nitrate  of  silver.  Nitrate  of  barium  reacts  like  the  chloride  with  sul- 
phuric acid,  and  imparts  a  similar  green  color  to  a  flame.  It  also  yields 
the  reactions  of  a  nitric  (see  nitric  acid,  p.  101,  ante). 

Carbonate  of  barium  is  a  white  insoluble  powder,  entirely  dissolved 
with  effervescence  (carbonic  acid)  by  diluted  hydrochloric  acid.  On  evap- 
oration, this  solution  yields  crystalline  plates  of  chloride  of  barium,  which 
may  be  tested  by  the  processes  above  described. 


CHAPTEEX. 

PHOSPHORUS. — RED    PHOSPHORUS. — SYMPTOMS    AND   APPEARANCES. CHRONIC    POISONING. 

CHEMICAL    ANALYSIS. 

Poisoning  with  phosphorus  is  not  uncommon  in  this  country,  as  the 
result  of  accident  and  suicide  ;  but  homicidal  poisoning  by  it  is  rare.  The 
ordinary  yellow  or  soluble  phosphorus  is  alone  poisonous ;  the  red, 
amorphous,  or  insoluble  variety  has  been  clearly  proved  not  to  be 
poisonous.  It  is  usually  given  either  in  the  form  of  vermin-killer  or  rat- 
paste — a  mixture  of  yellow  phosphorus,  fat,  flour,  and  sugar — or  as  tips 
of  lucifer  matches  infused  in  some  liquid.  The  smell  of  yellow  phosphorus, 
its  taste,  the  fumes  which  it  gives  off,  and  its  luminosity  in  the  dark, 
commonly  reveal  its  presence.  At  the  Norwich  Aut.  Ass.,  1871  (Reg.  v. 
Fisher),  a  girl  of  18  was  convicted  of  an  attempt  to  poison  a  family.  She 
put  a  vermin-compound  containing  phosphorus  into  a  teapot  with  the  tea. 
When  hot  water  was  poured  on  it,  the  smell  produced  at  once  led  to  sus- 
picion. Phosphorus  was  found  in  the  tea,  taken  from  a  pot  carelessly  left 
about  the  house.  The  girl  was  convicted.  Casper  described  a  case  in 
which  the  luminous  appearance  of  the  poisoned  food  led  to  a  suspicion  of 
poisoning  with  phosphorus,  and  this  was  subsequently  proved.  A  woman 
put  a  preparation  of  phosphorus  into  some  soup,  and  gave  it  to  her  hus- 
band.    He  ate  it  in  a  dark  room  in  the  presence  of  some  friends,  and  they 


PHOSPHORUS  —  SYMPTOMS.  115 

noticed  that  the  liquid,  as  he  stirred  it,  was  luminous.  (Yierteljahrsschr. 
f.  Gerichil.  Med.,  Julv,  18G4.)  In  this  way  a  person  may  be  warned  and 
a  life  saved.     (See  Ann.  d'Hyg.,  1870,  2,  p.  203.) 

Symjjtoms. — Phosphorus  acts  as  an  irritant  poison,  and  also  specifically. 
The  symptoms  of  irritation  may  manifest  themselves  in  a  few  minutes 
after  the  ingestion  of  the  poison.  In  general,  however,  there  is  a  longer 
interval  of  some  hours.  In  the  first  instance,  the  patient  experiences  a 
disagreeable  taste,  resembling  that  of  garlic,  which  is  peculiar  to  this 
poison.  An  alliaceous  or  garlic-like  odor  may  be  perceived  in  the  breath. 
There  is  pain  and  oppression  in  the  region  of  the  stomach,  malaise,  eruc- 
tation of  phosphoric  vapors  having  a  garlicky  odor ;  and  these  may  be 
luminous  in  the  dark.  Vomiting  is  sometimes  frequent  and  violent ;  in 
other  cases  quiet  and  at  longer  intervals.  The  abdomen  is  distended. 
Purging  is  not  common.  The  vomited  matters  are  coffee-colored,  or  3'ellow . 
and  bilious,  and  may  be  luminous.  There  is  intense  thirst.  The  symp- 
toms may  increase  in  severity,  ending  in  death  from  collapse  in  the  course 
of  a  few  hours — four  to  eight  in  the  worst  cases. 

Nevertheless,  in  the  majority  of  cases  the  progress  to  a  fatal  termination, 
though  no  less  sure,  is  slower  and  more  insidious.  The  irritant  symptoms 
in  a  great  measure  subside ;  and,  though  the  pulse  is  feeble  and  there  is 
a  certain  amount  of  malaise,  the  patient  may,  to  a  casual  observer,  appear 
to  be  in  an  almost  normal  state  of  health.  But  after  the  lapse  of  three 
or  four  days,  jaundice  sets  in  and  rapidly  increases ;  there  is  great  pros- 
tration of  strength  ;  the  abdomen  becomes  distended;  the  liver  is  observed 
to  be  greatly  enlarged,  and  vomiting  of  altered  blood  may  come  on,  with 
intense  thirst ;  the  skin  is  cold ;  the  pulse  feeble,  rapid,  and  perhaps  im- 
perceptible at  the  wrist;  the  urine  is  scanty  and  high-colored,  and  contains 
casts  from  the  kidneys.  The  feces,  previously  suppressed,  are  now  more 
abundant  and  contain  blood.  Coma  sets  in,  with  jactitation  of  the  limbs, 
or  muscular  twitchings ;  and  the  patient  succumbs,  generally  five  or  six 
days  after  the  administration  of  the  poison. 

A  female,  set.  20,  took  several  doses  of  phosphorus-paste  ;  the  first  on 
the  evening  of  January  11,  18T7.  The  dose  was  repeated  twice  on  the 
12th.  The  quantity  of  paste  taken  Avas  of  the  size  of  a  large  cobnut,  con- 
taining about  two  grains  of  phosphorus.  On  the  morning  of  the  13th  she 
retched,  and  at  midday  her  appetite  failed  at  dinner,  and  in  the  evening 
she  vomited.  At  10  P.M.  on  the  14th  .she  was  first  seen  by  T\'Son,  about 
seventy-two  hours  after  the  first,  and  forty-eight  hours  after  the  last  dose 
was  taken.  She  had  then  an  excited  aspect,  and  her  breath  had  a  phos- 
phoric odor.  There  was  tenderness  over  the  region  of  the  stomach.  On 
the  15th  there  was  faint  yellowness  of  the  conjunctivse  of  the  eyes,  slight 
pain  in  the  stomach,  and  nausea,  but  no  vomiting.  The  urine  was  high- 
colored  and  turbid.  On  the  IGth  there  was  decided  jaundice,  great  thirst, 
and  prostration.  There  was  still  a  slight  garlicky  odor  of  the  breath  ;  but 
the  urine  and  feces  showed  no  luminosity."^  There  was  no  obvious  enlarge- 
ment of  either  the  liver  or  the  spleen.  On  the  Uth  the  liver  was  en- 
larged ;  only  a  very  little  dark-colored  urine  was  passed ;  and  there  was 
much  epigastric  pain  and  tenderness.  In  the  evening  there  was  slight 
delirium.  From  this  time  she  gradually  sank,  and  died  on  the  ^8th, 
nearly  a  week  after  the  administration  of  the  first  dose  of  the  poison. 
On  post-mortem  examination  the  liver  was  found  to  be  of  the  usual  size, 
but  it  had  undergone  exten.sive  fatty  degeneration,  as  had  the  heart  also. 
There  was  no  marked  appearance  in  the  stomach,  which  was  almost  filled 
wnth  a  blackish  syrupy  liquid.      (Guy's  Hosp.  Rep.,  18T7,  xxii.  p.  452.) 

In  1876  a  woman,  and  her  daughter  tet.  5,  each  drank  some  phosphorus- 


116  PHOSPHORUS CHRONIC    POISONING. 

paste  in  warm  water.  The  woman  was  seen  four  days  later,  apparently 
in  her  usual  health.  Subsequently  she  sickened,  became  jaundiced,  and 
died,  a  week  after  the  poison  was  swallowed.  The  child  exhibited  no 
symptoms  till  1  A.  M.  on  the  day  after  taking  the  poison.  She  then 
vomited  some  slimy  material,  and  her  breath  had  a  garlicky  odor.  In  a 
few  hours  she  was  in  a  state  of  semi-collapse.  Next  day  she  became 
drowsy,  then  thirsty,  restless,  and  vomited  constant)}'.  There  was  no 
jaundice.  She  died  fifty-nine  hours  after  the  administration  of  the  poison. 
On  post-mortem  examination,  the  heart  was  found  to  have  undergone 
fatty  degeneration,  and  it  and  the  aorta  exhibited  ecchymosed  patches. 
The  stomach  was  considerably  injected,  and  its  surface  was  thickly 
coated  with  tenacious  mucus.  The  small  intestine  was  much  congested 
at  its  commencement,  and  to  a  less  degree  lower  down.  The  liver 
weighed  twenty-six  ounces,  was  yellow,  angemic,  and  showed  extreme 
fatty  degeneration,  except  in  isolated  patches.  In  neither  of  these  cases 
could  the  dose  of  phosphorus  taken  be  ascertained.  (Guy's  Hosp.  Rep., 
1877,  xxii.  p.  449.) 

Chronic  poisonivg. — Pho'spliorus-vapor. — Chronic  poisoning  by  phos- 
phorus is  accompanied  by  nauseous  eructations,  frequent  vomiting,  a  sense 
of  heat  in  the  stomach,  purging,  straining,  pains  in  the  joints,  wasting, 
hectic  fever,  and  disease  of  the  stomach,  under  which  the  patient  slowly 
sinks.  Some  interest  is  attacHed  to  the  chronic  form  of  poisoning  with 
phosphorus  from  the  researches  of  Strohl  and  others  on  the  effects  of  the 
vajjor  upon  persons  engaged  in  the  manufacture  of  phosphorus  or  lucifer 
niatches.  It  has  been  remarked  that  such  persons  have  suffered  from 
necrosis  of  the  jaw,  carious  teeth,  and  abscesses.  There  has  been  also 
great  irritation  of  the  respiratory  organs,  and  bronchitis  has  frequently 
shown  itself  among  them.  (See  On  Poisons,  2d  edit.  p.  345.)  Cases 
of  chronic  phosphorus-poisoning'  are  now  of  great  rarity,  owing  to  the 
precautions  adopted  among  workers  in  phosphorus  to  prevent  the  in- 
troduction of  the  poison  into  the  s^'stem.  The  fumes  of  phosphorus  pills 
may  cause  necrosis. 

Appearances. — Among  the  appearances  produced  by  phosphorus  are 
marks  of  irritation  and  inflammation  in  the  stomach  and  intestines.  The 
stomach  has  been  found  much  contracted,  and  its  mucous  membrane 
inflamed,  occasionally  softened,  and  presenting  purple  or  violet-colored 
spots.  In  one  fatal  case  the  body  was  found  in  a  state  of  great  muscular 
rigidity.  The  membranes  of  the  brain  were  congested,  and  there  was 
serous  effusion  between  them.  The  heart  was  flaccid  and  nearly  empty. 
The  mucous  membrane  of  the  stomach,  gullet,  and  small  Intestines  was 
very  red,  and  there  were  patches  in  which  the  membrane  was  destroyed. 
When  the  stomach  was  opened,  a  white  vapor  escaped,  accompanied  by  a 
strong  smell  of  phosphorus.  This  organ  contained  a  tablespoonful  of  a 
viscid  greenish  matter,  from  which  particles  of  phosphorus  with  some 
Prussian  blue  (used  as  a  coloring  for  the  phosphorus-paste)  subsided 
on  standing.  (Lancet,  1857,  i.  p.  600.)  The  mucous  membrane  has  been 
found  raised  in  small  bladders  or  vesications,  but  this  appearance  was 
probably  owing  to  putrefaction,  as  the  body  was  not  examined  until 
tweifty-three  days  after  death.  Schuchardt  describes  the  blood  as  dark 
and  fluid,  and  it  does  not  become  red  on  exposure  to  the  air.  Ecchymoses 
are  sometimes  found  on  the  skin,  on  the  surfaces  of  various  organs, 
and  on  the  lining  membrane  of  the  aorta.  (Brit,  and  For.  Med.  Rev., 
1857,  vol.  19,  p.  50G;  Jour,  de  Chim.  Med.,  1857,  p.  84.)  The  most  re- 
markable appearance  met  with  in  the  acute  form  of  poisoning  is  fatty 
degeneration  of  the  vomntary  muscles  and  other  organs. 


PHOSPHORUS — FATAL    DOSE.  117 

.  la  the  case  of  a  girl,  fet.  13,  who  died  on  the  sixth  day  after  taking 
phosphorus-paste  beaten  up  with  egg,  there  were  the  usual  symptoms, 
with  severe  paroxysms  of  vomiting  and  pain.  The  matters  first  vomited 
were  observed  to  be  luminous  in  the  dark.  There  were  numerous 
"eechymosed  patches  in  the  cellular  tissue  of  the  skin  of  the  abdomen  over 
the  rectus  muscle ;  these  were  also  seen  on  the  chest  and  on  the  dia- 
phragm. The  stomach  contained  a  dark-colored  thick  fluid,  like  altered 
blood;  the  coats  were  not  inflamed;  and  the  surface  of  the  innner  coat 
was  covered  with  a  brownish-colored  mucus  which  had  no  odor  of  phos- 
phorus. At  the  greater  curvature  the  surface  was  dotted  over  with 
numerous  small  dark  particles,  consisting  of  coagula  of  altered  blood 
adhering  to  the  membrane,  but  easily  removed  from  it.  They  had  the 
appearance  of  effused  coagula  of  blood,  in  petechial  spots.  The  contents 
of  the  stomach  owed  their  color  to  these  little  masses  of  blood  being  dis- 
seminated through  them.  The  duodenum  contained  a  similar  liquid. 
The  intestines  presented  no  abnormal  appearance.  The  liver  was  in 
an  advanced  state  of  fatty  degeneration.  This  condition  of  the  liver  has 
occurred  so  frequently  in  cases  of  phosphorus-poisoning  that  it  may  be  re- 
garded as  one  of  the  characteristic  appearances.  (Guy's  Hosp.  Rep.,  1868, 
p.  212.)  In  a  case  recorded  by  Habershon  (Med.-Chir.  Trans.,  1857,  vol. 
50,  p.  87),  in  which  a  woman  died  on  the  fifth  day,  the  symptoms  and 
appearances  were  similar  to  those  above  described.  The  phosphorus  was 
taken  in  the  form  of  paste,  and  it  is  supposed  in  a  dose  of  from  three 
to  four  grains.  There  w^as  much  ecchymosis  in  patches  in  and  about  the 
cellular  tissue  of  the  abdomen  and  chest.  There  Avas  fatty  degeneration 
of  the  liver  and  kidneys.  The  stomach  contained  a  large  quantity  of 
fluid,  like  soot  and  water,  and  was  covered  with  a  tenacious  bloody 
mucus.  There  w^as  some  congestion  in  the  mucous  membrane,  and 
there  was  much  redness  with  ecchymosis  in  the  small  intestines.  The 
fatty  degeneration  induced  by  phosphorus  i-s  usually  most  marked  in 
the  liver,  though  it  may  extend  to  the  kidneys,  the  heart,  the  glands  of 
the  stomach,  to  the  muscular  tissue  generally,  and  the  arterioles  and  capil- 
laries. *  The  editor  has  seen  considerable  enlargement  of  the  liver  produced 
within  forty-eight  hours  of  the  time  at  which  the  poison  was  administered. 
The  liver  is  usually  enlarged,  doughy,  antemic,  and  of  uniform  yellow  or 
3'ellowish-white  color.  The  acini  are  distinct.  Wagner  describes  an  in- 
terlobular hypertrophy  of  the  connective  tissue.  The  hepatic  cells  are 
loaded  with  fat.  The  heart  and  muscles  generally  may  be  soft,  yellow, 
and  of  defective  tenacity.  In  place  of  transverse  stria?,  innumerable  fat- 
globules  and  granules  of  fat  are  seen  Avith  the  microscope.  The  gland- 
ular epithelial  cells  of  the  gastric  follicles,  and  the  cortex  of  the  kidneys, 
may  be  filled-  with  fat-globules. 

Occasionally  the  liver  is  of  a  deep  }■  ellow  color,  alternating  with  reddish 
patches,  simulating  acute  yellow  atrophy  of  the  organ.  The  viscera  and 
the  flesh  of  animals  recently  poisoned  by  phosphorus  have  the  peculiar 
odor  of  this  substance,  and  if  the  case  is  recent  they  are  luminous  in  the 
dark.  (Graltier,  Toxicol.,  vol.  1,  p.  184.)  In  a  case  of  a  woman  who  died 
while  taking  phosphorus  medicinally  it  was  remarked  that  the  whole  of 
the  organs  were  luminous  ;  thus  indicating  the  diffusion  of  this  poison  by 
absorption.     (Casper's  Wochenschr.,  1816,  pp.  115,  135.) 

Fatal  dose. — That  phosphorus  is  a  powerful  poison  is  proved  by  two 
cases  quoted  by  Christison.  In  one,  death  was  caused  by  a  grain  and  a 
half  in  twelve  days ;  in,  the  other,  by  two  grains  in  about  eight  days. 
The  smallest  fatal  dose  met  with  is  in  a  case  quoted  by  Galtier.  A 
woman,  agt.  52,  took  in  divided  doses,  in  four  days,  rather  less  than  one 


118  AMORPHOUS  PHOSPHORUS. 

^?-azn  of  dissolved  phosphorus.  The  largest  does  taken  at  once,  i.  e.  on 
the  fourth  day,  is  stated  to  have  been  half  a  grain.  Symptoms  of  pain 
and  irritation  appeared,  and  the  patient  died  in  three  days.  The  gullet, 
stomach,  and  small  intestines  were  found  much  inflamed.  (Toxicol.,  vol. 
1.  p.  ST.)  When  the  phosphorus  is  dissolved  in  a  liquid,  or  when  it  is 
finely  divided,  as  in  phosphorus-paste  or  in  lucifer-matches,  its  action  is 
then  more  powerful,  as  it  is  in  a  state  well  fitted  for  absorption. 

In  general  several  days  elapse  before  a  case  proves  fatal.  Orfila  met 
with  one  which  terminated  fatally  in  four  hours,  and  Habershon  quotes 
a  case  Avhich  is  said  to  have  proved  fatal  in  half  on  hov.r.  (Med.- 
Chir.  Trans.,  176 Y,  vol.  50,  p.  92.)  This  is  the  most  rapid  case  on 
record. 

Chemical  Analysis. — Yellow  phosphorus  is  a  solid  of  waxy  consistency, 
having  a  peculiar  odor,  and  a  taste  resembling-  garlic.  It  is  the  odor  and 
taste  Avhich  prevent  it  from  being  criminally  employed  as  a  poison,  and 
render  it  easy  of  detection  in  articles  of  food.  It  evolves  a  white  vapor 
in  daylight,  and  a  faint  bluish  luminosity  in  the  dark.  It  melts  and  takes 
fire  at  a  temperature  of  112°  F.,  burning  with  a  bright  A^ellow  flame,  and 
producing  white,  opaque,  acid  vapors.  It  is  not  soluble  in  water,  but  it 
is  dissolved  by  alcohol,  ether,  chlorofcrm,  and  oils ;  and  especially  by 
disulphide  of  carbon. 

The  smell  which  phosphorus  imparts  to  solids  and  liquids  is  characteris- 
tic. When  it  has  been  taken  in  a  solid  form  the  particles  may  sometimes 
be  separated  as  a  sediment,  by  washing  the  contents  of  the  stomach  with 
water.  These  may  be  melted  under  water  into  one  mass,  either  by 
plunging  the  tube  containing  them  into  hot  water  or  by  pouring  hot 
Avater  upon  them  in  a  glass.  If  a  portion  of  the  organic  liquid  is  evapo- 
rated to  dryness  in  the  dark,  the  particles  of  phosphorus  will  be  easily 
recognized  by  their  luminosity  as  well  as  by  their  combustion  when  the 
surface  on  which  the  material  is  spread  is  heated.  Owing  to  its  great 
solubility  in  disulphide  of  carbon,  phosphorus  may  be  separated  from  many 
organic  matters  by  digestion  with  this  liquid.  It  is  thus  procured  from  flour 
and  phosphorus-paste,  or  from  the  residue  of  the  contents  of  the  ^omach 
after  washing  and  dccantation.  On  the  spontaneous  evaporation  of  the 
disulphide,  decanted  from  the  organic  liquid  or  solid,  the  phosphorus  may 
be  procured  in  small  globules  or  beads.  These  ignite  when  touched  with 
a  hot  wire,  and  burn  with  the  bright  flame  of  phosphorus.  Its  vapor 
blackens  nitrate  of  silver. 

If  the  phosphorus  is  in  a  state  of  solution  or  in  too  small  a  quantity  to 
be  dissolved  out  of  the  material  by  disulphide  of  carbon,  its  presence  may 
be  indicated  by  distilling  the  liquid  containing  it  in  the  dark.  The  vapor 
appears  luminous  as  it  is  condensed  in  a  glass  condensing-tube.  So  deli- 
cate is  this  process  of  distillation,  which  was  first  suggested  by  Mitscherlich, 
that  in  one  experiment  with  the  head  of  a  single  lucifer-match  the  lumi- 
nosity appeared  for  half  an  hour  in  the  condensing-tube.  Absolute 
darkness  is  required  for  the  success  of  this  experiment.  When  taken  in 
the  form  of  matches,  portions  of  sulphur,  vermilion,  or  Prussian  blue  may 
bo  found  in  the  sediment. 

The  substance  known  under  the  name  of  red  or  amorphous  pJiosphorns 
is  not  possessed  of  poisonous  properties.  This  fact,  long  since  announced 
by  Liebig,  has  been  confirmed  by  experiments,  which,  however,  need 
revision.  It  has  been  given  to  animals  in  doses  of  thirty  grains  without 
causing  symptoms  of  poisoning.  In  1860  a  woman,  set.  26,  swallowed 
the  composition  scraped  from  a  number  of  lucifer-matches  made  with 
amorphous  phosphorus.     She  suffered  no   inconvenience.     She  procured 


IODINE.  119 

other  matches  of  common  phosphorus,  took  a  decoction  of  them  in  coffee, 
and  died  from  the  effects. 

Amorphous  phosphorus  is  easily  recognized  by  its  red  color  and  in- 
fusibility  at  tiie  temperature  of  boiling  water.  When  a  mixture  contain- 
ing it  is  heated  to  about  500°  F.,  it  burns  like  common  phosphorus,  and 
yields  similar  products.  It  is  insoluble  in  all  liquids,  and  by  its  in- 
solubility in  disulphide  of  carbon  it  is  distinguished  and  separated  from 
common  phosphorus.  It  has  neither  color  nor  taste,  and  is  not  luminous 
in  the  dark. 

[Iodine. 

Symptoms. — From  experiments  on  animals,  as  well  as  from  observations 
of  its  effects  on  man,  iodine  has  a  strong  local  action  as  an  irritant  on  the 
stomach  and  bowels. 

In  large  doses,  it  occasions  a  burning  heat  in  the  throat,  severe  pain  in 
the  abdomen,  with  vomiting  and  purging,  the  vomited  matters  having 
the  peculiar  odor  of  iodine,  and  being  of  a  yellow  color,  except  when 
any  farinaceous  food  has  been  taken,  in  which  case  they  are  blue,  or  even 
black. 

The  fecal  matters  may  also  contain  free  iodine  if  the  poison  has  been 
taken  in  the  solid  state.  Besides  these  symptoms,  there  is  a  great  thirst, 
with  anxiety,  headache,  giddiness,  trembling,  and  convulsive  movements 
of  the  limbs,  and  fainting,  these  last  symptoms  indicating  that  the  poison 
has  become  absorbed.  When  taken  for  some  time  in  small  doses,  it  gives 
rise  to  salivation,  vomiting,  purging,  pain  in  the  stomach,  and  cramps; 
the  pulse  becomes  small  and  frequent  ;  there  is  a  general  wasting  of  the 
body,  and  it  has  been  observed  that,  in  this  form  of  chronic  poisoning, 
certain  glands  are  liable  to  become  affected  and  diminished  by  absoi'ption 
— the  breasts  in  the  female,  and  the  testicles  in  the  male.  Iodine  produces 
these  secondary  effects  (iodism),  whether  it  is  taken  internally  or  applied 
externally.  A  woman  swallowed  by  mistake  one  drachm  of  iodine  dis- 
solved in  an  ounce  of  alcohol.  When  seen  soon  afterwards,  she  com- 
plained of  a  violent  pain  in  the  throat  or  stomach,  followed  by  retching 
and  slight  vomiting  ;  the  pulse  was  rapid  and  full,  the  eyes  prominent 
and  suffused.  Vomiting,  promoted  by  diluents,  brought  no  relief  to  the 
symptoms. 

She  became  much  depressed,  and  died  on  the  following  day.  There  was 
no  examination  of  the  body.  (Prov.  Jour.,  June  30,  1847,  p.  356.)  For 
a  case  of  recoverv  after  half  a  drachm  had  been  taken,  see  Med.  Times 
and  Gaz.,  1861,  II.,  p.  669. 

Iodine  is  rarely  used  as  poison.  In  1864  an  attempt  was  made  by  a 
woman  to  poison  a  fellow-servant  by  mixing  tincture  of  iodine  with  food 
in  a  plate.  The  remarkable  discoloration  of  the  farinaceous  food  which  it 
produced  led  to  suspicion  and  prevented  any  ill  effects  from  following. 
Iodine  gives  a  blue,  green,  or  dark  color  to  the  most  organic  liquids,  and 
imparls  to  tbem  a  peculiar  odor.  It  stains  the  skin  and  other  organic 
substances  yellow,  the  color  being  removed  by  an  alkali.  When  in 
strong  solution,  it  is  corrosive,  and  destroys  the  parts  which  it  touches  ; 
in  this  state  it  has  been  maliciously  employed  for  throwing  on  the  person. 
Appearances. — As  this  is  an  irritant  as  well  as  a  corrosive  poison,  the 
lining  membrane  of  the  gullet,  stomach,  and  intestines  is  found  inflamed 
and  excoriated.  In  one  instance  the  mucous  membrane  near  the  pylorus 
was  corroded,  and  detached  in  a  space  of  two  or  three  inches. 

Analysis. — The  odor  is  in  general  sufficient  to  identify  it.  This  may 
be  concealed  by  alkalies  or  alkaline  substances.    When  heated,  it  sublimes 


120  IODINE. 

as  a  purple  vapor.  The  addition  of  a  cold  solution  of  starch  produces  a 
blue  color,  but  many  substances  prevent  this  reaction.  It  is  very  soluble 
in  disulphide  of  carbon,  forming  a  rich  pink  solution. 

The  sulphide  has  the  property  of  removing  it  from  water  or  organic 
liquids  in  which  it  is  dissolved. 

It  may  thus  be  separated  for  chemical  examination,  by  decanting  the 
M^atery  liquid  from  the  sulphide,  which,  on  evaporation,  leaves  the  iodine 
in  crystals.  Chloroform,  a  good  solvent  of  iodine,  may  be  substituted  for 
the  sulphide.] 


ARSENIC — ACUTE    POISONING.  121 


METALLIC    IRRITANTS. 


CHAPTER  XI. 

ARSENIC. ARSENIOUS      ACID. SYMPTOMS. CHRONIC       POISONING. APPEARANCES        AFTER 

DEATH. FATAL    DOSE. CHEMICAL    ANALYSIS. ARSENITES. ARSENIC    ACID.  —  OKPIMENT 

AND  OTHER  COMPOUNDS. 

White  Arsenic. — Arsei^ious  Acid. — This  substance,  when  freshly  pre- 
pared by  sublimation,  exists  in  the  form  of  vitreous  or  glassy  arsenic  in 
semi-transparent  white  masses,  which  gradually  become  opaque  on  ex- 
posure to  air  and  light.  More  commonly  it  is  met  with  in  commerce  as 
the  white  arsenic  or  arsenic  of  shops,  in  the  form  of  a  white  powder,  not 
unlike  flour  in  appearance,  but  visibly  crystalline  when  examined  with  a 
lens.  It  is  almost  tasteless,  and  hence  may  be  readily  introduced  unper- 
ceived,  and  in  large  quantites,  into  most  ordinary  articles  of  food  and 
drink.  It, is  sparingly  soluble  in  cold  water,  a  wineglassful  of  which  will 
dissolve  a  fatal  dose ;  but  it  is  much  more  soluble  in  many  other  liquids. 
Arsenic,  as  it  is  sold  to  the  public  in  small  quantities,  is  required  to  be 
mixed  either  with  l-16th  part  of  its  weight  of  soot,  vv^hich  gives  to  it  a 
grayish  color,  or  with  l-32d  part  of  its  weight  of  indigo,  and  then  it  is 
blue.  Sometimes,  in  place  of  indigo,  ultramarine  is  improperly  employed 
as  a  coloring.  When  ultramarine  is  used,  the  article  is  decolorized  by  all 
acid  liquids,  and  by  the  gastric  juice. 

Symptoms  of  Acute  Poisoning. — The  symptoms  produced  by  this  poison 
vary  according  to  the  form  and  dose  in  which  it  has  been  administered. 
The  time  at  which  they  usually  come  on  is  genei-ally  in  from  half  an  hour 
to  an  hour  after  the  poison  has  been  swallowed;  but  they  may  appear 
earlier  or  much  later.  In  a  case  in  which  sixty  grains  of  white  arsenic 
had  been  taken  on  an  empty  stomach,  no  symptoms  appeared  for  two 
hours;  in  another,  that  occurred  to  Lachesc,  in  which  a  large  dose  was 
taken,  there  were  no  symptoms  for  seven  hours.  (Ann.  d'Hyg.,  183T, 
vol.  1,  p.  344.  See  also  Med.  Chir.  Rev.,  1854,  p.  294.)  And'in  a  third 
their  appearance  was  protracted  for  ten  hours.  [Dr.  "Wood  cites  a  case 
where  a  drachm  had  been  swallowed,  and  the  symptoms  of  poisoning- 
were  delayed  for  sixteen  hours.  (U.  S.  Dispensatory,  18G5,  p.  26.)] 
The  maximum  period  yet  known  is  eighteen  hours.  (Seidel.)  In  all 
cases  in  which  arsenic  enters  the  system  from  without,  as  by  its  applica- 
tion to  the  skin,  or  to  ulcerated  or  diseased  surfaces,  the  symptoms  are 
rarely  manifested  until  after  the  lapse  of  some  hours  or  even  days. 

The  person  first  experiences  a  feeling  of  sinking  or  faintness,  depression, 
nausea  followed  by  sickness,  with  an  intense  burning  pain  in  the  region 
of  the  stomach,  usually  but  not  invarialjly  increased  by  pressure.  The 
pain  in  the  abdomen  becomes  more  and  more  severe;  and  there  is  violent 
vomiting  of  a  brown  turbid  matter,  mixed  with  mucus,  and  sometimes 
streaked  with  blood.     These  symptoms  are  followed  by  purging,  which  is 


122  ARSENIC — CHRONUC    POISONING. 

more  or  less  violent,  and  this  generally  accompained  by  severe  cramps  in 
the  calves  of  the  legs.  At  the  trial  of  Mrs.  Maybrick  (Reg.  v.  Florence 
Maybrick,  Liverpool  Sum.  Ass.,  1889)  the  ab.sence  of  cramps  in  the  calves 
and  tenderness  at  the  pit  of  the  stomach  was  asserted  to  negative  the  con- 
clusion that  the  deceased  died  from  arsenic  ;  but  the  prisoner  was  convicted 
[which,  however,  should  have  no  weight  upon  the  question,  as  the  verdict 
has  been  generally  criticised.  The  Home  Secretary  commuted  the  sen- 
tence, in  response  to  an  almost  overwhelming  popular  demand  and,  all  the 
more  remarkable,  over  the  protest  of  the  trial  judge,  a  very  unusual  occur- 
rence in  England].  The  matters  discharged  from  the  stomach  and  bowels 
have  had  in  some  instances  a  yellowish  color,  as  it  was  supposed,  from  a 
partial  conversion  of  the  poison  into  sulphide,  but  more  probably  from  an  j 
admixture  of  bile.  The  vomited  matters  are  in  some  cases  colored  with 
blood,  and  the  mixture  of  blood  with  bile  has  often  given  to  them  a  green, 
yellow,  or  brown  color.  In  other  cases  they  may  consist  of  a  large  quantity 
of  mucus  ejected  in  a  flaky  state  arid  having  a  milky-white  appearance,  as 
if  from  admixture  with  the  poison.  The  color  of  the  vomited  matters  may 
be  blue  or  black  when  colored  arsenic  has  been  taken  ;  or  the  admixture 
of  bile  may  render  them  of  a  deep-green  color.  The  vomiting  is  in  general 
violent  and  incessant,  and  is  excited  by  any  liquid  or  solid  taken  into  the 
stomach.  There  is  tenesmus  Cstraining),  and  the  discharges  by  the 
bowels  are  frequently  tinged  with  blood.  There  is  a  sense  of  constriction 
with  a  feeling  of  burning  heat  in  the  throat,  commonly  accompanied  by 
the  most  intense  thirst.  The  pulse  is  small,  very  frequent,  irregular,  and 
sometimes  wholly  imperceptible.  The  skin  is  cold  and  clammy  in  the 
.^tage  of  collapse;  r.t  other  times  it  is  very  hot.  The  respiration  is  painful 
from  the  tender  state  of  the  stomach.  There  is  great  restlessness,  but 
before  death  stupor  sometimes  supervenes,  with  paralysis,  tetanic  convul- 
sions, or  spasms  in  the  muscles  of  the  extremities.  In  one  instance  trismus 
(lockjaw)  appeared  in  three-quarters  of  an  hour.  (Orfila.)  In  another, 
severe  and  prolonged  nervous  symptoms,  among  the  most  prominent  of 
which  were  epileptoid  fits.  (Marshall  )  Although  pain  is  in  general 
among  the  early  and  well-marked  symptoms,  arsenic  appears  in  some 
cases  to  destroy  sensibility.  In  a  case  in  Avhich  the  stomach  was  found 
intensely  inflamed  after  death,  the  patient  complained  of  no  pain  during 
the  time  which  she  survived.  In  some  cases  purging  is  absent.  Should 
the  patient  live  for  a  fow  days,  paralysis  is  a  not  uncommon  symptom,  due 
to  neuritis  like  that  met  with  in  chronic  alcoholism.  Melanosis  has  been 
rarelv  observed.     (Correspondenzbl   f.  Schweizer  Aertze,  1890,  'So.  15.) 

[Prof.  Reese,  a  very  high  authority,  has  said  that  cases  of  poisoning  by 
arsenic  present  the  greatest  possible  variety  in  the  character,  combination, 
and  severity  of  the  symptoms,  most  frequently  being  those  just  described. 

In  a  second  class  they  present  those  of  collapse,  with  extreme  prostra- 
tion of  strength,  a  cofd,  clammy  skin,  a  frequent,  almost  imperceptible 
pulse,  or  one  as  low  as  thirty  to  forty  beats  per  minute. 

A  third  class,  marked  by  the  patient  falling  into  a  profound  sleep,  which 
terminates  in  a  fatal  coma.] 

Chrordc  Poisoning. — Should  the  person  recover  from  the  first  effects, 
and  the  case  be  protracted,  or  should  the  dose  have  been  small  and  ad- 
ministered at  intervals,  there  will  be  tarsal  irritation,  inflammation  of  the 
conjunctivse,  with  suffusion  of  the  eyes  and  intolerance  of  light — condi- 
tions which  are,  however,  often  present  among  the  early  symptoms  above 
described.  There  is  also  irritation  of  the  skin,  accompanied  by  a  vesicular 
eruption  which  has  been  called  eczema  arsenicale.     Sometimes  this  has 


POST-MORTEM    APPEARANCES.  123 

a^^siinied  the  form  cf  nettle-rash  or  of  the  eruption  attending  scarlet  fever. 
These  conditions  may,  however,   not  all    be  present.      Local  paralysis, 
preceded   by  numbness   or  tingling  in  the  fingers  and  toes,  and  other 
symptoms  of  nervous  disorder,  are  also  common  consequences.     Exfoli- 
ation of  the  cuticle  and  skin  of  the  tongue,   and  falling  off  of  the  hair, 
have  likewise  been  witnessed.      Salivation  has  been  observed  to  follow, 
especiiillv  when  small  doses  of  the  poison  have  been  given  for  a  length  of 
time.     (Med.  Gaz.,  vol.  xvi.,  p.  790.)     Strangury  and  jaundice  have  been 
noticed  among  the  secondary  symptoms.     (Marshall  on  Arsenic,  pp.  44, 
111.)     At  Hyeres,  in  1888,  an  alarming  outbreak  of  arsenical  poisoning 
occurred,  thepoison  having  been  accidentally  introduced  into  wine,  which 
was  drunk  by  many  persons  for  a  considerable  time.     The  symptoms  at 
the  outset  were  tho^se  of  dyspepsia,  with  nausea,  vomiting,  and  purging; 
but  nausea  and  vomiting  were  not  invariable.    The  gastro-intestinal  svmp- 
toms  generally  disappeared  in   a  few  days.     There  was  dryness  of  the 
mouth,  loss  of  appetite,  a  sense  of  constViction  at  the  pit  of  the  stomach, 
and  wasting.     Bronchial  irritation  was  marked,  Avith  scanty  secretion  of 
mucus.     There  were  pains  in  the  limbs  and  oedema  of  the  joints.     The 
patellar  reflexes  were  weakened  or  abolished.     Wandering  pains  were  felt 
in  various  regions,  and  headache,  and  the  sense  of  touch  was  diminished. 
A  garlicky  taste  was  felt  in  the   mouth,  but  the  sense  of  taste  was  not 
diminished.      The  vision  was  disturbed,  and  the  conjunctiva  of  the  eye 
was  inflamed.     There  were  scaly  eruptions  on  both  surfaces  of  the  hands 
and   feet.       Of  Co  reported   cases,    30    were   slight,    18    serious,  and  15 
fatal. 

Arsenic  is  not  an  accumulative  poison  ;  it  is  temporarily  deposited  in 
the  organs  after  absorption,  but  is  rapidly  eliminated  by  the  urine ;  and  in 
from  two  to  three  weeks,  if  the  person  survives,  the  whole  of  that  which 
has  been  absorbed  may  be  removed  from  the  body.  Occasionally  arsenic 
may  be  detected  in  the  organs,  especially  the  bones,  after  a  longer  period. 
R.  C.  Maclagan  states  that  he  has  found  it  passing  out  of  the  body  by  the 
urine  as  early  as  three-quarters  of  an  hour  after  it  had  been  taken.  (Ed. 
Med.  Jour.,  1864,  II.  p.  200.) 

Appearances  after  Death — The  principal  changes  produced  by  arsenic 
are  generally  confined  to  the  stomach  and  bowels.  They  are  commonly 
Avell  marked  in  proportion  to  the  largeness  of  the  dose,  and  the  length  of 
time  that  the  person  has  survived  after  taking  the  poison.  Attention  must 
he  first  directed  to  the  stomach.  Arsenic  seems  to  have  a  specific  effect  on 
this  organ  ;  for,  by  whatever  channel  the  poison  may  have  entered  into 
the  system,  whether  through  a  wounded,  diseased,  or  ulcerated  surface, 
or  by  the  act  of  swallowing,  or  when  introduced  into  the  rectum  or  vagina, 
the  stomach  has  been  found  inflamed.  The  mucous  membrane  of  the 
stomach  is  sometimes  partly  detached,  and  is  covered  with  a  layer  of 
mucus,  mixed  with  blood  or  bile,  and  with  a  thick,  white,  pasty-looking 
substance  containing  arsenic.  It  is  commonly  found  red  and  inflamed  in 
dotted  or  striated  patches,  extending  between  the  two  apertures:  the 
color,  which  is  of  a  dull  or  brownish  red,  becomes  brighter  on  exposure 
to  the  air  ;  at  other  times  it  is  of  a  deep  crimson  hue,  interspersed  with 
black-looking  lines  or  patches  of  altered  blood.  The  redness  is  usually 
most  strongly  marked  at  the  greater  end  of  the  stomach  ;  in  one  case  it 
may  be  found  spread  over  the  whole  mucous  surface,  giving  to  it  the 
appearance  of  red  velvet;  in  another  it  will  be  chiefly  seen  on  the  promi- 
nences or  folds  of  the  membrane.  In  one  instance  the  coats  were 
thickened  and  of  a  gelatinous  consistency,  without  any  marked  inflamma- 
tory redness.     The  stomach  has  been  found  highly  inflamed  in   a  case 


12-1  POST-MORTEM    APPEARANCES. 

which  proved  fatal  in  two  hours.  Thus  it  would  appear  that  intense  in- 
flammation of  the  mucous  membrane  may  be  obi^erved  within  a  very  short 
period.  This  organ  usually  contains  a  mucous  liquid  of  a  dark  color 
tinged  with  blood.  The  coats  are  sometimes  thickened  in  patches,  being 
raised  up  into  a  sort  of  tumor,  with  arsenic  embedded  in  them  ;  at  other 
times  the}'-  have  been  found  thinned.  The  mucous  membrane  is  rarely 
found  ulcerated,  and  still  more  rarely  gangrenous.  Ulceration  of  the 
membrane,  as  the  result  of  the  action  of  arsenic,  has  been  found  as  early 
as  ten  hours  after  the  poison  had  been  taken.  Perforation  of  the  coats  is 
not  a  common  result  of  arsenical  poisoning ;  there  are  but  few  instances 
on  record.  Murray  Thomson  met  with  a  case  in  which  there  was  on  the 
inner  coat  of  the  stomach  a  patch,  black  and  hardened,  as  large  as  the 
palm  of  the  hand.  Various  appearances  are  said  to  have  been  met  "with 
in  the  lungs,  heart,  brain,  and  urinary  organs ;  but  they  are  not  so 
characteristic  of  arsenical  poisoning  as  to  admit  of  medico-legal  use  in  en- 
abling a  medical  man  to  distinguish  poisoning  from  disease.  It  is  to  the 
stomach  and  intestines  that  he  must  look  as  the  basis  of  reliable  evidence 
in  iregard  to  appearances  after  death.  Wilkes  has  pointed  out  an  ecchy- 
mosed  condition  of  the  lining  membrane  of  the  left  ventricle  of  the  heart 
in  cases  of  acute  poisoning  by  arsenic;  and  this  condition  may  be  associ- 
ated Avith  a  general  punctated  ecchymosis  of  the  pleura  and  peritoneum. 
The  editor  has  seen  the  serous  membranes  generally  presenting  an  appear- 
ance as  if  they  had  been  sprinkled  over  with  minute  drops  of  blood  ; 
this  condition  being  due  to  minute  sub-serous  extravasation  of  blood.  In 
a  few  instances,  the  mouth,  throat,  and  gullet  have  been  found  inflamed  ; 
but  in  general  there  are  no  changes  in  these  parts  to  attract  particular 
attention.  The  mucous  membrane  of  the  small  intestines  may  be  inflamed 
throughout;  but  commonly  the  inflammator}^  redness  is  confined  to  the 
upper  part,  i.e.  the  duodenum,  especially  to  that  portion  of  it  which  joins 
the  stomach.  Of  the  large  intestines,  the  rectum  appears  to  be  the  most 
prone  to  inflammation.  In  the  case  reported  by  Murray  Thomson  the 
intestines  were  normal,  though  the  stomach  was  bright  red  and  inflamed, 
with  arsenic  adherent  to  it.  The  liver,  spleen,  and  kidneys  present  no 
appearances  which  can  be  connected  with  the  action  of  arsenic,  except 
occasional  fatty  degeneration  (Reg  v.  Webster,  Ed.  High  Ct.  of  Just., 
Feb.  1891),  although  these,  like  the  other  soft  organs,  may  become  recept- 
acles of  the  absorbed  poison.  It  is  worthy  of  observation,  in  relation  to 
the  known  antiseptic  properties  of  arsenic,  that  the  parts  especially  affected 
by  this  poison  (the  stomach  and  intestines)  occasionally  retain  the  well- 
marked  characters  of  irritant  poisoning  for  a  long  time  after  death.  Ab- 
sorbed arsenic  does  not,  however,  appear  to  prevent  the  decomposition  of 
the  soft  organs  in  which  it  is  deposited.  That  putrefaction  is  frequently 
retarded  or  arrested  in  the  bodies  of  those  poisoned  by  arsenic  is  generally 
admitted,  and  this  may  result  in  mummification.  Schauenstein,  however, 
does  not  consider  thatretardation  of  putrefaction  is  proved,  and  still  less 
mummification.  We  entertain  no  doubt  as  to  the  retardation,  and  mum- 
mification appears  also  to  be  a  well-established  fact.  (See  Kornfield  in 
Friedreich's  Blatter  fur  Gerichtl.  Med.,  1885,  p.  149.)  A  peculiar  yellow 
pigment  is  often  observed  in  the  intestines  of  bodies  exhumed  after 
arsenical  poisoning.  This  has  usually  been  ascribed  to  the  formation  of 
yellow  sulphide  of  arsenic  (orpiment).  It  may  be  due  to  this  pigment, 
but  Campbell  Brown  is  of  opinion  that  it  is  due  to  a  peculiar  alteration  of 
the  pigments  of  the  bile.  (Lancet,  1884,  i.  p.  421  ;  Brit.  Med.  Jour.,  1884, 
i.  p.  600.) 


ACTIOX    THROUGH    THE    SKIN — FATAL    DOSE.  125 

Action  of  Arsenic  through  the  Skin. — Arsenic  may  destroy  life  as  the 
result  of  external  application  to  the  skin,  to  any  diseased  or  ulcerated 
surface,  or  to  a  wound.  (Guy's  Hosp.  Rep.,  18()4,  p.  220.)  Some  im- 
portance is  attached  to  this  form  of  arsenical  poisoning-  from  the  fact  that 
the  lives  of  many  infants  were,  in  1878,  destroyed  by  the  use  of  a  pou  der 
sold  under  the  name  of  violet  powder.  Instead  of  employing'  pure  starch 
in  the  manufacture  of  this  powder,  some  makers  have  recommended  as  a 
substitute  terra  alba,  or  powdered  gypsum.  In  the  Bradford  lozenge  case 
(Ox  Poisons,  3d  edit.,  p.  354),  arsenic  had  been  substituted  for  terra  alba, 
and  caused  the  deaths  of  many  infants  by  external  application.  In  twenty- 
eight  cases  .in  which  this  powder  had  been  used  to  infants,  there  were 
twelve  or  thirteen  deaths.  (Brit.  Med.  Jour.,  1878.  i.  p.  795.)  It  set  up_ 
inflammation  and  irritation  in  the  skin,  and  was  then  absorbed.  In  one 
case  the  child  was  washed  and  then  dusted  over  with  this  poisoned  powder, 
which  was  also  applied  to  its  genital  organs.  On  the  second  day  after 
birth  the  powder  was  applied  four  times."  There  was  at  this  time  an  un- 
natural redness  of  the  skin.  On  the  third  day  the  skin  was  intensely  red, 
and  appeared  unhealthy  about  the  navel  and  vagina.  The  powder  was 
then  withdi-awn,  but  the  eruption  became  worse,  and  in  some  parts  the 
skin  had  a  sloughy  appearance.  On  rhe  tenth  day  of  the  child's  life,  and 
on  the  sixth  day  fi-om  the  last  application  of  the  powder,  the  child  died 
from  the  effects  of  the  absorbed  poison.  On  a  po.st-mortem  examination 
there  was  nothing  remarkable  in  the  condition  of  the  viscera.  The  body 
was  buried,  but  exhumed  twenty-one  days  after  death  for  examination. 
Tidy  found  in  the  liver  1.5  grain  of  arsenic,  in  the  stomach  and  intestines 
one  grain,  and  in  the  kidneys  traces.  The  powder  used,  which  should 
have  consisted  of  starch  and  magnesia,  with  orris  root,  contained  38.5  per 
cent,  of  white  arsenic,  with  starch  and  magnesia.  (Lancet,  1878,  ii.  p.  250.) 
For  one  of  the  deaths  thus  caused  the  vendor  of  the  powder  was  tried  on 
a  charge  of  manslaughter  (Reg.  v.  King,  C.  C.  C,  1878),  but  acquitted  ; 
and  it  was  thus  decided  that  there  was  no  criminal  neglect  or  culpable 
ig-norance  In  a  drysalter  not  being  able  to  disting'uish  arsenic  from  plaster 
of  Paris.  It  was  simplv  a  case  of  caveat  emptor.  (Pharm.  Jour.,  Aug. 
1878,  p.  119.) 

The  smallest  fatal  dose  of  arsenic  hitherto  recorded  is  tico  groins. 
(Prov.  Med.  Jour.,  1848,  p.  347  ;  also,  Med.  Gaz.,  vol.  39,  p.  116.)  'Under 
circumstances  favorable  to  the  operation  of  this  poison,  the  fatal  dose  in 
an  adult  may  be  assigned  at  from  two  to  three  grains,  though  one  grain 
may  perhaps  kill.  The  editor  has  seen  a  case  of  arsenical  poisoning  in 
which  repeated  three-quarter  grain  doses  of  white  arsenic,  given  with 
homicidal  intent,  were  followed,  after  the  usual  symptoms,  b\^  general 
paralysis,  beginning  in  the  lower  extremities,  and  gradually  creeping  up- 
wards till  the  lower  intercostal  and  other  re.=;piratory  muscles  were  affected. 
Large  doses  of  arsenic  commonly  destroy  life  in  from  eighteen  hours  to 
three  days.  The  average  time  at  which  death  takes  place  is  twenty-four 
hours  ;  but  the  poison  may  destroy  life  within  a  much  shorter  period.  In 
one  case  death  took  place  in  two  hours  and  a  half.  (Guv's  Hosp.  Rep., 
1851,  188.  See  also  Ann.  d'Hyg.,  1837,  vol.  1,  p.  339.)  Foster  met  with 
the  case  of  a  child  under  three  years  of  age,  that  from  the  effects  of  arsenic 
died  within  tivo  hours.  Finlay  met  with  a  case  which  proved  fatal  in  one 
hour.  (Lancet,  1883,  ii.  p.  943)  One  (a  doubtful)  case  is  said  to  have 
proved  fatal  in  twenty  minutes.  On  the  other  hand,  life  is  occasionally 
protracted  for  many  days.  In  1847,  a  man  who  had  swallowed  220  grains 
of  arsenic  was  admitted  into  Guy's  Hospital,  and  died  on  the  seventh  day. 
In  the  case  of  Dr.  Alexander,  death  took  place  on  the  sixteenth  day  ;  and 


126 


ARSENIC — CHEMICAL  ANALYSIS. 


Fig.  4. 


though  a  large  quantity  of  arsenic  had  been  taken,  no  traces  were  found 
in  the  body.  (Med.  Time.s  and  Gaz.,  1857,  i.  p.  389  )  In  an  instance  in 
which  arsenic  was  applied  externally  to  the  head,  the  person  did  not  die 
until  the  tvjentieth  day. 

Chemical  Analysis. — Arsenic  as  a  solid. — In  the  simple  state,  ichife 
arsenic   may    be    identified    by   the    following    properties :     1.    A    small 

quantity  of  the  powder,  placed  on  platinum- 
foil,  is  entirely  volatilized  at  a  moderate 
heat  (about  400°  F.).  If  a  small  portion  of 
the  white  powder  is  very  slowly  heated  in  a 
glass  tube  of  narrow  bore,  it  will  be  sub- 
limed without  melting,  and  form  a  ring  of 
minute  octahedral  and  tetrahedral  crystals, 
remarkable  for  their  lustre  and  brilliancy. 
Under  a  microscope  the  appearance  of  these 
crystals  is  highly  characteristic  (Fig.  4). 

2.  On  boiling  a  small  quantity  of  the 
powder  in  distilled  water,  it  is  not  readily 
dissolved,  but  it  partly  floats  in  a  sort  of 
film,  while  a  part  becomes  aggregated  in 
small  lumps  at  the  bottom  of  the  vessel.  It 
requires  long  boiling  in  order  that  it  should 
become  dissolved  and  equally  diffused  through  water. 

3.  It  is  not  perceptibly  altered  in  color  when  moistened  with  a  weak 
solution  of  sulphide  of  ammonium. 

4.  "When  a  small  portion  of  the  white  powder,  i.  e.  from  one-fourth  to 
one-twentieth  part  of  a  grain,  is  heated  with  two  parts  of  soda-fivx 
(obtained  by  incinerating  acetate  or  tartrate  of  sodium  in  a  closed  vessel) 
in  a  glass  tube  about  three  inches  long  and  from  one-eighth  to  a  quarter 
of  an. inch  in  diameter,  it  is  decomposed:  a  ring  of  metallic  arsenic  of 
an  iron-grav  color  is  sublimed  and  deposited  in  a  cool  part  of  the  tube.  In 
place  of  soda-flux  a  mixture  of  one  part  of  cyanide  of  potassium  with  three 
parts  of  drv  (anhydrous)  carbonate  of  sodium  may  be  employed.  During 
the  reduction  there  is  a  perceptible  odor,  resembling  that  of  garlic,  which 
is  possessed  by  metallic  arsenic  only  while  passing  from  a  state  of  vapor 
to  arsenious  acid.  In  this  experiment  of  reduction,  there  are  frequently 
two  rings  deposited  in  the  tube — the  upper  and  larger  ring  has  a  brown 
color,  and  appears  to  be  a  mixture  of  finely-divided  metallic  arsenic  and 
arsenious  oxide  ;  the  lower  ring  is  small,  and  consists  of  the  pure  metal. 
The  appearances  presented  by  these  sublimates  are  indicated  in  the  annexed 
illustration  (Fig.  5).     By  heating  gently  the  tube  containing  the  sublimate 


Crrstals  of  Arsenious  Acid  bysubli 
mation,  magnified  30  diameters. 


Fig.  5. 


Eeduction-tubc,  -n-ith  two  sublimates:  the  upper,  brownish  black  ;  the  lower,  the  pure  metal  in  an 

annular  deposit. 


(reduced  to  powder)  in  another  tube  of  larger  diameter,  the  metallic 
arsenic,  durins-  volatilization,  forms  octahedral  and  tetrahedral  crystals  of 
arsenious  acid,  which,  after  examination  by  the  microscope,  may  be  dis- 
solved in  a  few  drops  of  water  and  tested  by  one  or  two  more  of  the 
liquid  reagents. 

The  metallic  sublimates,   or  the  crystals  produced  from  them,  may  be 


TESTS    FOR    ARSENIC    IN    SOLUTION. 


127 


further  subjected  to  the  following  process :  Break  the  glass  on  which  the 
sublimate  is  deposited  into  fragments,  and  digest  these  in  a  few  drops  of 
the  strong  nitric  acid  previously  proved  to  be  free  from  arsenic.  The  sub- 
limate is  thereby  converted  into  arsenic  acid.  The  acid  solution  should  be 
evaporated  to  dryness,  and  the  white  residue  ol)tained  dissolved  in  a  few 
drops  of  distilled  water,  and  a  strong  solution  of  nitrate  or  of  ammonio- 
nitrate  of  silver  added  in  small  quantity  to  the  residue.  A  brick-red  color- 
ation indicates  arsenic  acid,  and  thus  proves  incontestably  that  the  subli- 
mate was  of  an  arsenical  nature. 

The  upper  or  brownish-looking  sublimate  may  be  readily  converted  into 
one  of  the  m-etal  by  gently  heating  it  in  the  flame  of  a  spirit-lamp. 
Arsenious  acid  is  then  volatilized,  and,  an  iron-gray  deposit  of  the  less 
volatile  metallic  acid  appears.  If  the  heat  is  continued,  the  whole  of  the 
metallic  sublimate  is  volatilized  and  deposited  in  a  cool  part  of  the  tube  in 
transparent  and  colorless  octahedra  of  arsenious  acid.  This  is  the  special 
character  of  an  arsenical  sublimate ;  it  may  be  thus  distinguished  from 
sublimates  of  all  metals  or  metalloids.  The  lower  metallic  sublimate  pro- 
cured by  reduction  sometimes  presents  itself,  not  in  an  annular  Ibrni,  but 
in  detached  particles  of  an  irregular  spherical  shape.  These  are  of  an  iron- 
gray  color,  quite  unlike  sublimed  mercury,  and,  when  examined  with  the 
microscope,  it  may  be  seen  that  they  consist  of  crystalline  nucleated 
masses,  and  that  they  are  not  accurately  spherical.  This  sublimate  is 
frequently  produced  in  the  last  stage,  when  the  residue  in  the  tube  is 
strongly  heated.  The  process  of  reduction,  with  the  corroborative  results 
above  mentioned,  is,  when  thus  applied,  conclusive  of  the  arsenical  nature 
of  the  substance  under  examination. 

5.  A  solution  of  stannous  chloride  is  mixed  with  its  volume  of  fuming 
hydrochloric  acid  and  brought  to  the  boiling  point.  If  the  hydrochloric 
acid  is  pure,  it  should  remain  colorless  ;  but  if  it  contains  a  trace  of  arsenic, 
the  liquid  will  acquire  a  light-brown  color.  On  adding  a  minute  quantity  of 
solid  arsenious  oxide  to  such  a  mixture,  the  oxide  is  dissolved  and  instantly 
decomposed,  metallic  arsenic  being  deposited  in  the  form  of  a  brown  or 
brownish-black  precipitate,     A  salt  of  antimony  is  not  thus  affected. 

Arsenic  in  solution  in  Water.  Liquid  Tests. — The  solution  of  arsen- 
ious acid  is  clear,  colorless,  possesses  scarcely  any  perceptible  taste,  and  has 
but  a  feeble  acid  reaction.  In  this  state  we  should  first  evaporate  slowly 
a  few  drops  on  a  glass  slide,  when  a  crystalline  deposit  will  be  obtained. 
On  examining  this  with  a  microscope,  it  will 
be  found  to  consist  of  numerous  minute  octahe- 
dral crystals,  presenting  triangular  surfaces 
Avhen  viewed  by  reflected  light  (see  Fig.  6). 

1.  Silver  Test. — On  adding  to  the  solution 
of  white  arsenic  ammonio-nitr ate  of  silver,  a 
pale-yellow  precipitate  of  arsenite  of  silver 
falls.  The  test  is  made  by  adding  to  a  strong 
solution  of  nitrate  of  silver  a  weak  solution  of 
ammonia,  and  continuing  to  add  the  latter  until 
the  brown  oxide  of  silver  at  first  thrown  down 
is  almost  redissolved.  The  yellow  precipitate 
is  soluble  in  nitric  and  acetic  acids,  as  well  as 
in  ammonia. 

2.  Copper  Test. — On  adding  to  another  por- 
tion of  the  solution  ammonio-sulphate  of  cop- 
per, a  light-green  precipitate  (arsenite  of  copper)  is  formed,  the  tint  of  which 
varies  according  to  the  proportion  of  arsenic  present  and  the  quantity  of  the 


Fig. 


Crystals  of  Arsenious  Acid,  from  a 
solution,  magnified  i24  diameters. 


128  marsh's  process. 

test  added  ;  hence,  if  the  arsenic  is  in  small  proportion,  no  green  precipitate 
at  first  appears,  and  the  liquid  simply  acquires  a  blue  color  from  the  test. 
In  less  than  an  hour,  if  arsenic  is  .present,  a  bright-green  deposit  is  formed, 
which  may  be  easily  separated  from  the  blue  liquid  by  decantation.  This 
test  is  made  by  adding  ammonia  to  a  weak  solution  of  sulphate  of  copper, 
until  the  bluish-white  precipitate  at  first  produced  is  nearly  redissolved. 
It  should  not  be  used  in  large  quantity  if  concentrated,  as  the  deep  blue 
color  tends  to  obscure  or  conceal  the  green  precipitate  formed.  The  dried 
precipitate  of  arsenite  of  copper,  when  slowly  and  moderately  heated  in 
a  well-dried  reduction-tube,  will  yield  a  ring  of  octahedral  crystals  of 
arsenious  oxide, 

3.  Sulphwre.tted  Hydrogen  T^est. — The  gas  procured  by  adding  to 
ferrous  sulphide,  in  a  proper  apparatus,  a  mixture  of  one  part  of  strong 
sulphuric  acid  and  eight  pai-t  of  water,  is  washed  by  passing  it  through  a 
little  water  made  faintly  alkaline  with  soda.  The  arsenical  liquid  should 
be  slightly  acidulated  with  pure  diluted  hydrochloric  acid  before  the  gas 
is  passed  into  it.  A  yellow  precipitate  of  sulphide  is  produced  if  arsenic 
is  present ;  and  it  may  be  collected  by  subsidence.  It  is  known  to  be  sul- 
phide of  arsenic  by  the  following  properties  :  1.  It  is  insoluble  in  water, 
alcohol,  and  ether,  as  well  as  in  diluted  hydrochloric  acid  ;  but  it  is  decom- 
posed by  strong  nitric  and  nitro-hj^drochloric  acids.  2.  It  is  immediately 
dissolved  by  potash,  soda,  or  ammonia,  forming,  if  no  organic  matter  is 
present,  a  colorless  solution  ;  also  by  sulphide  of  ammonium.  3.  When 
dried  and  heated  with  three  parts  of  soda-flux,  or  an  equal  part  of  dry 
cyanide  of  potassium,  it  yields  a  sublimate  of  metallic  arsenic. 

4.  Marsh-s  Process.  Nascent  Hydrogen  Test. — The  action  of  this 
test  depends  on  the  decomposition  of  arsenious  acid  and  its  soluble 
compounds  by  nascent  hydrogen,  evolved  from  the  action  of  diluted 
sulphuric  or  hydrochloric  acid  on  zinc.  The  material  should  always 
be  first  proved  to  be  free  from  arsenic.  The  apparatus  used  is  so  well 
known  as  to  need  no  description  or  illustration.  The  arsenic  may 
be  introduced  in  the  state  of  powder  ;  but  it  is  far  better  to  dissolve 
it  in  water  by  boiling,  either  with  or  without  the  addition  of  a  few  drops 

of  hydrochloric  acid.    The  arsenic  combines  with 

Fig.   7.  the  hydrogen,  forming  arsenetted  hydrogen  gas, 

which    possesses    the    following    properties ;    1. 

Filter-paper  wetted    with   a  solution    of  nitrate 

of  silver  is  immediately  blackened  by  the  gas, 

and    lead-paper  is  not  changed  in  color.     2.  It 

burns  with  a  pale  bluish-white  flame,  and  thick, 

white  smoke  (arsenious  acid)  is  evolved.     3.  A 

slip  of  glass  or  of  white  porcelain  held  in  the 

flame  near  the  point  (for  not  too  long  a  time) 

acquires  a  dark  stain  from  the  deposit  of  metallic 

arsenic  upon  it.     This  deposit  presents  a  metallic 

Deposit  obtained  by  Marsh's      lustre  in  the  Centre  (Fig.   7,  a),  a  white  film  of 

Apparatus.  arsenious  acid  on  the  outside  (c),  and  between 

A,  MetaL    B, Mixed  deposit.        j.u     i  i      i         •  e  i  i       j.         i     i. 

c.  Arsenious  Acid.  the  two  a  dark    rnig  ot  a  pulverulent  substance 

(b),  which,  when  viewed  by  transmitted  light,  is 
hair-brown  in  color  towards  the  mai'gin,  but  opaque  in  the  centre.  In 
order  to  determine  the  arsenical  nature  of  the  deposits,  the  following  plan 
niay  be  adopted.  Several  of  the  deposits  should  be  received  and  accumu- 
lated in  small  porcelain  capsules,  held  in  the  flame  of  the  burning  gas. 
To  one,  add  a  solution  of  chlorinated  soda :  the  arsenical  deposit  is 
immediately   dissolved.     To   a    second,    add   a   solution    of  sulphide    of 


ARSENIC — REINSCH'S    PROCESS.  129 

ammonium  :  the  metallic  deposit  is  detached,  but  not  perfectly  dissolved ; 
and  on  evaporation  it  yields  a  pale-yellow  film  of  sulphide  of  arsenic.  To 
a  third,  add  a  few  drops  of  the  strong-  nitric  acid.  The  deposit  is  dissolved. 
Evaporate  the  acid  solution  gently  to  dryness,  carefully  neutralize  the 
residue  with  ammonia,  and  add  one  or  two  drops  of  a  solution  of  nitrate 
of  silver :  a  brick-red  stain  or  a  dark-red  precipitate  of  arsenate  of  silver 
will  be  produced. 

5.  Beinsch^s  Process. — In  the  application  of  this  process,  the  lic^uid 
suspected  to  contain  arsenic,  or  the  solid  dissolved  in  distilled  water,  is 
boiled  with  from  one-sixth  to  one-eighth  of  its  bulk  of  pure  hydrochloric 
acid  (proved  to  be  free  from  arsenic),  and  a  small  slip  of  pure  copper  is 
then  introduced.  A  slip  of  polished  copper-foil  (electrolytic  copper)  about 
a  quarter  of  an  inch  square,  attached  to  the  end  of  a  thin  platinum  wire, 
may  be  employed  for  the  experiment.  The  copper  must  be  first  proved 
to  be  free  from  arsenic,  as  this  is  a  very  common  contamination  of  all 
commercial  copper  in  the  form  of  foil,  gauze,  or  wire.  Copper  of  a  high 
degree  of  purity  is,  however,  now  a  commercial  article.  If  arsenic  is 
present  in  the  liquid,  even  in  small  quantity,  the  polished  copper  acquires, 
either  immediately  or  within  a  few  minutes,  a  dark  iron-gray  coating  from 
the  deposit  of  this  metal.  This  is  apt  to  scale  otf  if  the  arsenic  is  in  large 
quantity,  or  if  the  liquid  is  very  acid  or  long  boiled.  Remove  the  slip  of 
copper,  wash  it  in  water,  dry  it,  and  gently  heat  it  in  a  small  reduction-tube, 
when  arsenious  oxide  will  be  sublimed  in  minute  octahedral  or  tetrahedral 
crystals;  if  these  should  not  be  apparent  from  one  piece  of  copper,  several 
may  be  successively  introduced.  When  the  quantity  of  arsenic  is  small, 
the  polished  copper  merely  acquires  a  faint  blue  or  grayish  tint.  The 
deposit  is  in  all  cases  materially  affected  by  the  degree  of  dilution,  and 
sometimes  it  will  appear  only  after  the  liquid  has  been  much  concentrated 
by  evaporation.  The  presence  of  arsenic  as  an  impurity  in  copper  may 
be  detected  by  the  following  method  suggested  by  Abel.  Add  to  pure 
hydrochloric  acid,  diluted  with  six  parts  of  water,  one  or  two  drops  of  a 
weak  solution  of  ferric  chloride.  Boil  the  acid  lic[uid  and  introduce  the 
copper,  well  cleaned  and  polished,  into  the  boiling  liquid.  Arsenical  copper 
soon  acquires  a  dark  tarnish,  while  the  non-arsenical  copper  retains  its  red 
color  under  these  circumstances. 

Arsenic  iyi  liquids  containing  organic  matter. — Arsenic  may  exist  in 
an  insoluble  form — i.  e.  as  a  crystalline  powder — in  the  contents  of  the 
stomach  or  any  liquid  article  of  food.  If  coarsely  powdered,  it  may  be 
separated  as  a  heavy  sediment  by  carefully  washing  with  distilled  water, 
and  then  dried  and  tested  by  the  reduction  process  (p.  126).  Any  liquid 
for  analysis  should  be  strained  through  muslin,  or  filtered  throus^h  paper, 
in  order  to  separate  all  insoluble  matters;  these  should  be  well  pressed 
and  drained.  Should  the  liquid  be  colored,  this  is  of  little  moment,  provided 
it  is  clear.  If  viscid,  it  should  be  diluted  with  water  and  boiled  with  a 
small  quantity  of  hydrochloric  acid  ;  on  standing,  a  deposit  may  take  place, 
and  this  should  be  separated  by  a  filter.  As  a  trial-test,  Ave  may  now  boil 
a  slip  of  pure  polished  copper  in  a  portion  of  the  liquid  acidulated  with 
pure  hydrochloric  acid,  and  examine  any  deposit  on  the  metal  by  the 
method  of  Reinsch  above  described.  If  the  copper  comes  out  unchanged, 
there  is  no  considerable  quantity  of  arsenic  present. 

When  arsenic  is  present  in  an  organic  liquid  in  large  quantity,  it  may 
be  precipitated  as  sulphide  by  a  current  of  washed  sulphuretted  hydrogen. 
The  liquid  should  be  boiled,  filtered,  and  acidulated  with  hydrochloric  acid 
before  passing  the  gas  into  it.  When  precipitation  has  ceased,  the  liquid 
should  be  again  filtered,  the  precipitate  collected,  dried,  and  weighed.  Bv 
9 


130 


SEPARATION    OF    ARSENIC    BY    DISTILLATION. 


operating  on  a  measured  portion  of  the  solution,  the  amount  of  white 
arsenic  present  may  be  determined  by  the  weight  of  the  sulphide  obtained 
— five  parts  by  weight  of  sulphide  being  very  nearly  equal  to  four  parts 
of  white  arsenic.  The  properties  of  the  yellow  precipitate  should  be 
verified  according  to  the  directions  given  at  p.  129. 

Distillation  Process. — When  the  poison  is  in  so  small  a  quantity  that 
it  does  not  admit  of  precipitation  by  sulphuretted  hydrogen,  and  no  solid 
particles  of  arsenic  are  found  in  the  stomach,  in  its  contents,  or  in  any 
article  of  food,  another  method  may  be  resorted  to  for  detecting  its  pres- 
ence.    This  method  equally  applies  to  the  detection  of  arsenic  deposited 

Fig.  8. 


Apparatus  for  distilling  organic  and  mineral  substances  containing  arsenic. 

as  a  result  of  absorption  in  the  soft  organs  of  the  body,  as  in  the  liver, 
kidney,  or  heart,  and  to  arsenic  in  all  its  forms,  except  the  pure  insoluble 
sulphide  or  orpiment.  The  substance,  whether  food,  blood,  mucus,  the 
liver  or  other  organ,  should  be  first  thoroughly  dried,  either  in  vacuo,  in 
a  current  of  dry  air,  or  in  a  water-oven.  The  dried  solid  should  then  be 
broken  into  small  portions  and  placed  in  a  flask  or  retort  of  sufficient 
capacity,  with  enough  of  the  strongest  hydrochloric  acid  (free  from 
arsenic)  to  drench  it  completely.  After  some  hours'  digestion  in  the  cold, 
the  retort  or  flask  (a,  Fig.  8)  containing  the  mixture — which  should  be 
of  such  a  size  that  the  materials  should  not  fill  it  to  more  than  one-third 
or  one-half  of  its  capacity — should  be  fitted  with  a  long  condensing-tube 
(c)  (or  a  Liebig's  condenser  may  be  used),  and  then  gradually  heated  by 
a  sand-bath  until  the  acid  liquid  begins  to  pass  over.  A  metallic  head, 
formed  of  a  cone  of  tin-plate  or  sheet-copper  should  be  placed  over  the 
retort  or  flask  so  as  to  concentrate  the  heat  and  prevent  condensation  in 
the  upper  part  of  the  vessel.  A  small  flask  receiver  (d)  with  a  loosely 
fitting  cork  may  be  employed  to  collect  the  product.  This  should  contain 
a  small  quantity  of  distilled  water,  so  as  to  fix  and  condense  any  acid 
vapors  that  may  pass  over.  The  receiver,  as  well  as  the  condensing-tube, 
should  be  kept  cool  by  wetting  its  surface  with  cold  water  diffused  on  a 
layer  of  blotting-paper  placed  over  it.  A  perfect  condensation  of  the 
distilled  liquid  is  insured  by  this  arrangement.  The  distillation  may  be 
carried  to  dryness,  or  nearly  so,  on  a  sand-bath ;  and  it  is  advisable,  in 
order  to  insure  the  separation  of  the  whole  of  the  arsenic  as  chloride,  to 
add  to  the  residue  in  the  retort  when  cold,  another  portion  of  pure  and 
concentrated  hydrochloric  acid,  and  again  distil  to  dryness.  By  this  pro- 
cess arsenic  is  at  once  separated  from  every  metal  excepting  antimony, 
and  these  metals  may  be  easily  distinguished  by  tests  applied  to  the  dis- 


CONVERSION    OF    ARSENIC    INTO    CHLORIDE.  131 

tillate.  If  a  little  pianoforte  wire  be  dir^solved  in  dilute  hydrochloric  acid, 
and  then  added  to  the  solution  in  the  flask,  no  antimony  will  pass  into 
the  distillate. 

The  liquid  product  may  be  colored,  turbid,  and  highly  offensive  if  dis- 
tilled from  decomposed  animal  matter.  Exposure  to  the  air  for  a  few 
hours  sometimes  removes  the  offensiveness,  and  there  is  a  precipitation  of 
sulphur  or  of  some  sulphide  of  arsenic.  The  distillate  may  be  separated 
from  any  deposit  by  filtration,  and,  if  still  turbid,  it  may  be  redistilled  to 
separate  it  from  any  org-anic  matter  that  may  have  come  over.  If  there 
is  a  yellow  deposit,  it  should  be  examined  for  sulphide  of  arsenic. 

If  arsenic  is  present  in  the  substance  submitted  to  distillation,  the  dis- 
tillate will  contain  arsenic  in  the  form  of  soluble  chloride:  this  does  not 
volatilize  from  a  diluted  solution  at  common  temperatures.  The  quantity 
of  dry  organic  substance  used  in  the  experiment  must  depend  on  the 
quantity  of  arsenic  present,  as  revealed  by  a  preliminary  trial  with 
Reinsch's  process.  If  large,  one-third  of  an  ounce  of  the  dried  substance, 
or  even  less,  will  yield  sufficient  chloride  of  arsenic  for  further  proceed- 
ings. For  the  absorbed  and  deposited  poison,  half  an  ounce  of  the  dried 
organ,  corresponding  to  two  ounces  of  the  soft  organ,  will  frequently  suf- 
fice ;  but  a  negative  conclusion  of  the  absence  of  arsenic  should  not  be 
drawn  from  a  smaller  quantity  than  from  two  to  four  ounces  of  the  dried 
substance,  whether  liver,  kidney,  or  heart.  These  tissues,  it  'must  be 
remembered,  contain  about  76  per  cent,  of  water.  If  oily  matter  should 
be  distilled  over,  this  may  be  separated  by  passing  the  distillate  through 
a  paper  filter  wetted  with  water. 

The  distilled  liquid,  containing  chloride  of  arsenic,  should  be  submitted 
to  a  further  analysis.  For  this  purpose  one-third  of  it  should  be  diluted 
with  three  or  four  parts  of  water  and  boiled  in  a  clean  flask.  "When  boil- 
ing, a  piece  of  bright  copper-foil  (free  from  arsenic),  about  1-1 6th  of  an 
inch  square,  should  be  introduced.  If  there  is  chloride  of  arsenic  in  the 
liquid,  even  the  l-4000th  of  a  grain,  its  presence  will  be  indicated  by  a 
change  of  color  and  by  the  deposit  of  a  dark  metallic  film  on  the  copper. 
If  the  quantity  of  arsenic  present  is  believed  to  be  very  small,  the  surface 
of  copper  introduced  should  be  proportionately  small.  Another  portion 
of  the  distilled  liquid  added  to  the  stannous  chloride  and  boiled  (see  p. 
127)  will  give  a  brown  color  or  a  brown  precipitate,  according  to  the 
quantity  of  arsenic  present.  If  this  is  large,  a  dark  mirror-like  "layer  of 
metallic  arsenic  is  deposited  on  the  inside  of  the  tube.  The  remaining 
two-thirds  of  the  distilled  liquid,  sufficiently  diluted,  should  now  be  intro- 
duced into  a  Marsh's  apparatus,  or  into  an  evolution-flask  provided  with 
a  funnel-tube,  the  capacity  of  which  must  be  regulated  by  the  quantity 
of  acid  liquid  to  be  examined.  The  kind  of  apparatus  employed  in  this 
stage  is  represented  in  the  engraving  (Fig.  9,  below):  A  the  flask,  with 
funnel-tube  b,  and  connecting-piece  c ;  the  funnel-tube  should  be  long 
enough  to  dip  just  below  the  surface  of  the  acid  liquid.  The  short  con- 
necting-piece is  bent  at  a  right  angle,  and,  like  d,  is  carried  through  a 
closely-fitting  cork  in  the  neck  of  the  flask.  This  tube  should  be  only 
long  enough  to  go  through  the  cork,  and  its  open  end  should  be  bevelled 
off  so  that  any  vapor  which  is  condensed  on  it  may  drop  back  as  a  liquid 
into  the  flask.  D  is  the  -drying-tube  containing  fragments  of  spongy 
chloride  of  calcium,  secured  by  cotton  wool  at  both  ends.  At  the  flask 
end  of  this  tube  should  be  placed  some  well-dried  bibulous  paper  saturated 
with  acetate  of  lead.  This  has  the  advantage  of  stopping  any  gaseous 
sulphur  compound  which  may  escape  from  the  zinc  or  acid  liquid,  e  E,  a 
hard  and  not  easily  fusible  glass  tube,  free  from  lead,  contracted  in  two 


132 


REDUCTION    OF    CHLORIDE. 


situations,  k  k',  to  about  the  diameter  of  the  tenth  of  an  inch  or  less,  the 
tube  itself  having  a  diameter  of  from  a  quarter  to  three-eighths  of  an  inch, 
r  r  are  supports  made  of  stout  wire,  to  prevent  the  tube  from  falling  when 


Fi-.  9. 


Apparatus  for  testing  Chloride  of  Arsenic  obtained  by  distillation. 
Fig.   10. 


Portion  of  tube  separated  ■with  a  deposit  of  Metallic  Arsenic  in  the  contracted  portion. 

heated  to  redness,  g  is  a  test-glass  to  hold  one  or  two  fluid  drachms  of  a 
strong  solution  of  nitrate  of  silver,  h  is  a  Bunsen  burner  ;  or  a  spirit»lamp 
may  be  used. 

The  arrangement  being  thus  made,  the  zinc  and  hydrochloric  acid  are 
first  tested  as  to  their  freedom  from  arsenic.  Portions  of  pure  zinc  are 
placed  in  the  flask  A,  the  parts  of  the  apparatus  are  then  connected,  an-d 
pure  hydrochloric  acid,  diluted  with  three  or  four  parts  of  water,  is  poured 
into  the  flask  by  the  funnel  b,  which  operates  as  a  safety-valve.  Bubbles 
of  air  and  gas  speedily  appear  in  the  liquid  in  g,  if  the  cork  fits  well  and 
the  whole  of  the  arrangements  are  air-tight.  Pure  zinc  is  sometimes  but 
imperfectly  acted  on  by  the  acid.  In  this  cape  some  clean  platinum  wire 
or  foil  may  be  wound  round  the  bars  of  the  zinc,  and  the  evolution  of 
hydrogen  will  be  thus  accelerated.  It  is,  however,  better  that  the  hydro- 
gen should  come  off"  rather  slowly.  If  the  materials  are  pure,  the  solution 
of  niti'ate  of  silver  should  undergo  no  change  of  color.  The  glass  G  should 
be  placed  on  a  sheet  of  white  paper,  whereby  the  slightest  tinge  of  brown 
or  black  is  made  perceptible.  When  all  the  air  is  expelled  from  the  tube, 
the  smokeless  flame  H  may  be  applied  to  it  at  about  one  inch  in  front  of 
a  contraction  of  the  tube,  as  indicated  in  the  engraving,  and  the  glass 
heated  to  redness.  No  metallic  deposit  should  take  place  at  k.  If  the 
materials  are  quite  pure,  the  transparenc}^  of  the  g'lass  tube  at  k  will  be 
unchanged.  From  a  quarter  to  half  an  hour  will  be  sufficient  for  this 
experiment.  Now  add  to  the  acid  liquid  in  the  flask  A  a  portion  of  the 
liquid  obtained  by  distillation.  The  presence  of  arsenic  in  this  will  be 
immediately  revealed  by  the  silver  solution  in  the  glass  G  acquiring  a 
brown  or  black  color,  according  to  the  quantity  of  arsenic  present,  and  at 
the  same  time  deposits  of  metallic  arsenic  may  be  obtained  by  heating 
the  glass  tube  e  e. 

The  silver  solution  is  allowed  to  become  saturated  with  the  gas.  Any 
escape  of  the  gas  from  the  glassj  or  by  leakage  from  any  of  the  junctions 
of  the  apparatus,  is  at  once  indicated  by  holding  near  to  the  spot  filtering- 
paper  wetted  with  nitrate  of   silver.      This  is  blackened  if  arsenic  is 


ARSENIC    IN    ORGANIC    LIQUIDS    AND    SOLIDS.  18B 

escaping.  The  glass  with  the  silver  solution  is  removed,  the  end  of  the 
tube  well  washed,  or  another  tube  substituted  for  e  e,  and  this  is  allowed 
to  dip  into  about  one  drachm  of  fuming  nitric  acid  in  a  test-glass  similar 
to  G,  or  in  a  small  porcelain  capsule.  After  a  time  the  acid  loses  its  color, 
and  the  arsenic  of  the  gas  is  converted  into  arsenic  acid,  which  may  be 
obtained  by  evaporation. 

The  further  testing  of  the  products  is  simple.  1.  The  silver  solution 
contains  arsenic  in  the  state  of  dissolved  ar.senious  acid,  with  some  excess 
of  nitrate  of  silver.  By  filtration  it  is  obtained  colorless  and  clear.  A 
weak  solution  of  ammonia  is  then  added  to  it,  and  yellow  arsenite  of  silver 
is  precipitated  (see  p.  127).  2.  The  nitric  acid  liquid  is  evaporated  to 
dryness  in  a  small  porcelain  capsule.  One  or  two  drops  of  water  are 
added  to  the  residue,  with  a  drop  of  weak  ammonia  if  it  should  be  very 
acid.  A  solution  of  nitrate  of  silver  is  then  added  to  it;  arsenate  of 
silver,  of  its  well-known  brick-red  color,  is  immediately  produced.  3. 
The  portions  of  tube  k  k'  with  the  metallic  deposits  in  them  may  be 
separated  by  a  file,  and  then  hermetically  sealed  ;  or,  if  necessary,  one  or 
more  of  them  may  be  tested  by  the  methods  described  on  pp.  128,  129. 

With  these  results  the  evidence  of  the  presence  of  arsenic  may  be  con- 
sidered to  be  conclusive.  The  poison  is  obtained  by  this  process,  not 
only  in  its  pure  metallic  state,  but  in  the  distinct  two  forms — arsenious 
and  arsenic  acids.  It  will  be  observed  that  the  process  here  employed  is 
an  improved  form,  in  which  the  burning  of  the  gas  is  unnecessary. 

The  editor  prefers  to  precipitate  the  liquid  in  the  receiver,  after  dilution 
with  water,  by  means  of  a  stream  of  sulphuretted  h3'drogen  gas,  and  to 
collect,  wash,  and  dry  the  precipitate.  It  is  then  mixed  with  a  dry  flux 
of  carbonate  of  sodium  and  cyanide  of  potassium,  and  introduced  into  a 
hard  narrow  glass  tube,  through  which  a  stream  of  dry  carbonic  acid  gas 
is  passing.  On  applying  heat  to  the  mixture  of  yellow  sulphide  of 
arsenic  and  flux,  a  fine  sublimate  of  metallic  arsenic  is  obtained,  even  with 
a  minute  trace  of  arsenic  ;  and  to  this  sublimate  appropriate  tests  .can  be 
applied  (see  p.  128). 

Eeinsch^s  process  can  be  employed  for  detecting  arsenic,  deposited  as  a 
result    of  absorption,  in   the   liver,  kidneys,  or   other  soft  parts.     About 
four  ounces  of  the  organ,  or  more  if  necessary,  cut   into 
small  pieces,  may  be  boiled  in  a  flask  in  a  mixture  of    one  Fig-  H- 

part  of  pure  hydrochloric  acid  and  four  of  water,  until  the 
structure  of  the  organ  is  broken  up.  The  flask  may  be  of 
the  shape  represented  in  the  annexed  engraving  (Fig.  11), 
and  either  a  naked  flame  or  a  sand-bath  may  be  employed, 
A  small  glass  funnel  should  be  placed  in  Vhe  neck  of  the 
flask.  This  receives  and  condenses  the  vapors,  which  fall 
back  into  the  flask.  By  this  arrangement  the  boiling  may 
be  continued  for  a  long  time  without  material  loss  by 
evaporation.  The  flask  should  not  be  more  than  half  full, 
and  heated  gently  until  all  froth  is  expelled.  A  fine  plati- 
num wire,  having  a  small  piece  of  pure  copper-foil,  should  ^  a- 
be  immersed  in  the  liquid  when  boiling.  This  enables  tiie  TnaivsL  of 
the  operator  to  remove  the  copper  and  examine  it  at  in-  Ednsch^r  prV- 
tervals,  after  immersing  it  in  distilled  water.  If  it  is  cess. 
much  coated  with  metallic  deposit,  larger  portions  of  cop- 
per-foil may  be  successively  introduced  until  the  liquid  is  exhausted. 
The  deposit  on  the  copper  may  then  be  tested  by  the  method  described  at 
p.  129.  The  deposit  is  permanent.  Some  copper  gauze  on  which  arsenic 
had  been  thus  deposited  was  examined  after  twenty-five  yeai-s,  and,  al- 


134  AESEXITE  OF  POTASSIUM. 

though  much  changxd  in  appearance  bj  exposure,  it  yielded  a  perfect  sub- 
limate of  octahedral  crystals. 

It  need  hard!}'  be  observed  that  the  quantity  of  arsenic  found  in  the 
stomach  or  other  organs  can  convey  no  accurate  idea  of  the  quantity 
actually  taken  by  the  deceased,  since  more  or  less  of  the  poison  may  have 
been  removed  by  violent  vomiting  and  purging  as  well  as  by  absorption 
and  elimination.  A  large  quantity  found  in  the  stomach  or  bowels  indi- 
cates a  large  dose ;  but  the  finding  of  a  small  quantity  does  not  prove 
that  the  dose  was  small.  The  value  of  chemical  evidence  does  not  depend 
on  the  discovery  of  any  particular  quantity  of  poison  in  the  stomach — it 
is  merely  necessary  that  the  evidence  of  its  presence  in  the  body  should 
be  clear,  distinct,  conclusive,  and  satisfactory.  At  the  same  time,  a  reas- 
onable objection  may  be  taken  to  a  dogmatic  reliance  upon  the  alleged 
di-scovery  in  a  dead  body  of  minute  fractional  portions  of  a  grain  ;  and, 
considei'ing  the  great  liability  to  fallacy  from  the  accidental  presence  at 
that  date  of  arsenic  in  the  articles  used  for  its  detection,  the  chemical  evi- 
dence in  the  French  case  of  Madame  Laffarge  (1840),  in  which  the  whole 
quantity  discovered  in  the  dead  body  was  stated  to  be  the  l-130th  part 
of  a  grain,  was  of  a  most  unsatisfactory  kind,  and  should  have  been  re- 
jected. No  man  ought  to  base  evidence  on  such  a  minute  quantity  of 
poison  in  a  case  of  life  and  death. 

The  condition  of  the  arsenic  found  in  a  stomach  should  be  specially 
noticed.  A  witness  should  be  prepared  to  say  whether  it  is  in  fine 
powder  or  in  coar.se  fragments ;  whether  it  is  mixed  with  soot  or  indigo, 
or  whether  it  is  in  the  ordinary  state  of  white  arsenic.  These  points  may 
be  material  as  evidence  in  reference  to  proof  of  possession,  of  purchase, 
or  administration.  Arsenic  is  not  a  normal  constituent  of  the  human 
body.  Under  no  circumstances  is  it  found  in  the  tissues  after  death, 
except  in  cases  in  which  it  has  been  taken  or  administered  during  life. 

Arsexite  of  Potassium.  Liquor  Arsenicalis.  (Fowler's  Solu- 
iios.)-^Symptoms  and  A'ppearances. — There  is  a  case  recorded  in  which 
this  medicinal  solution  destroyed  life.  A  woman  took  half  an  ounce 
(  =  two  grains  of  white  arsenic)  in  divided  doses,  during  a  period  of  five 
days,  and  died  from  the  effects.  There  was  no  vomiting  or  purging,  but 
after  death  the  stomach  and  intestines  were  found  inflamed.  (Prov.  Jour., 
1848,  p.  341.)  A  mixture  of  arsenic,  soft-soap,  and  tar- water  is  largely 
used  in  agricultural  districts  for  killing  the  fly  in  sheep.  This  has  caused 
death,  under  the  usual  symptoms  of  arsenical  poisoning,  in  at  least  two 
in.stances.  In  1814  the  Coombs  family,  consisting  of  eight  persons — the 
father,  mother,  and  six  children — were  all  poisoned  by  drinking  water 
from  a  bucket  which  had  contained  an  arsenical  sheep-dipping  composi- 
tion. The  mother  and  three  of  the  children  died.  The  symptoms  pro- 
duced w'ere  unusual — diarrhoea  being  a  less  prominent  symptom  than 
vomiting.  The  poison  appeared  to  exercise  a  profound  impression  upon 
the  nervous  system,  producing  tetanic  spasms  and  convulsions.  An 
arsenical  rash  was  a  characteristic  of  the  severest  and  fatal  cases.  In  the 
bodies  of  the  mother  and  one  child  the  editor  detected  arsenic.  The 
bodies  of  the  other  two  children  were  not  examined  for  poison. 

Analysis. — The  solution  has  the  odor  of  tincture  of  lavender,  is  of  a 
reddish  color,  and  has  an  alkaline  reaction.  One  fluidounce  of  it  contains 
4^  grains  of  ar.<enious  oxide.  It  gives  a  green  precipitate  (arsenite  of 
copper)  with  sulphate  of  copper  and  a  yellow  precipitate  with  nitrate  of 
silver.  Acidulated  with  hydrochloric  acid,  and  treated  with  a  current  of 
sulphuretted  hydrogen  gas,  it  yields  a  yellow  sulphide  ;  and,  when  boiled 


FLY-WATER ARSENITE    OF    COPPER.  135 

with  that  acid  and  pure  coppei'  a  deposit  is  obtained  which  readily  fur- 
nishes, by  heat,  octahedral  crystals  of  arsenious  oxide. 

Fly- WATER  is  a  name  applied  to  solutions  of  various  arsenical  com- 
pounds in  water.  Mixtures  of  this  kind  are  formed  by  dissolving-  one  part 
of  the  arsenite  of  sodium  or  potassium  and  two  parts  of  sugar  in  twenty 
parts  of  water.  Paper  soaked  in  this  solution,  and  dried,  is  used  for 
killing  flies  under  the  name  of  Fapier  moure ;  and  perhaps  this  is  the 
safest  form  in  which  arsenic  can  be  used  for  such  a  purpose.  The  editor 
has  found  the  fly-papers  of  commerce  to  contain  from  7i  to  10  grains  each 
of  arsenious  acid  in  a  soluble  form.  In  1884  two  women  were  convicted 
(Reg.  V.  Flannagan  and  Higgins,  Liverpool  Winter  Ass.,  1884)  of  the 
murder  of  four  persons  by  means  of  infusions  of  such  paper.  (Brit.  Med. 
Jour.,  1884,  i.  pp.  419,  469.) 

Arsenite  of  Copper.  Scheele's  Green.  Emerald  Green. — This 
is  a  metallic  arsenite,  met  with  in  commerce  and  the  arts ;  and  it  con- 
stitutes, M^holly  or  in  part,  a  great  variety  of  green  pigments  employed 
for  paper-hangings,  known  as  emerald  green  (aceto-arsenite  of  copper), 
mineral  green,  Brunswick,  Schweinfurt,  Vienna,  or  Paris  green.  It  is  also 
found  in  the  form  of  oil-paint,  forming  cakes  in  boxes  of  water-colors, 
spread  over  confectioner}^,  in  wafers,  on  adhesive  envelopes,  in  wrappers 
for  chocolate,  isinglass,  etc.,  and  lastly,  and  most  abundantly,  in  various 
kinds  of  green  decorative  papers  used  for  covering  the  walls  of  sitting  and 
bedrooms 

Although  this  compound  is  insoluble  in  water,  it  is  sufficently  soluble 
in  the  acid  mucous  fluids  of  the  stomach  to  be  taken  up  by  the  absorbents 
and  carried  as  a  poison  into  the  blood.  Eoussin  has  traced  the  means  by 
which  the  insoluble  poison  finds  it  way  through  the  skin,  and  the  circum- 
stances under  which  it  may  be  absorbed  by  the  unbroken  skin.  In  two 
cases  which  proved  fatal  in  1865,  the  workmen  suffered  chiefly  from  vomit- 
ing and  colicky  pains.  The  skin  was  tinged  of  a  green  color  and  arsenic 
was  detected  in  the  soft  organs.  He  found  that  all  poisons  were  liable  to 
be  absorbed  by  the  unbroken  skin  when,  as  a  result  of  evaporation,  a  solid 
film  was  left  on  the  surface.  Alcohol  and  other  solvents  of  fat,  when  used 
as  solvents  for  the  poisonous  solid,  would  favor  its  absorption  into  the 
body.     (Ann.  d'Hyg.,  1867,  pp.  179,  182.) 

In  a  case  which  was  the  subject  of  a  criminal  trial,  the  substance  was 
proved  to  have  caused  the  death  of  a  gentleman  by  reason  of  its  having 
been  employed  to  give  a  rich  green  color  to  some  blanc-mange  served  at  a 
public  dinner — the  person  who  employed  it  considering  that  emerald  or 
mineral  green  was  nothing  more  than  an  extract  of  spinach,  which  is  com- 
monly employed  for  coloring  confectionery  and  ices.  It  led  to  death  under 
the  usual  symptoms,  and  the  parties  were  convicted  of  manslaughter. 
(Reg.  V.  Franklin  and  Randall,  Northampton  Sum.  Ass.,  1848.) 

The  symptoms  of  poisoning  that  have  been  observed  in  persons  who 
have  inhabited  rooms  of  which  the  walls  were  covered  with  this  arsenical 
compound  are  as  follows  :  dryness  and  irritation  of  the  throat,  bronchial 
cough,  irritation  of  the  mucous  membrane  of  the  eyes  and  nostrils,  languor, 
headache,  loss  of  appetite,  nausea,  colicky  pains,  numbness,  ci-amp,  irrita- 
bility of  the  bowels  attended  with  mucous  discharges,  great  prostration  of 
strength,  a  feverish  condition,  and  wasting  of  the  body.  These  symptoms 
may  not  all  present  themselves  in  any  one  case  ;  they  are  derived  from 
the  examination  of  numerous  cases.  No  suspicion  of  the  cause  has  in 
many  instances  been  entertained  until  ordinary  treatment  hnd  failed  to  im- 
part relief  and  an  analysis  of  the  paper  had  been  made.  The  connection 
of  the  symptoms  with  this  cause  appears  to  have  been  in  some  instances 


136  SULPHIDES    OF    ARSENIC. 

elearly  established  by  the  fact  that,  after  the  removal  of  the  paper,  especi- 
ally from  bedrooms,  the  symptoms  have  disappeared.  (Brit.  Med.  Jour., 
1876,  ii.  p.  653  ;  also,  187T,  i.  p.  8.)  Yet  comparatively  few  of  those  who 
are  exposed  suffer  from  symptoms  of  poisoning'.  Various  deaths,  chiefly 
among"  children,  from  the  use  of  this  paper  are  now  recorded  ;  and  it  is 
probable  that  to  the  noxious  practice  of  covering  the  walls  of  our  sitting 
and  bedrooms  with  large  quantities  of  arsenic  in  loose  powder  many  in- 
sidious cases  of  illness  and  chronic  disease  may  be  referred.  Men  and 
women  employed  in  the  manufacture  of  these  poisonous  pigments  suifer 
severely.  Girls  employed  in  making  artificial  green  leaves,  in  which  this 
substance  is  used  in  fine  powder,  may  suffer  from  inflammation  of  the 
conjunctivse,  with  thickening  and  swelling  of  the  eyelids.  (Lancet,  1873, 
i.  p.  174.)  The  precautions  now  adopted  render  such  cases  rare.  Children's 
toys  are  often  colored  with  this  poisonous  compound.  In  one  case  a 
child,  £et.  5  years,  was  seized  with  sickness,  diarrhoea,  and  great  depres- 
sion. The  cause  of  these  symptoms  was  traced  to  a  box  of  counters 
colored  bright  green.  The  child  had  imbibed  the  poison,  either  by  hand- 
ling or  patting  the  counters  into  its  mouth. 

Analysis. — For  the  chemical  characters  of  Scheele's  Green,  see  p. 
128.  The  wall-paper  pigment  called  Emerald  Green  is  a  mixture  of 
arsenite  and  acetate  of  copper.  The  green  color  is  very  intense,  even  by 
candle-light.  The  presence  of  arsenic  in  this  compound  may  be  easily 
detected  by  the  test  for  solid  arsenic  (p.  126);  but  the  following  is  a 
simple  method  which  admits  of  speedy  application  :  A  slip  of  the  sus- 
pected paper  should  be  soaked  in  a  moderately  strong  solution  of  ammonia. 
The  green  color  is  removed,  and  a  blue  compound  of  copper  is  formed  and 
dissolved  in  a  few  minutes.  This  result  establishes  only  the  presence  of 
a  compound  of  copper  soluble  in  ammonia.  If  the  ammonia  does  not  be- 
come blue,  there  is  no  compound  of  copper  present ;  if  it  does  become  blue, 
a  large  crystal  of  nitrate  of  silver  should  be  placed  in  a  white  saucer  and 
a  small  portion  of  the  blue  liquid  poured  over  it.  The  presence  of  arsenic 
in  the  blue  liquid  is  revealed  by  the  production  of  yellow  arsenite  of  silver 
over  the  surface  of  the  crystal. 

Arsenic  Acid.  Alkaline  Arsenates. — Arsenic  acid  is  an  artificial 
product  almost  entirely  confined  to  the  chemical  laboratory  and  to  the 
manufactory.  Some  authors  state  that  it  is  a  more  powerful  poison 
than  arvsenious  acid  ;  others,  that  it  is  less  poisonous.  No  fatal  case  of 
poisoning  by  it  in  the  human  subject  has  been  recorded.  The  arsenates 
of  potassium  and  sodium  must  be  regarded  as  active  poisons,  although  there 
are  but  few  instances  on  record  in  which  life  has  been  destroyed  by  them. 

Analysis. — Arsenic  acid  is  a  white,  non-crystalline,  deliquescent  solid. 
1.  It  is  very  soluble  in  water,  forming  a  highly  acid  solution.  2.  It  is 
precipitated  of  a  brick-red  color  hj  ammonio-nitrate  of  silver. 

Sulphides  of  Arsenic.  —  Orpiment,  or  Yellow  Arsenic,  owes  its 
poisonous  properties  to  the  presence  of  a  variable  proportion  of  arsenious 
acid,  sometimes  amounting  to  as  much  as  thirty  per  cent,  of  its  weight. 
Orpiment  is  much  employed  in  the  arts,  in  painting,  dyeing,  paper-stain- 
ing, the  coloring  of  toys,  and  formerly  for  the  coloring  of  sweetmeats; 
but  it  is  not  often  used  as  a  poison.  In  the  exhumation  of  the  bodies  of 
persons  Avho  have  died  from  arsenic  it  is  common  to  find  the  yellow  sul- 
phide in  the  stomach.  White  may  be  converted  into  yellow  arsenic  in 
the  dead  body,  but  yellow  cannot  be  changed  into  Vi'hite  arsenic  during 
putrefaction. 

Orpiment  produces  syviptoms  and  appearances  similar  to  those  caused 
by  arsenious  acid  ;  but  the  dose  required  to  destroy  life  varies  according 


CHLORIDE    OF    ARSENIC — ARSENETTED    HYDROGEN.  137 

to  the  proportion  of  arsenious  acid  with  which  it  happens  to  be  mixed. 
This  is  not  a  common  form  of  poisoning  ;  the  yellow  color  of  the  poison 
would  lead  to  suspicion  ;  but  by  reason  of  this  color,  orpiment  may  be 
given  or  taken  by  mistake  for  mustard  or  turmeric.  The  editor  has  met 
in  his  practice  with  one  fatal  case.  The  symptoms  differed  in  no  respect 
from  those  of  a  typical  case  of  poisoning*  by  white  arsenic.  Orpiment  is 
largely  used  in  tanning. 

Analysis. — The  commercial  sulphide  yields  a  solution  of  arsenious  acid 
on  boiling  it  in  water  acidulated  with  hydrochloric  acid.  It  readily  gives 
the  well-known  sublimates  of  metallic  arsenic,  either  with  soda-flux  or 
cyanide  of  potassium  (see  p.  126). 

Chloride  of  Arsenic. — This  is  a  solution  of  arsenic  in  diluted  hydro- 
chloric acid,  used  in  pharmacy.  It  contains  4^  grains  of  arsenious  acid 
in  one  fluidounce.  It  is  a  highly  poisonous  preparation.  In  1857  a 
woman  took,  in  three  doses,  thirty  minims  over  a  period  of  twenty-four 
hours.  The  quantity  of  arsenic  taken  was  not  more  than  the  tenth  pai^t 
of  a  grain,  and  yet  the  symptoms  which  followed  were  of  a  severe  kind, 
resembling  those  of  chronic  poisoning.  These  were  constriction  of  the 
throat,  pain  and  irritation  of  the  stomach  and  bowels,  tingling  and  numb- 
ness of  the  hands  and  feet,  loss  of  muscular  power,  and  a  feeling  of 
extreme  depression.  The  medicine  was  withdrawn,  and  the  patient 
slowly  recovered.  It  seems  that  she  had  not  taken  arsenic  previously, 
and  there  was  no  evidence  of  the  existence  of  a  peculiar  susceptibility  to 
the  effects  of  arsenic.  The  quantity  taken  was  very  small  to  produce 
such  alarming  symptoms.  The  usual  medicinal  dose  of  this  solution  is 
from  two  to  eight  minims. 

Analysis. — This  compound  is  the  product  obtained  in  the  separation 
of  arsenic  from  organic  solids  by  distillation  with  hydrochloric  acid  (see 
p.  130).  It  may  be  tested  by  the  processes  of  Marsh  and  Reinsch,  as 
there  described.  When  boiled  with  fuming  stannous  chloride,  it  is  decom- 
posed and  metallic  arsenic  of  a  brown-black  color  is  deposited. 

Arsenetted  Hydrogen. — This  is  a  gaseous  poison  of  arsenic,  producing 
when  respired,  even  in  small  quantity,  very  serious  effects  upon  the  system. 
It  has  caused  death  in  several  instances  among  chemists  who  have  incauti- 
ously breathed  the  deadly  vapor  while  performing  scientific  experiments. 
Trost  has  reported  three  other  fatal  cases  with  a  full  account  of  the  symp- 
toms and  appearances.  These  cases  occurred  accidentally  among  workmen 
engaged  in  separating  silver  from  lead  by  means  of  zinc  and  hydrochloric 
acid.  The  latter  was  found  to  contain  much  arsenic,  which  escaped  with 
the  hydrogen.  (Vierteljahrsschr.  f  Gerichtl.  Med.,  1873,  1,  p.  269.  See 
On  PoisoiNS,     Chem.  News,  1863,  ii.  p.  3U7,) 


l38  MERCURY CORROSIVE    SUBLIMATE. 


CHAPTER   XII, 

POISOXIXG    BY    MERCURY. CORROSIVE    SUBLIMATE. SYMPTOMS.  —  CHRONIC    POISONING. AP- 
PEARANCES   AFTER    DEATH. CHEMICAL    ANALYSIS. PROCESS    FOR    MERCURY    IN    ORGANIC 

LIQUIDS. CALOMEL. WHITE  AND    RED    PRECIPITATES. OTHER  COMPOUNDS  OF    MERCURY. 

Metallic  mercury  is  not  commonly  regarded  as  a  poison.  It  is  usually 
stated  that  a  large  quantity  of  it  may  be  swallowed  without  affecting- 
health,  or  without  causing  more  uneasiness  than  that  Avhich  may  arise 
from  its  great  weight.  It  rapidly  passes  through  the  bowels.  A  case 
which  occurred  to  Gibb  shows  that  this  is  not  strictly  true.  For  the  pur- 
pose of  causing  abortion  a  girl  swallowed  four  and  a  half  ounces  by 
weight  of  mercury.  It  had  no  effect  on  the  womb,  but  in  a  few  days  the 
girl  suffered  from  a  trembling  and  shaking  of  the  body  (mercurial  tremors) 
and  loss  of  muscular  power.  These  symptoms  continued  for  months,  but 
there  was  no  salivation  and  no  blue  mark  on  the  gums,  (Lancet,  1873, 
i.  p.  339.)  If  mercury  is  breathed  or  swallowed  in  a  state  of  vajoor,  or  if 
applied  to  the  skin  or  mucous  membrane  in  a  state  of  extreme  mechanical 
division,  in  which  state  it  appears  to  be  easily  susceptible  of  oxidation,  it 
is  liable  to  be  absorbed,  and  to  produce  a  poisonous  action  on  the  body. 
The  effects  are  principally  manifested  by  salivation,  trembling,  and  in- 
voluntary motions  of  the  limbs,  loss  of  appetite,  and  emaciation.  These 
symptoms  are  occasionally  seen  in  workmen  engaged  in  trades  in  which 
they  are  exposed  to  the  inhalation  of  mercurial  vapors. 

Corrosive  Sublimate. — This  substance  has  received  a  variety  of 
chemical  names.  It  has  been  at  various  times  called  Oxymvriate,  Chlo- 
ride, Bichloride,  Mercuric  Chloride,  and  Perchloride  of  Mercury.  To 
prevent  any  confusion  from  scientific  chemical  nomenclature,  the  old  and 
popular  name  of  Corrosive  Sublimate,  expressing  the  principal  properties 
of  the  substance,  is  here  retained.  It  is  commonly  seen  under  the  form 
of  heavy  crystalline  masses,  or  of  a  white  crystalline  powder.  Its  taste 
is  powerfully  austere  and  metallic,  so  that  no  poisonous  quantity  of  it 
could  be  easily  swallowed  without  the  person  becoming  immediately 
aware  of  it.  Its  solutions,  even  when  very  highly  diluted — 1  in  20,000 — 
have  an  intensely  metallic  (coppery)  taste.  It  is  very  soluble  m  water, 
hot  or  cold,  and  speedily  sinks  in  it,  in  which  properties  it  differs  strik- 
ingly from  arsenic.  At  the  ordinary  temperature  it  dissolves  in  about 
fifteen  parts  of  water;  but  the  poison  is  more  freely  soluble  in  alcoholic 
liquids  and  ether.     It  is  largely  used  as  an  antiseptic. 

Symptoms. — The  symptoms  produced  by  corrosive  sublimate  generally 
come  on  immediately,  or  within  a  few  minutes  after  the  poison  has  been 
swallowed.  In  the  first  place,  a  .strong  metallic  taste  in  the  mouth,  often 
described  as  a  coppery  taste,  is  perceived  ;  and  there  is,  during  the  act  of 
swallowing,  a  sense  of  constriction  almost  amounting  to  suffocation,  with 
l}urning  heat  in  the  throat,  extending  downwards  to  the  stomach.  In  a 
few  minutes  violent  pain  is  felt  in  the  abdomen,  increased  by  pressure, 
especially  in  the  region  of  the  stomach.  There  is  nausea,  with  frequent 
vomiting  of  long,  stringy  masses  of  white  mucus,  mixed  with  blood, 
attended  with  severe  pain  in  the  abdomen  and  profuse  purging.  The 
countenance  is  sometimes  swollen  and  flushed  :  in  other  cases  it  has  been 


CORROSIVE    SUBLIMATE  —  SYiMPTOMS.  139 

pale  and  anxious.  The  pulse  is  small,  frequent,  and  irreg-ular,  and  is 
scarcely  perceptible  when  the  symptoms  become  ag-gravated.  The  tongue 
is  white  and  t^hrivelled,  the  skin  cold  and  clammy,  the  breathing  difficult; 
and  death  i.s  commonly  preceded  by  fainting,  convulsions,  or  general  in- 
sensibility. The  internal  parts  of  the  mouth,  when  examined,  are  swollen, 
and  sometimes  present  a  white  appearance,  as  if  the  cavity  had  been 
recently  washed  with  a  solution  of  nitrate  of  silver;  the  lips  are  often 
swollen.  Suppression  of  urine  has  been  frequently  noticed  among  the 
symptoms  :  it  existed  in  a  vvell-marlced  case  of  poisoning  by  this  substance 
where  the  patient  lived  four  days,  but  did  not  pass  any  urine  during  the 
whole  of  this  time.  (Gruy's  Hosp.  Rep.,  1844,  p.  24.)  This  symptom 
was  observed  in  a  case  reported  by  Wegeler  (Casper's  Wochenschrift, 
1846,  p.  30),  in  which  a  youth,  ^t.  IT,  swallowed  three  drachms  of  the 
poison,  and  died  on  the  sixth  day.  During  the  last  three  daj's  no  urine 
was  secreted.  The  case  was  otherwise  remarkable  from  the  fact  that  no 
pain  was  experienced  on  pressure  of  the  abdomen,  and  that  the  pulse 
underwent  no  change  until  shortly  before  death.  In  another  case,  in  which 
twenty  grains  of  corrosive  sublimate  in  solution  were  swallowed,  suppres- 
sion of  urine  and  salivation  came  on  the  third,  and  the  patient  died  on  the 
ninth  day.     (Lancet,  1845,  ii.  pp.  650,  698.) 

The  external  application  of  corrosive  sublimate  to  tumors  or  ulcers  may 
destroy  life  with  all  the  usual  symptoms  of  acute  mercurial  poisoning. 
A  quack  was  convicted  of  manslaughter  (Winchester  Lent  Ass.,  1859, 
Reg.  V.  Crook)  by  applying  corrosive  sublimate  in  powder  to  a  cancerous 
tumor  on  the  face  of  the  deceased.  The  man  died  under  the  usual  symp- 
toms. After  death  the  bowels  were  found  extensively  inflamed  and  ulcer- 
ated. Corrosive  sublimate  was  detected  in  the  diseased  part.  At  the 
Exeter  Lent  Assizes,  1878,  a  quack-doctor  was  indicted  for  the  man- 
slaughter of  a  woman  under  similar  circumstances.  The  deceased  had 
ulcers  on  her  legs,  and  a  solution  of  corrosive  sublimate,  largely  diluted, 
was  applied  by  the  prisoner  in  order  to  cure  them.  The  death  of  the 
woman  was  assigned  to  the  absorption  of  the  poison  ;  but  the  judge  held 
that  gross  and  culpable  ignorance  had  not  been  proved,  and  under  his 
direction  the  prisoner  was  acquitted.  A  girl,  set.  9,  died  from  the  effects 
of  this  poison  locally  applied  to  the  scalp  for  the  treatment  of  ringworm. 
The  liquid  applied  was  alcohol  containing  eighty  grains  of  corrosive  sub- 
limate to  the  ounce.  She  suffered  from  mei'curial  poisoning  in  a  severe 
form,  and  died  on  the  fifth  day  after  the  application.  (Pharm.  Jour., 
Sept.  9,  1871,  p.  216;  Lancet,  1871,  ii.  p.  413  ;  and  Med.  Times  and  Gaz., 
1871,  p.  353.)  Xo  theory  of  idiosyncrasy  is  required  to  account  for  death 
under  such  circumstances.  In  the  first  edition  of  the  author's  work  On 
Poisons  (1848),  p.  394,  fatal  cases  are  related  of  poisoning  by  corrosive 
sublimate  through  the  unbroken  skin.  Two  brothers  thus  lost  their 
lives,  the  one  dying  on  the  fifth  and  the  other  on  the  eleventh  day. 
Those  who  deny  the  power  of  the  unbroken  skin  to  absorb  corrosive  sub- 
limate and  cause  all  the  usual  effects  of  acute  mercurial  poisoning,  should 
make  themselves  and  not  their  patients  the  subjects  of  experiment"  Severe 
salivation  sometimes  follows  the  external  application  of  a  mercurial  com- 
pound. In  1884  a  man  was  tried  at  the  Surry  Sessions  for  putting  corro- 
sive sublimate  into  a  kettle  of  water.  He  was  acquitted.  Several  persons 
suffered  from  partaking  of  the  poisoned  liquid. 

Corrosive  sublimate  differs  from  arsenic:  1,  in  having  a  well-marked 
taste  ;  .2,  in  producing  violent  symptoms  in  a  few  minutes;  and  3,  in  the 
fact  that  the  evacuations  are  more  frequently  mixed  with  blood.  The 
symptoms  produced  by  corrosive  sublimate,  in  the  first  Instance,  resemble 


140  APPEARANCES  AFTER  DEATH, 

those  of  cholera ;  but  if  the  person  should  survive  several  days  they  are 
more  like  those  of  dj^sentery — violent  straining  and  shreddy  mucous  dis- 
charges mixed  with  blood  being  frequently  observed. 

Stow  07-  Chronic  Poisoning. — The  symptoms  are  much  modified  when 
the  poison  is  taken  in  small  doses  at  intervals  for  some  days  or  weeks. 
There  are  colicky  pains  with  nausea,  vomiting,  general  uneasiness,  and 
depression.  The  salivary  glands  become  inflamed  and  painful ;  the  tongue 
and  gums  are  red  and  swollen,  sometimes  ulcerated,  and  there  is  fetor  of 
the  breath.  A  deep  blue  line,  like  that  observed  in  poisoning  by  lead,  is 
sometimes  found  around  the  edges  of  the  gums.  The  patient  experiences 
difficulty  of  swallowing  and  breathing.  The  constitutional  effects  are 
indicated  by  irritability  or  looseness  of  the  bowels,  difficulty  of  breathing, 
spitting  of  blood,  cough,  general  trembling  or  convulsive  movements  of 
the  limbs,  and  palsy,  with  fever  and  emaciation,  under  which  the  patient 
sinks.  One  of  the  most  marked  effects  of  slow  or  chronic  poisoning  by 
mercurial  preparations  is  salivation,  or  ptyalism,  indicated  by  an  increased 
flow  of  saliva.  This  is  by  no  means  a  necessary  symptom  in  cases  of 
acute  poisoning  by  corrosive  sublimate,  but  it  not  unfrequently  shows 
itself  about  the  second  or  third  day.  In  many  instances  the  patient 
dies  too  rapidly  for  this  effect  to  follow ;  but  even  when  he  survives  some 
days,  salivation  is  not  always  observed.  In  placing  reliance  upon  this 
symptom,  it  must  be  remembered  that  salivation  ma}^  arise  from  a  variety 
of  causes  irrespective  of  the  use  of  mercury.  (See  On  Poisons,  3d  edit., 
p.  366.)  Substances  sold  under  the  name  of  Worm  Lozenges  have  been 
known  to  cause  death  by  producing  fatal  salivation.  In  the  salivation 
caused  by  mercurial  compounds  the  saliva  always  contains  mercury,  which 
may  be  detected  by  Reinsch's  process.  The  elimination  of  this  metal 
takes  place  by  all  the  fluid  secretions,  but  chiefly  by  the  urine  and  intes- 
tinal liquids.  (Lancet,  1813,  i.  p.  476.)  Workmen  exposed  to  the  vapors 
of  metallic  mercury  exhibit  a  peculiar  form  of  paralysis,  known  as  mer- 
curial tremors  or  "trembles." 

Appearances  after  Death. — These,  as  in  the  case  of  arsenic,  are  chiefly 
confined  to  the  stomach  and  bowels.  Corrosive  sublimate,  however,  affects 
the  mouth,  throat,  and  gullet;  the  mucous  membrane  is  softened,  of  a 
white  or  bluish-gray  color,  and  inflamed  ;  that  lining  the  gullet  is  simi- 
larly affected,  and  partly  corroded  and  softened.  The  mucous  membrane 
of  the  stomach  is  more  or  less  inflamed,  sometimes  in  patches;  and  there 
are  masses  of  black  extravasated  blood  found  beneath  it.  Occasionally 
this  has  a  slate-color,  and  the  mucous  coat  beneath  may  be  found  reddened. 
A  case  occurred  in  Guy's  Hospital  in  which  the  mucous  membrane  was 
simply  inflamed,  much  resembling  the  condition  presented  in  cases  of 
arsenical  poisoning.  The  coats  of  the  stomach  are  sometimes  corroded, 
and  so  much  softened  that  they  cannot  be  removed  from  the  body  without 
laceration.  Similar  appearances  have  been  met  with  in  the  small  and 
large  intestines,  especially  in  the  cyecum.  In  a  case  reported  by  Herapath, 
in  which  twenty  grains  were  taken  and  death  occurred  on  the  ninth  day, 
the  mucous  membrane  of  the  stomach  was  softened,  but  there  were  no 
well-marked  appearances  of  the  irritant  action  of  the  poison  on  this  organ. 
The  csccum  had  been  the  seat  of  the  most  violent  inflammation,  the  whole 
surface  being  of  a  deep  black-red  color  and  there  were  patches  of  slough- 
ing in  the  coats.  (Lancet,  1845,  ii.  p.  TOO;  Edin.  Month.  Jour.,  Dec. 
1851,  p.  532.)  Perforation  of  the  stomach  is  rare  as  an  effect  of  this 
poison  :  there  is  one  case  on  record.  Appearances  like  those  just  described 
have  been  seen  in  the  intestines,  not  only  where  the  case  has  terminated 


CORROSIVE    SUBLIMATE ANALYSIS. 


141 


fatally  in  a  few  hours,  but  svhero  it  has  been  protracted  for  six,  eight,  and 
even  eleven  days. 

The  smallest  dose  that  is  reported  to  have  destroyed  life  is  three  grains. 
This  was  in  the  case  of  a  <  hild,  and  the  quantity  was  accurately  deter- 
mined from  the  facit  of  its  having  been  made  up  by  mistake  for  three 
grains  of  calomel,  which  a  physician  had  intended  to  order.  It  is  pro- 
bable that,  under  favorable  circumstances,  from  three  to  five  grains,  or 
even  less^  would  destroy  an  adult. 

In  an  acute  case  a  person   commonly  dies  in  from  one  to  five  days,  but 
death  may  take  place   much  sooner  or   later  than  this.     In   the  shortest 
fatal  case  on   record   the   man  died   in   less  than   half  an  hour :  but  the 
quantity  of  poison  taken  was  not  ascertained.     (On  Poisons;  Corrosive- 
Sublimate.) 

Chemical  Analysis. — Corrosive  sublimate  is  usually  seen  in  heavy 
crystalline  masses,  or  in  the  form  of  a  white  powder.  In  the  solid  state — 
1  When  the  powder  is  heated  on  platinam-foil,  it  melts  and  is  volatilized 
as  a  white  vapor  without  leaving  any  residue.  2.  When  heated  in  a 
closed  tube,  unlike  arsenic,  it  melts  before  subliming,  and  forms  a  sublimate 
consisting  of  stellate  prismatic  crystals  (see  Fig-.  12).  3.  The  powder  is 
changed  in  color  by  the  folloAviug  reagents  :  iodide  of  potassium  pro- 
duces a  bright  scarlet,  potash  a  yellow,  and  sulphide  of  ammonium  a 
black  compound  ;  ammonia  does  not  alter  its  color,  i.  The  mercury  and 
chlorine  may  be  discovered  by  one  process.  Mix  the  powder  with  four 
parts  of  dried  carbonate  of  sodium  free  from  chlorides  (obtained  by  inciner- 
ating the  bicarbonate),  until  the  residue  in  the  reduction-tube  fuses  and 
becomes  white.     A   sublimate  of  metallic  mercurv  in   distinct  and  well- 


Fig.  12. 


FiR.  13. 


stellate  Crystals  obtained  by  beating 
Corrosive  Sublimate,  magnitied  30 
diameters. 


Prismatic  Crystals  of  Corrosive  Sublimate 
from  a  solution  iu  water,  magnified  30 
diameters. 


defined  globules  will  be  obtained  (see  Fig  14).  Detach  by  a  file  the  end 
of  the  tube  containing  the  fused  residue,  which  is  chloride  of  sodium  with 
some  undecomposed  carbonate.  Digest  it  in  water  with  nitric  acid  and 
apply  heat  until  it  is  entirely  dissolved  ;  then  add  to  the  solution  nitrate 
of  silver.  A  white  precipitate  of  chloride  of  silver  insoluble  in  boiling 
nitric  acid  will  be  at  once  produced  The  solid  is  thus  proved  to  con- 
tain both  mercury  and  chlorine,  and  the  only  compound  of  these  elements 
which  is  soluble  in  water  is  corrosive  sublimate. 

In  solution  of  water.  A  few  drops  of  the  solution  of  corrosive  subli- 
mate evaporated  on  a  glass  slide  yield  slender,  opaque,  silky  prisms  (see 
Fig.  13).  When  a  weak  solution  of  iodide  of  potassium  is  dropped  on 
them    they    acquire    a    bright    scarlet    color.       This    scarlet    coloration, 


142  DETECTION    IN    ORGANIC    LIQUIDS. 

which  may  he  obtained  from  the  minutest  crystal  and  only  one  drop  of 
solution,,  proves  that  the  body  dissolved  in  water  is  corrosive  sublimate: 
it  is  thus  distinguished  from  every  other  mineral  poison  and  all  other 
substances  whatever.  1.  Stannous  chloride  added  to  a  solution  of 
corrosive  sublimate  produces  a  gray  precipitate,  which,  after  it  has  been 
boiled,    is  resolved  into  globules  of.  metalh'c  mercury.     2.   Sulphuretted 

hydrogen  and  sulphide  of  ammonium  produced, 
Fig.  14.  after  a  time,  a  biack  sulphide,  not  soluble  in 

alkaline  or  diluted  acid.  3.  If  after  the  liquid 
has  been  acidulated  Avith  hydrochloric  acid, 
bright  copper-foil,  wire,  or  gauze  is  plunged 
into  it,  the  copper  will  acquire  a  silver-white 
deposit,  even  in  the  cold,  but  more  rapidl}^  by 
heat.  When  the  copper  with  the  metallic 
deposit  is  dried  and  heated  in  a  tube,  globules 
of  mercury  are  sublimed  (see  Fig.  14). 

In  organic  liquids. — The  liquids  should  be 
separated  by  filtration  from  any  insoluble  por- 
tions.    The   latter   should    be   pressed,  dried, 
and  set  aside   for   a   separate   analysis.     The 
Globules  of  Mercury.  liquid   portion    should    be   slightly  acidulated 

with  hj'drochloric  acid,  warmed,  and  a  slip  of 
copper-foil  introduced  ;  if  this  is  not  immediately  coated  with  mercury,  it 
may  be  allowed  to  remain  for  some  hours.  When  a  deposit  has  taken 
place,  the  copper  should  be  removed,  washed  in  water  and  afterwards  in 
ether,  and  dried.  If  the  quantity  of  corrosive  sublimate  dissolved  in  an 
organic  liquid  is  moderately  large,  it  may  be  removed  by  means  of  ether. 
Place  the  filtered  liquid  supposed  to  contain  the  dissolved  poison  in  a 
stoppered  tube  ;  add  to  it  twice  its  volume  of  ether,  and  agitate  the  liquid 
at  intervals  for  a  few  minutes.  Allow  the  liquid  to  subside,  pour  ofi"  the 
ether  into  a  large  watch-glass,  and  submit  the  liquid  to  spontaneous 
evaporation.  As  the  ether  evaporates,  the  corrosive  sublimate  will  be 
deposited  in  white,  silky-looking  prisms.  These  may  be  purified,  if 
necessary,  by  solution  in  water  or  alcohol,  and  the  solution  again  crys- 
tallized. Corrosive  sublimate  may  thus  be  separated  from  arsenic  and 
other  mineral  poisons  in  solution.  If  mercury  and  arsenic  are  associated 
in  a  poisonous  mixture,  or  in  the  tissues,  the  arsenic  may  be  entirely 
removed  by  distillation  with  hydrochloric  acid  (p  130).  Masses  of  corro- 
sive sublimate  may  be  sometimes  locked-up  in  thick,  viscid  mucus  ;  and, 
in  such  cases,  the  coarse  powder  being  heavy,  it  may  be  separated  by 
simply  agitating  the  viscid  liquid  in  water  and  then  decanting  the  upper 
portion  suddenly.  This  poison  is  decomposed  and  precipitated  by  many 
organic  substances,  such  as  albumen,  fibrin,  mucous  membrane;  also  by 
gluten,  tannin,  and  other  vegetable  substances.  Thus,  then,  we  cannot 
always  expect  to  find  it  in  the  stomach  in  a  state  of  solution.  Other 
methods  of  analysis  are  chiefly  directed  to  the  separation  of  the  mercury 
only.  The  suspected  liquid  is  boiled,  filtered,  and  acidulated  with  hydro- 
chloric acid.  1.  To  one  portion  add  stannous  chloride  in  excess,  again 
boil  the  liquid  and  filter  to  separate  the  mercury,  the  whole  of  which  is 
precipitated  either  as  a  black  powder  or  in  gray  globules.  On  boiling  this 
deposit  in  strong  hydrochloric  acid,  the  small  globules  coalesce  to  form 
liquid  mercur}'".  2.  Into  another  portion  of  the  liquid  introduce  copper 
foil  and  gently  warm.  The  copper  becomes  covered  with  a  layer  of 
silvery-white  metal,  either  immediately  or  in  a  few  hours.  A  large 
quantity  of  copper  may  be  thus  coated.     The  coated  copper  should  be 


DETECTION    OF    MERCURY    IN    THE    TISSUES.  143 

digested  in  warm  alcohol  or  ether,  dried,  and  heated  in  a  reduction-tube, 
when  a  sul)limate  of  silvery-while  gloliules  will  be  obtained,  well  marked 
by  their  opacity,  lustre,  and  spherical  shape  when  examined  with  the 
microscope  (see  Fig.  14,  p.  142).  The  sublimate  of  metallic  mercury 
differs  from  that  of  arsenic  in  the  fact  that,  when  heated,  it  sublimes 
simply  as  metal  without  change.  It  is  not  oxidized  (like  metallic  arsenic) 
by  heating  it  in  a  reduction-tube,  but  is  simply  transferred  with  its 
metallic  lustre  and  globular  form  from  one  part  of  the  tube  to  another. 
hi  the  event  of  a  doubt  existing  respecting  the  nature  of  the  sublimate,  the 
following  experiment  will  solve  it.  Cut  off  by  a  file  the  portion  of  glass 
on  which  the  globules  are  deposited  ;  introduce  this  into  a  wide,  short  tube, 
with  a  few  drops  of  nitric  acid.  Heat  the  acid  liquid  and  evaporate  it 
to  dryness  on  a  sand-bath.  White  crystals  will  reaiain  if  the  sublimate 
was  mercury  and  too  great  a  heat  has  not  been  applied.  On  touching 
the  white  residue  cautiously  with  a  drop  of  a  weak  solution  of  iodide  of 
potassium  the  crystals  will  acquire  a  scarlet  color.  In  place  of  copper,  a 
weighed  slip  of  gold-foil  may  be  wound  round  a  rod  of  zinc  and  intro- 
duced into  the  acidulated  liquid.  The  gold  is  soon  covered  with  a  silvery- 
white  layer  of  mercury.  In  doubtful  cases  the  deposition  may  be  allowed 
to  go  on  for  twenty-four  or  even  forty-eight  hours.  The  gold-foil  must 
then  be  detached  from  the  zinc,  rinsed  successively  with  water,  alcohol, 
and  ether,  dried,  and  introduced  into  a  reduction-tube.  On  gently  heating 
the  portion  of  the  tube  containing  the  gold -foil,  a  sublimate  of  metallic 
globules  of  mercury  is  obtained,  and  the  foil  resumes  its  original  yellow 
color  and  weight.  The  sublimate  must  be  further  examined  and  tested,  as 
above  described. 

In  the  tissues. — Insoluble  substances  suspected  to  contain  mercury,  as 
well  as  the  soft  organs,  e.g.  liver  and  kidneys,  may  be  cut  up  and  boiled 
in  one  part  of  hydrochloric  acid  and  four  parts  of  water  until  dissolved. 
The  mercury  may  then  be  separated  by  copper  or  by  gold  with  zinc. 
This  method  will  show  th3  presence  of  mercury,  but  not  of  corrosive  sub- 
limate, in  the  body.  Whether  the  mercurial  compound  has  acted  as  a 
poison  or  not  must  be  determined  from  symptoms  and  appearances ; 
whether  it  has  been  given  or  taken  as  a  medicine  or  not,  is  a  conclusion 
.which  must  also  be  determined  from  other  circumstances.  The  proof  that 
the  mercury  was  really  in  the  form  of  corrosive  sublimate  could  only  be 
derived  from  the  discovery  of  some  undissolved  portions  of  the  solid 
poison  in  the  stomach  or  its  contents,  or  from  a  separation  of  the  poison 
itself  by  means  of  ether.  If  thus  obtained  after  filtration  of  an  organic 
liquid,  it  would  show  its  presence  in  the  form  of  a  soluble  salt ;  and  it  mav 
be  remarked  that  all  the  soluble  salts  are  poisonous,  and  are  rarely  used 
internally  as  medicines.  If  undissolved,  the  absorbed  mercury  may  hare 
been  derived  from  some  mercurial  medicine  innocently  taken  by  the  de- 
ceased. Nothing  is  more  common  than  to  discover  traces  of  mercury  in 
the  stomach,  bowels,  liver,  kidneys,  or  other  organs  of  a  dead  body.  No 
importance  can  be  attached  to  this  discovery  in  the  absence  of  evidence 
that  the  deceased  had  actually  suffered  from  symptoms  of  mercurial  poison- 
ing. As  to  the  mercury  found  in  the  tissues,  it  may  have  been  derived 
from  a  soluble  or  insoluble  compound,  or  from  exposure  to  the  vapors  of 
the  metal  or  of  its  salts  in  various  trades. 

Calomel.  Mf.rcurous  Chloride. — This  substance,  although  commonly 
regarded  as  a  mild  medicine  in  small  doses,  may  destroy  life  by  causing 
excessive  salivation  with  ulceration  and  gangrene  ;  and  in  large  doses  it 
acts  as  an  irritant  poison.  A  man  suffering  from  eczema  of  the  scrotum 
was   directed  to  employ  black  wash,  consisting  of  one  drachm  of  calomel 


14t1:  POISONI^"G    ■\VITII    RED    PRECIPITATE. 

in  eig'ht  ounces  of  lime-water.  In  a  few  days  he  had  fetor  of  the  breath, 
swelling  and  tenderness  of  the  gums,  with  salivation.  (Brit.  Med.  Jour., 
1878,  i.  p.  867.) 

Analysis. — It  is  known  from  corrosive  sublimate  by  its  insolubility  in 
water,  alcohol,  and  ether.  It  is  known  from  white  precipitate  by  its 
insolubility  in  acids  and  by  its  being  blackened  by  alkalies.  A  mercurial 
sublimate  may  be  obtained  from  it  by  heating  it  with  dry  sodium  carbonate. 
Under  certain  conditions,  this  compound  may  Ije  changed  into  corrosive 
sublimate  in  the  stomach.     (Pharm.  Jour.,  Aug.  31,  1878,  p.  164.) 

TTniTE  Precipitate.  Ammoniafed  Mei^cury. — The  symptoms  which 
this  compound  produces  are  violent  vomiting,  cramps,  great  thirst,  purg- 
ing, pain  in  the  stomach  and  bowels,  and  convulsions.  Tenderness  of  the 
gums  and  salivation  have  been  observed.  After  death  the  results  of 
inflammation  of  the  stomach  and  bowels  are  seen.  Experiments  on  dogs 
and  rabbits  have  shown  that  this  is  a  formidable  poison.  The  greater 
number  of  recoveries  have  been  probably  owing  to  the  substance  being 
early  ejected  by  vomiting,  llabbits  (which  do  not  vomit)  were  killed  by 
doses  of  four  and  five  grains  in  a  few  hours.  After  death,  mercury  was 
found  deposited  in  various  organs,  but  more  in  the  kidneys  than  in  the 
other  viscera.  (For  additional  facts  connected  with  the  action  of  this 
poison,  see  Guy's  Hosp.  Pep.,  18G0,  p.  483.)  A  trial  for  attempting  to 
poison  b}'  this  substance  took  place  in  1869.  (Peg.  v.  Seaham,  Maidstone 
Sum.  Ass.,  1869.)  The  compound  is  white,  but,  as  the  result  of  boiling, 
it  gave  a  yellow  color  to  the  gruel  in  which  it  was  administered.  In  Peg. 
V.  Hargreaves  (Manchester  Lent  Ass.,  1866),  a  girl  was  convicted  of  an 
attempt  to  poison  her  father  by  this  substance.  The  poison  Avas  put  into 
milk  and  medicine.  It  produced  a  burning  sensation  in  the  throat  and 
stomach,  and  thus  led  to  suspicion.  About  ten  grains  of  white  precipitate 
were  detected  in  some  buttermilk.  In  February,  1873,  a  boy,  aet.  12,  was 
convicted,  at  the  Central  Criminal  Court,  of  administering  this  poison 
feloniously  in  medicine.  The  prosecutor  experienced  a  hot  sensation,  un- 
like the  bitter  taste  he  had  before  perceived.  A  white  powder  was  found 
in  the  medicine,  which  proved  to  be  white  precipitate. 

Analysis. — White  precipitate  is  a  chalky-looking  compound  containing 
about  eighty  per  cent,  of  mercury.  It  is  insoluble  in  water  and  alcohol. 
As  sold,  it  frecpently  contains,  as  an  impurity,  corrosive  sublimate  to  the 
amount  of  one  or  two  per  cent.,  separable  by  ether  or  alcohol.  It  is  sol- 
uble in  acids,  not  blackened  by  alkalies,  and  yields  a  mercurial  sublimate 
when  heated  with  carbonate  of  sodium.  Stannous  chloride  produces  with 
it  a  black  deposit  of  mercury.  If  boiled  in  a  solution  of  potash,  it  evolves 
ammonia  and  yellow  oxide  of  mercury  is  formed.  It  may  be  detected  in 
organic  liquids  and  solids  by  boiling  them  in  one  part  of  hydrochloric 
acid  and  four  parts  of  water.  The  mercury  may  then  be  separated  by 
means  of  copper  (see  p.  143).  It  is  not  used  internally,  but  it  is  much 
employed  by  the  poorer  classes  in  the  treatment  of  ringworm. 

Ped  Precipitate.  Mercuric  Oxide.  Red  Oxide  of  Mercury. — This 
substance  is  poisonous,  but  instances  of  poisoning  by  it  are  rare.  One 
case  occurred  at  Gay's  Hospital  in  1833.  The  patient  recovered  in  four 
days.  In  another  case  a  woman,  ast.  20,  swallowed  a  quantity  of  beer 
containing  red  precipitate.  Four  hours  after  she  was  in  a  state  of  stupor, 
with  a  weak,  irregular,  scarcely  perceptible  pulse,  dilated  pupils,  cold  and 
clammy  skin,  and  copious  discharge  from  the  mouth.  She  had  vomited 
once  shortly  before,  and  red  particles  were  seen  in  the  ejected  fluid.  There 
was  pain  in  the  abdomen.  Under  treatment  the  symptoms  abated,  but 
there  was  pain  in  the  region  of  the  stomach,  a  desire  to  vomit,  much  sali- 


SUGAR  OF  LEAD — SYMPTOMS.  145 

ration,  and  slight  diarrhoea.  She  gradually  recovered.  (Brit.  Med.  Jour., 
1878,  ii.  p.  101.)  A  case  of  recovery  after  the  administration  of  120 
grains  has  been  recorded,     (lirit.  Med.  Jour.,  1884,  i.  p.  5G.) 

Analysis. — By  its  great  density  and  insolubility  in  water  it  may  be 
separated  from  all  liquids.  Its  red  color  is  characteristic.  When  heated 
in  a  closed  tube,  it  is  resolved  into  oxygen  and  mercury,  the  latter  being- 
deposited  in  globules. 

Other  compounds  of  mercury,  such  as  the  nitrates,  the  sulphates,  the 
cyanide,  and  the  sulphocyanide,  have  given  rise  to  accidents,  and  in  a  few 
instances  have  destroyed  life,  but  they  very  rarely  require  the  notice  of  a 
medical  practitioner.  In  February,  1891,  two  men  died  from  the  external 
application  of  nitrate  of  mercury  as  a  remedy  for  an  eruption  of  the  skin. 
The  sulphide  (vermilion),  on  account  of  its  insolubility,  is  probably  quite 
inert. 

When  heated  in  a  dry  state  with  anhydrous  carbonate  of  sodium,  all" 
the  compounds  of  mercury  yield  sublimates  of  the  metal  in  globules.  All 
the  liquid  and  solid  compounds  give  a  dark  precipitate  of  mercury  when 
boiled  with  stannous  chloride. 


CHAPTER    XIII. 

POISOXING    WITH     LEAD. SUGAR    OF     LEAD. SYMPTOMS. APPEARANCES    AFTER    DEATH. 

CHEMICAL    ANALYSIS LEAD    IN  ORGANIC    MIXTURES. RED    LEAD. CARBONATE  OR  WHITE 

LEAD. CHRONIC    POISONING. POISONING    WITH     COPPER. BLUE    VITRIOL. SYMPTOMS. 

APPEARANCES. CHEMICAL    ANALYSIS. COPPER     IN    ORGANIC    LIQUIDS. 

Sugar  of  Lead. 

Acetate  of  Lead. — Symptoms. — Acetate  or  sugar  of  lead  is  by  no  means 
an  active  poison.  In  medical  practice  it  has  often  been  given  in  consider- 
able doses  without  any  serious  effects  resulting.  When  from  one  to  two 
ounces  have  been  taken,  the  following  symptoms  have  been  observed :  a 
burning,  pricking  sensation  in  the  throat,  with  dryness  and  thirst,  vomit- 
ing, and  uneasiness  at  the  pit  of  the  stomach,  followed  by  severe  colic. 
Tlie  abdomen  is  tense,  and  the  skin  covering  it  is  sometimes  drawn  in. 
The  pain  is  intermittent  and  relieved  by  pressure.  There  is  generally 
constipation  of  the  bowels.  If  any  feces  are  passed,  they  are  commonly 
of  a  dark  color,  indicative  of  the  conversion  of  a  portion  of  the  lead  into 
sulphide.  The  skin  is  cold,  and  there  is  great  prostration  of  strength. 
The  pulse  is  slow.  When  the  case  is  protracted,  the  patient  has  been 
observed  to  suffer  from  cramp  in  the  calves  of  the  legs,  pain  in  the  inside 
of  the  thighs,  numbness,  and  sometimes  paralysis  of  the  limbs.  The 
affection  of  the  nervous  system  is  otherwise  indicated  by  giddiness, 
torpor,  and  even  coma.  A  well-marked  blue  line  has  been  noticed  round 
the  margin  of  the  gums,  where  they  join  the  teeth.  (For  a  remarkable 
series  of  cases  of  poisoning  by  acetate  of  lead,  see  Lancet,  1849,  i.  p.'  478.) 
In  1882  a  woman  was  convicted  (Reg.  v.  Louisa  Jane  Taylor,  C.  C.  C, 
Dec.  1882)  of  the  murder  of  Mrs.  Tregelles,  an  aged  female,  by  the  re- 
peated administration  of  acetate  of  lead.  The  administration  extended  over 
several  weeks  ;  and  the  editor  found  the  bodv  largely  impregnated  with 
10 


146 


SUGAR  OF  LEAD  —  CHEMICAL  ANALYSIS. 


lead — more  especially  the  stomach.  The  symptoms  were  colic,  vomiting, 
blackening  of  the  teeth,  paralj^sis,  and  at  the  last  epileptiform  convulsions. 
Appearances. — In  one  fatal  case  of  acute  poisoning  the  mucous  mem- 
brane of  the  stomach  was  destroyed  in  several  places,  especially  near  the 
intestinal  opening,  and  the  greater  part  of  the  intestines  were  in  a  state 
of  acute  inflammation.  In  animals,  according  to  Mitscherlich,  when  the 
dose  is  large  the  mucous  coat  of  the  stomach  is  attacked  and  corroded  ; 
this  change  appears  to  be  purely  chemical,  and  takes  place  in  those  parts 
of  the  body  with  which  the  salt  of  lead  comes  in  contact.  If  given  in 
a  small  dose,  it  is  decomposed  by  the  gastric  secretions  and  exerts  no 
corrosive  action  on  the  mucous  membrane.  When  acetate  of  lead  was 
given  in  a  state  of  albuminate  dissolved  in  acetic  acid,  death  took  place 
with  great  rapidity;  but  on  inspection,  the  stomach  was  not  found  cor- 
roded. This  corrosive  action  belongs  to  the  neutral  salt,  and  is  not  mani- 
fested when  the  dose  is  small  or  when  the  poison  is  combined  with  an 
acid.  Nothing  is  actually  known  concerning  the  fatal  dose  of  this  sub- 
stance ;  but  it  may  be  taken  in  comparatively  large  quantity  without  pro- 
ducing serious  effects.  Thirty  or  forty  grains  have  been  given  daily  in 
divided  doses  without  injury. 

Chemical  Analysis.  Acetate  of  Lead  as  a  solid. — 1.  If  a  portion  of 
the  powder  is  heated  in  a  small  reduction-tube,  it  melts,  then  becomes 
solid  ;  again  melts,  acquiring  a  dark  color,  and  gives  off  vapors  of  ace- 
tone and  acetic  acid,  easily  recognized  by  their  odor  and  reaction  on 
litmus-paper.  A  black  mass  is  left  in  the  tube,  consisting  of  carbon  and 
reduced  metallic  lead.  No  sublimate  is  formed.  If  heated  on  mica, 
yellow  oxide  of  lead  with  reduced  metal  remains.  2.  It  is  very  soluble 
even  in  cold  water  ;  spring  water  containing  carbonic  acid  and  sulphates 
is  turned  milky  by  it.  3.  A  small  portion  of  the  powder  dropped  into  a 
solution  of  iodide  of  potassium  acquires  a  bright  yellow  color.  4.  When 
dropped  into  solution  of  potash  it  remains  white.  5.  In  sulphuretted 
hydrogen  water  or  sulphide  of  ammonium  it  is  turned  black,  in  Avhich 
respect  it  resembles  the  white  salts  of  some  other  metals.  6.  When  the 
powder  is  boiled  in  a  tube  with  diluted  sulphuric  acid,  acetic  acid,  known 
by  its  odor  and  volatility,  escapes.  All  these  properties  taken  together, 
prove  that  the  salt  is  acetate  of  lead. 

Acetate  of^  Lead  in  solution. — 1.  A  small  quantity,  slowly  evaporated 
on  a  glass  slide,  will  give  slender  white  prismatic  crystals  (see  Fig.  15), 

which  are  turned  yellow  by  iodide  of  potas- 
sium and  black  by  sulphide  of  ammonium. 
2.  Diluted  sul2:)huric  acid  produces  an 
abundant  white  precipitate,  insoluble  in 
nitric  acid,  but  soluble  in  hydrochloric  acid 
and  in  a  large  excess  of  potash.  3.  It  is 
precipitated  of  a  yellow  color  by  iodide  of 
potassium.  The  yellow  iodide  of  lead  is 
soluble  in  potash,  forming  a  colorless  solu- 
tion. It  is  also  dissolved  by  concentrated 
hydrochloric  acid  and  by  hot  water.  4. 
Sulphide  of  ammonium,  or  sulphuretted 
hydrogen  gas,  ijroduces  a  black  precipitate, 
even  when  less  than  a  100,000th  part  of  the 
salt  is  dissolved.  5.  Place  a  few  drops  of 
the  solution  on  clean  platinum-foil,  acidulate 
with  acetic  acid,  then  apply,  through  the  solution,  to  the  surface  of  the 
platinum  a  thin  slip  of  polished  zinc — dark-bluish  crystals  of  metallic 


Fiff.  1.5. 


Crystals  of  Acetate  of  Lead,  magni- 
fied 80  diameters. 


DETECTION    OF    LEAD    IN    THE    TISSUES.  .147 

lead  are  instantly  deposited  on  the  zinc ;  bj  this  method  a  small  quantity 
of  the  metal  may  be  detected  and  separated. 

Lead  in  organic  liquids. — Acetate  of  lead  is  precipitated  by  many 
oro-anic  substances,  especially  by  albumen  and  tanuiu.  Thus  we  may 
have  to  analyze  either  an  organic  liquid  containing  lead,  or  a  solid  pre- 
cipitate consisting-  of  mucus  or  mucous  membrane,  or  albumen  combined 
with  lead.  The  liquid  should  be  hitered  and  examined  by  a  trial  test,  i.  e. 
either  by  adding  to  a  portion  sulphuric  acid,  when  sulphate  of  lead  is 
precipitated,  or  by  exposing  filter  paper,  dipped  into  the  suspected  liquid, 
to  a  current  of  sulphuretted  hydrogen  gas.  If  the  paper  is  not  stained 
brown,  there  is  not  much  lead  dissolved ;  if  it  is  stained  brown,  we  dilute 
the  liquid  to  destroy  its  viscidity,  should  this  be  necessary,  and  pass  into 
it  a  current  of  washed  sulphuretted  hydrogen  gas  tin  til  a  precipitate  ceases 
to  form.  The  black  sulphide  of  lead  should  be  collected  on  a  filter,  washed, 
and  dried  ;  then  boiled  for  a  quarter  of  an  hour  in  a  mixture  of  one  part 
of  nitric  acid  diluted  with  four  parts  of  water.  This  has  the  effect  of 
transforming  it,  at  least  in  part,  into  soluble  nitrate  of  lead.  This  liquid, 
when  filtered,  may  be  evaporated  to  dryness,  the  crystalline  residue  dis- 
solved in  water,  and  the  tests  for  lead  then  applied  to  the  solution.  If 
the  quantity  is  too  small  for  the  application  of  all  the  tests,  we  may  first 
add  sulphuric  acid  ;  should  a  white  precipitate  be  formed,  soluble  in  potash 
(free  from  lead),  and  this  alkaline  solution  be  again  turned  black  by  sul- 
phide of  ammonium,  this  is  sufficient  evidence  of  the  presence  of  lead. 
Should  there  be  no  lead  dissolved,  we  must  decompose  the  solid  and  in- 
soluble matters  by  boiling  them  with  dilute  nitric  acid,  filter,  and  test  the 
filtered  liquid,  previously  neutralized  ;  or  we  may  evaporate  at  once  to 
dryness,  destroy  the  organic  matter  by  heat,  and  redissolve  the  residue  in 
nitric  acid  for  testing. 

In  the  tissues. — The  organic  matter,  such  as  a  part  of  the  liver  or  any 
other  organ,  should  be  dr-ied,  and  afterwards  incinerated  in  a  porcelain 
vessel.  The  ash  should  be  heated  with  a  small  quantity  of  dilute  nitric 
acid  and  evaporated  to  dryness.  The  dry  residue  should  be  digested  in  a 
small  quantity  of  distilled  water  (free  from  lead),  filtered,  and,  after  it 
has  been  slightly  acidulated  with  nitric  acid,  a  current  of  washed  sulphur- 
etted hydrogen  gas  should  be  passed  into  it.  The  production  of  a  brown 
color  or  a  brown  precipitate  in  a  slightly  acid  liquid  indicates  the  pres- 
ence of  lead.  The  precipitate  may  be  dissolved  in  nitric  acid  and  further 
examined.  Lead  may  thus  be  detected  in  the  dry  residue  of  urine.  All 
liquid  and  solid  organic  substances  containing  lead  yield  the  metal  or  its 
oxide  by  incineration  in  a  porcelain  capsule. 

Goulard^ s  Extract  is  a  solution  of  subacetate  of  lead,  containing 
thirty-five  per  cent,  of  the  salt ;  and  Goulard  Water  is  a  mixture  of  two 
drachms  of  this  solution  in  a  pint  of  water.  The  effects  of  these  com- 
pounds, Avhen  swallowed  or  applied  locally,  are  similar  to  those  produced 
b}^  the  acetate,  but  are  more  severe. 

Red  Lead. — This  is  a  mixture  or  compound  of  the  protoxide  and  per- 
oxide of  lead,  much  used  in  the  arts.  It  has  occasionally  acted  as  a  fatal 
poison.  Dey  relates  the  case  of  a  woman  w^ho  died  from  its  effects  in 
four  or  five  hours,  after  convulsions.     (Lond.  Med.  Rec,  1882,  p.  117.) 

White  Lead.  Subcarbonate  of  Lead. — This  is  an  insoluble,  chalky- 
looking  compound,  which,  like  other  salts  of  lead,  may  give  rise  to  the 
usual  symptoms  of  lead-poisoning.  In  one  instance  it  appears  to  have 
proved  fatal.  White  lead  has  been  used  as  a  cosmetic  to  give  a  fair  com- 
plexion. It  is  liable  to  absorption,  and  to  cause  the  usual  symptoms  of 
poisoning.     The  cosmetic  liquid  of  Madame  Rachel  consisted  of  a  lead 


148  CHRONIC    LEAD-POISONING. 

compound  with  fuiier's-earth,  starcl],  and  hj^drochloric  acid.  Such  a  com- 
pound applied  to  the  skin  clearl}^  would  set  up  irritation  in  the  skin  and 
be  most  injurious  to  health.  Most  of  the  cases  of  poisoning  by  this  sub- 
stance have  been  of  a  chronic  character,  carbonate  of  lead  being  one  of 
the  products  of  the  action  of  water  upon  lead.  Buchner  has  also  reported 
the  history  of  a  family  poisoned  b}^  lead  accidentally  introduced  as  white 
lead  into  flour  in  a  mill.  (Freidreich's  Bliitt.  f.  Gerichtl.  Med.,  1884,  p. 
161.) 

Chronic  Poisoning. — C'olica  Pictonum,  or  Painter'' s  Colic,  may  be 
considered  as  the  usual  chronic  form  of  poisoning  by  carbonate  of  lead. 
The  disease  is  not,  however,  confined  to  an  affection  of  the  intestinal  canal 
( colic j,  though  this  is  the  most  common  symptom.  There  is  a  peculiar 
form  of  paralysis — lead  paralysis,  or  ''  vjrist-drop ;''"'  pains  in  the  joints, 
often  termed  "  rheumatic  ;  "  and  a  peculiar  form  of  cerebral  affection,  of  a 
fatal  character,  the  prominent  symptoms  of  which  are  epileptoid  convul- 
sions simulating  ordinary  epilepsy  and  ending  in  coma.  The  fiymptoms 
of  lead-colic  are  usually  well  marked.  There  is  at  first  pain,  with  a  sense 
of  sinking  commonly  in  or  about  the  region  of  the  navel  (the  seat  of  the 
colon).  Next  to  pain  there  is  obstinate  constipation,  retraction  of  the 
skin  of  the  abdomen,  loss  of  appetite,  thirst,  a  fetid  odor  of  the  breath, 
and  general  emaciation  ;  with  paralysis  of  a  peculiar  kind  affecting  the 
extensor  muscles,  and  causing  a  dropping  of  the  wrist,  or  showing  itself 
in  a  general  paralysis  of  the  limbs.  The  skin  acquires  a  sallow  color, 
generally  well  marked  in  the  face  ;  and  the  patient  experiences  a  sweetish, 
styptic,  or  astringent  taste  in  the  mouth.  A  symptom  of  a  peculiar 
nature  was  first  pointed  out  by  Burton  (Med.  Gaz.,  vol.  25,  p.  G87), 
namely,  a  blue  line  on  the  edge  of  the  guvis  where  these  join  the  bodies 
of  the  teeth  ;  the  teeth  are  of  a  brownish  color.  The  blue  line  on  the 
gums  may  be  regarded  as  a  distinguishing  sign  of  lead-poisoning.  It  is 
owing  to  the  deposition  of  lead  in  these  structures — a  fact  proved  by  the 
action  of  chromic  acid  on  the  excised  gums.  When  touched  with  it  they 
acquire  a  5'ellow  color  (chromate  of  lead),  and  when  afterwards  treated 
with  an  alkaline  sulphide  they  become  black  from  the  formation  of 
sulphide  of  lead.     (Lancet,  1878,  i.  p.  913.) 

Lead-palsy  usually  comes  on  after  several  attacks  of  colic.  It  shows 
itself  first,  and  most  prominently,  in  the  extensor  muscles  of  the  forearm 
— the  muscles  supplied  by  the  musculo-spiral  nerve  ;  hence  the  sujnvator 
longus  muscle  escapes.  The  disease,  hoAvever,  is  not  always  confined 
to  the  forearm.  The  dropped  hand,  and  the  inability  to  raise  it,  give 
rise  to  the  term  "dropped  wrist."  Epileptiform  convulsions  ending  in 
coma  are  a  late  affection,  in  severe  cases,  as  e.  g.  among  workers  in  white- 
lead  factories,  and  are  commonly  a  fatal  affection.  The  editor  has  met 
with  several  such  cases. 

Hair-washes  generally  contain  a  salt  of  lead  in  solution.  The  use  of 
them  may  lead  to  all  the  symptoms  of  chronic  lead-poisoning. 

Chronic  poisoning  with  lead  often  kills  the  patient,  since  a  great  amount 
of  mischief  is  usually  done  before  the  cause  is  discovered.  The  appearances 
found  after  death  have  been  a  contraction  of  the  cavity  of  the  large  and 
small  intestines,  a  considerable  thickening  of  their  coats,  and  degeneration 
of  the  kidneys.  The  contractions  have  been  especially  noticed  in  the  colon 
■ — the  seat  of  colic.  The  various  circumstances  under  which  this  form  of 
poisoning  is  liable  to  occur  are  elsewhere  fullv  described.  (See  On  Poisons, 
p.  409.) 

One  of  the  most  frequent  causes  of  chronic  lead-poisoning  is  the  use  of 
water  kept  in  leaden  cisterns  or  pipes  ;  or  the   careless  employment  of 


CHRONIC    LEAD-POISONINa.  149 

white  or  red  lead  as  a  cement  for  pipes  and  cisterns.  For  an  instructive 
series  of  cases  showing  the  effects  of  water  thus  poisoned,  the  reader  is 
referred  to  a  paper  by  De  Mussey.  (Dublin  Quar.  Jour.,  May,  1849; 
also  Med.  Gaz.,  vol.  44,  p.  260.)  These  cases  occurred  at  Claremont, 
among  the  members  of  the  ex-royal  family  of  France.  The  effects  were 
traced  to  the  use  of  water  which  had  acquired  an  impregnation  of  lead  by 
contact  with  that  metal,  in  the  proportion  of  one  grain  to  the  gallon. 
Thirteen  out  of  thirty-eight  persons  were  aff"ected,  and  to  such  a  degree 
that  the  nails  of  the  toes  and  fingers  in  some  acquired  a  bluish  discolor- 
ation. The  children  of  the  family  did  not  suffer.  No  symptoms  appeared 
until  after  the  water  had  been  in  use  for  a  period  of  from  five  to  seven 
months,  and  more  than  half  of  those  who  used  the  water  escaped  any  ill 
effects.  The  presence  of  lead  in  public  water-supplies  has  recently  at- 
tracted great  attention,  in  consequence  of  the  pollution  of  the  supplies  of 
Sheffield,  Keighly,  Huddersfield,  and  Bacup.  It  appears  that  soft  Avaters, - 
especiallv  if  acid,  are  very  prone  to  act  injuriously  upon  leaden  pipes. 
(Lend.  Med.  Rec,  1882,  p.  430;  Chem.  News,  1882,  ii.  p.  88  ;  Brit.  Med. 
Jour.,  1889,  i.  p.  992  et  seq.) 

Cases  of  poisoning  are  sometimes  observed  as  the  result  of  the  acci- 
dental introduction  of  lead  into  the  sjstem  in  wine,  beer,  cider,  milk, 
lemonade,  and  other  liquids.  Earthenware  glazed  with  litharge  imparts 
lead  to  fat  in  dripping,  also  to  acid  liquids.  Snulf  is  sometimes  adulterated 
with  7^ed  lead  to  improve  its  color,  and  some  cases  of  lead-poisoning  have 
occurred  from  the  use  of  such  snuff. 

A  spurious  tinfoil,  consisting  chiefly  of  lead  faced  with  tin,  is  much  used 
as  a  covering  or  wrapper  for  articles  of  food.  When  exposed  to  damp, 
this  metallic  alloy  undergoes  chemical  changes  whereby  subcarbonate  of 
lead  is  produced.  Children's  farinaceous  food  has  thus  become  impreg- 
nated with  lead.  In  tinned  iron  vessels  there  is  often  a  large  quantity  of 
lead  alloyed  with  the  tin,  as  it  is  a  much  cheaper  metal.  Hamilton  has 
noticed  that  lead-poisoning  has  been  produced  in  India  by  the  use  of  the 
tinned  cooking-pots.     (Lancet,  187T,  i.  p.  253.) 

There  is  another  unsuspected  method  by  vt'-hich  lead  may  find  its  way 
into  that  common  article  of  food — flour.  It  is  sometimes  a  custom  of 
millers  to  repair  the  holes  in  their  millstones  with  melted  lead.  The 
lead  is  thus  ground  into  and  mixed  with  the  flour.  Alford  states  that 
tifteen  or  twenty  persons,  in  different  families,  suffered  from  colic  and 
other  symptoms  of  chronic  lead-poisoning,  from  this  cause.  The  blue 
line  on  the  gums  was  well  marked.  It  was  found  that  they  had  all  had 
their  own  corn  ground  at  the  same  mill.  On  examining  the  millstones 
they  were  found  to  be  honeycombed  with  lead.  There  was  on  the  sur- 
face of  the  stone's  about  ten  pounds  of  lead.  (Brit.  Med.  Jour.,  1877,  i.  p. 
627.) 

The  workers  in  white  lead,  especially  those  engaged  in  the  operation  of 
stoving  and  grinding  the  compound,  are  most  prone  to  suffer  in  a  severe 
form  from  lead-poisoning.  This  has  been  made  a  matter  of  recent  legisla- 
tion, in  order  to  protect  the  workpeople  from  the  insidious  effects  of  lead 
compounds. 

[Judge  Penrose  (Philadelphia)  reports  that  in  1886  whole  families  in 
New  York  were  poisoned  by  using  flour  manufactured  where  lead  had 
been  used  for  filling  cavities  in  the  millstones  by  the  mill-owners.] 


150  POISONING    WITH    COPPER. 

Copper. 

All  the  salts  of  copper  are  poisonous.  The  two  most  commonly  known 
in  commerce  are  the  Sulphate,  or  Blue  Vitriol,  and  the  Subacetate,  or 
Verdigris. 

Blue  Vitriol.  Sulphate  of  Copper. — Syviptoms.  —  The  medicinal 
dose  of  sulphate  of  copper  as  an  emetic  is  from  five  to  fifteen  grains,  and, 
as  a  tonic,  from  one  to  three  or  four  grains.  It  has  been  frequently"  given 
for  the  purpose  of  procuring  abortion.  In  doses  of  half  an  ounce  and 
upwards  it  acts  as  an  irritant  on  adults,  and  a  much  smaller  quantity 
would  suffice  to  destroy  infants  or  children.  The  salt  speedily  causes 
vomiting  of  the  most  violent  kind  ;  this  sometimes  expels  the  poison  from 
the  stomach  and  the  person  recovers.  There  is  headache,  with  colicky 
pains  in  the  abdomen,  and  purging  ;  and  in  aggravated  cases  there  are 
spasms  of  the  extremities  and  convulsions.  Perceval  met  with  an  instance 
in  which  violent  convulsions  were  produced  in  a  young  woman  by  sixty 
grains  of  sulphate  of  copper.  Paralysis,  insensibility,  and  even  tetanus, 
have  preceded  death  when  the  poison  was  administered  to  animals. 
Among  the  symptoms  occasionally  met  with  in  the  human  being  may  be 
mentioned  jaundice.  This  has  been  observed  to  attend  poisoning  with 
the  sulphate,  as  well  as  by  Scheele's  green.  Two  children,  one  eight  and 
the  other  six  years  old,  ate  a  quantity  of  wheat  which  had  been  washed 
in  a  solution  of  sulphate  of  copper.  They  were  seized  with  incessant 
vomiting,  the  vomited  matter  being  of  a  bluish  or  greenish  color.  The 
vomiting  continued  more  or  less  for  several  days.  There  was  no  purging. 
The  elder  child  recovered,  but  the  younger  was  very  much  prostrated 
and  died  about  two  months  afterwards.  (Brit.  Med.  Jour.,  1877,  ii.  p. 
292.)  In  1884  a  girl  was  convicted  of  poisoning  her  mistress  by  intro- 
ducing sulphate  of  copper  into  a  jug  of  beer.  The  taste  of  the  substance 
Avas  perceived  ;  the  only  results  were  severe  vomiting.  (Reg.  v.  Mary 
Baker,  C.  C.  C,  Oct.  1874.)  In  1886,  a  man  was  convicted  of  attempting 
to  murder  his  wife  by  administering  to  her  sulphate  of  copper  in  spruce 
and  peppermint  water.  He  was  sentenced  to  twenty  years'  penal 
servitude.  (Reg.  v.  Reynolds,  C.  C.  C,  Sept.  1886.)  the  vomited 
matters  are  remarkable  for  being  generally  of  a  blue  or  green  color; 
broken  crystals  of  blue  vitriol  were  discovered  in  them  in  a  case  in 
which  the  poison  was  taken  in  the  state  of  coarse  powder.  If  the 
green  color  of  the  vomited  liquid  is  owing  to  altered  bile,  it  will  not 
acquire  a  blue  tint  on  adding  to  a  portion  of  it  a  solution  of  ammonia; 
but  if  caused  by  a  salt  of  copper  this  change  of  color  will  serve  to 
indicate  the  fact. 

Verdigris,  or  subacetate  of  copper,  in  large  doses,  produces  similar 
symptoms. 

Chronic  poisoning  by  copper  is  occasionally  seen  among  Avorkers  in 
this  metal  and  its  salts.  The  poison  enters  the  system  partly  by  the 
lungs  in  the  form  of  dust,  and  partly  by  the  skin  in  handling  the  metal 
or  its  salts.  The  marked  symptoms  are  a  coppery  taste  in  the  mouth, 
giddiness,  pain  in  the  bowels,  vomiting,  occasional  diarrhoea,  and  wasting 
of  the  body.  Clapton  has  pointed  out  another  symptom,  namely,  a  green 
line  on  the  margin  of  the  gums.  He  met  with  this  in  a  sailor  and  in 
some  working  coppersmiths,  (Med.  Times  and  Gaz.,  1868,  i.  p,  658.) 
The  author  saw  two  of  these  cases  in  1868.  The  green  line  was  well 
marked.  The  men  brought  with  them  a  hammer  used  in  their  Avork.  It 
had  a  greenish  color,  and  this  was  proved  by  tests  to  be  owing  to  the 
presence  of  copper.     The  perspiration  from  the  hands  in  Avorking  had  con- 


APPEARANCES CHEMICAL    ANALYSIS.  161 

verted  the  copper  into  a  basic  chloride,  and  had  thus  led  to  its  absorption 
by  the  »kin.  Several  cases  of  chronic  poisoning  by  copper  among  copper- 
smiths have  been  treated  by  Cameron,  but  this  symptom  was  not  noticed. 
(Med.  Times  and  Gaz.,  1870,  1,  p.  581.)  Gallippe  (Sur  le  Cuivre)  denies 
the  injurious  action  of  copper  compounds  upon  the  human  body. 

[Prof.  Reese  reports  that  poisoning  by  bronze-poioder  (an  alloy  of 
copper  in  very  fine  powder),  used  for  printing  in  gold,  is  not  infrequent. 

The  powder  is  dusted  over  the  prepared  size,  and  it  more  or  less  mixes 
with  the  air  of  the  apartment;  it  must  consequently  be  inhaled  into  the 
lungs. 

The  Phila.  Med.  News  and  Abstract  of  Sept,  1880,  quotes  a  case  from 
the  Brit.  Med.  Jour.,  July  24,  1880,  of  a  boy  aged  13,  who  died  from  in- 
haling bronze-powder  in  a  printing  establishment.  He  suffered  from 
sickness,  pain  in  the  bowels,  great  distention  and  tenderness  on  pressure;- 
no  diarrhoea.  He  fell  into  collapse,  and  died  on  the  twelfth  day  after  com-  _ 
mencing  the  work  and  the  eighth  day  of  his  sickness.  Death  was  found 
to  have  resulted  from  peritonitis;  no  inflammation  of  stomach  or  bowels. 
Dr.  Tidy  detected  copper  in  the  stomach  and  liver.] 

Cases  have,  however,  been  observed  of  the  injurious  effect^  of  preserved 
vegetables,  the  green  color  of  which  is  often  preserved  by  the  use  of  sul- 
phate of  copper ;  and  the  cases  of  poisoning  by  sulphate  of  copper  already 
referred  to  are  conclusive  against  G-allippe's  views. 

Appearances. — In  the  ^aw  fatal  cases  which  have  been  hitherto  ex- 
amined, the  mucous  memljraue  of  the  stomach  and  intestines  has  been 
found  more  or  less  thickened  and  inflamed,  and  in  some  cases  eroded  and 
softened.  The  gullet  has  presented  an  inflammatory  appearance.  In  one 
case  of  poisoning  by  verdigris  the  stomach  was  inflamed  and  thickened, 
especially  towards  the  intestinal  opening,  the  orifice  of  which,  from  the 
general  thickening,  was  almost  obliterated.  The  small  intestines  were 
throughout  inflamed,  and  perforation  had  taken  place,  so  that  part  of  the 
green  liquid  was  effused  into  the  abdomen.  The  large  intestines  were 
distended  in  some  parts  and  contracted  in  others,  and  the  rectum  was 
ulcerated  on  its  inner  surface.  (Orfila,  Toxicologic.)  The  lining  mem- 
brane of  the  intestines  has  been  found  throughout  of  a  deep-green  color, 
owing  to  small  particles  of  the  copper  salt  (verdigris)  adhering  to  it. 

Chemical  Analysis. — The  salts  of  copper,  whether  in  the  solid  state  or 
in  solution,  are  generally  known  by  their  blue  or  green  color.  Tests  — 1. 
Solution  of  Ammonia  gives,  in  a  solution  of  a  salt  of  copper,  a  bluish-white 
precipitate,  which  is  soluble  in  an  excess  of  the  test,  forming  a  deep  violet- 
blue  liquid.  2.  Ferrocyanide  of  potassium  gives,  in  a  very  diluted  solu- 
tion, a  rich  claret-red  precipitate.  If  the  quantity  of  copper  is  small,  the 
liquid  acquires  merely  a  light-red  color;  if  large,  the  precipitate  is  of  a 
deep  red-brown  color  and  of  a  gelatinous  consistency.  Ferrocyanide  of 
potassium  will  act  on  the  violet-blue  solution  produced  by  ammonia,  pro- 
vided a  few  drops  of  acetic  acid  are  added  in  order  to  neutralize  the  am- 
monia. One  portion  of  the  liquid  may  thus  be  tried  with  the  two  tests. 
3.  Sulphuretted  hydrogen  gas  and  sulphide  of  ammonium  give  a  deep 
chocolate-brown  precipitate,  even  in  an  acid  solution,  or,  if  the  copper  is 
in  small  proportion,  merely  a  light-brown  color.  4.  A  slip  of  polished 
iron  (a  common  needle)  suspended  by  a  thread  in  the  liquid  slightly  acidu- 
lated with  sulphuric  acid  is  speedily  coated  with  a  red  layer  of  copper, 
even  when  the  salt  is  in  very  small  proportion.  The  iron  thus  coated  may 
be  washed,  immersed  in  ammonia,  and  exposed  to  air.  The  liquid  becomes 
slowly  blue,  and  may  then  be  tested  with  ferrocyanide  of  potassium  as 
above.    A  minute  quantity  of  copper  may  be  thus  easily  detected.    5.  The 


152  DETECTION    OF    COPPER    IN    THE    TISSUES. 

electrolytic  teat.  If  a  few  drops  of  the  copper  solution  are  placed  on 
platinum-foil,  slightly  acidulated  with  a  diluted  acid,  and  the  platinum  is 
then  touched  through  the  solution  with  a  rod  of  zinc,  metallic  copper, 
of  its  well-known  red  color,  is  immediately  deposited  on  the  platinum. 
When  the  quantity  of  copper  is  very  small,  there  is  merely  a  brown  stain ; 
but  a  blue  liquid  is  formed  by  pouring  on  it  ammonia  and  exposing 
it  to  air.  A  coil  of  fine  platinum  and  zinc  wire  may  be  substituted  for 
the  foil. 

Copper  in  organic  liquich. — Copper  is  liable  to  be  precipitated  by 
certain  organic  matters,  e.  g.  albumen,  fibrin,  and  mucous  membrane ; 
but  some  of  these  organic  compounds  are  easily  dissolved  by  acids,  or 
even  by  an  excess  of  the  solution  of  copper  salt."^  A  portion  at  least  of 
the  salt  of  copper  is,  therefore,  commonly  held  dissolved.  In  such  cases 
the  liquid  is  usually  of  a  greenish  color,  and  has  a  strong  coppery  or 
metallic  taste,  even  when  the  copper  salt  is  in  far  less  than  a  poisonous 
proportion.  Having  filtered  the  organic  lic[uid,  let  a  portion  of  it  be 
placed  in  a  clean  platinum  capsule.  A  few  drops  of  diluted  sulphuric 
acid  should  be  added  and  a  rod  of  zinc  introduced.  Wherever  the  platinum 
is  touched  by  the  zinc  metallic-  copper  is  deposited ;  and,  after  having  in 
this  way  coated  the  platinum  capsule,  the  surplus  hquid  may  be  poured 
off  and  the  capsule  well  washed  out.  The  deposited  copper,  which  is  of  a 
deep-red  color,  is  then  dissolved  in  nitric  acid,  and  the  tests  are  applied 
after  the  excess  of  acid  has  been  driven  off  by  heat,  and  the  residue  dis- 
solved in  water.  In  place  of  nitric  acid  and  heat,  a  solution  of  ammonia 
may  be  poured  on  the  metallic  deposit  in  the  cold.  Under  exposure  to 
air  the  metal  is  oxidized  and  dissolved  in  a  few  minutes,  forming  a  blue 
solution.  This  ammoniacal  solution  may  be  neutralized  with  acetic  acid 
and  ferrocyanide  of  potassium  then  added.  The  red  color  of  the  deposit 
on  platinum  is  characteristic  of  copper,  and  the  mode  of  testing  here  ad- 
vised renders  the  results  conclusive. 

In  the  tissves. — Dry  and  incinerate  the  organic  matter  over  a  Bunsen 
burner  provided  with  an  iron  tube.  If  the  ordinary  burner  with  brass 
tube  be  used,  some  copper  will  be  volatilized  from  the  burner  and  de- 
posited on  the  ashes.  Digest  the  residuary  ash  in  pure  hydrochloric  acid 
by  heat  and  then  evaporate  nearly  to  dryness.  This  residue  may  be  dis- 
solved in  a  small  quantity  of  water  and  a  polished  needle  immersed  in  it 
for  some  hours.  The  metallic  deposit,  if  any,  on  the  needle  may  be  recog- 
nized as  copper,  either  by  its  color  or  by  the  action  of  ammonia. 

Traces  of  copper  have  been  found  in  many  hinds  of  food,  as  well  as  in 
the  tissues  of  the  body,  irrespective  of  the  introduction  of  a  copper  salt 
as  a  poison.  Thus  copper  has  been  detected  in  various  green  pickles,  in 
preserved  peas  and  other  vegetables.  It  has  been  used  in  these  cases  as 
an  artificial  coloring.  In  prosecutions  under  the  Sale  of  Food  and  Drugs 
Act,  the  question  has  arisen  whether  such  a  quantity  of  copper  as  0.28 
grain  in  a  pound  would  render  the  article  injurious  as  food.  Copper  is  a 
noxious  substance,  and  there  is  a  penalty  on  the  wilful  admixture  of  any 
noxious  substance  with  any  article  intended  for  food,  whatever  the  pro- 
portion may  be.  In  some  cases,  a  grain  and  a  half  of  sulphate  of  copper 
has  been  found  in  a  pound  of  peas.  The  restrictions  on  the  regreening 
of  preserved  vegetables  in  France  have  been  recently  removed. 


TARTAR  EMETIC  —  SYMPTOMS.  15'6 


CHAPTER   Xiy. 

TARTAR  EMETIC. ANTIMONIAL  WINE. SYMPTOMS. — APPEARANCES. — CHRONIC  POISONING. — 

CHEMICAL    ANALYSIS. CHLORIDE    OR    BUTTER    OP    ANTIMONY. POISONING    WITH    SALTS    OF 

ZINC   AND    IRON. POISONING   WITH    CHROMATES. 

Tartar  Emetic. 

Tartar  Emetic,  or  Tartarated  Antimony,  is  met  with  in  commerce  as 
a  heavyish  white  powder,  freely  soluble  in  twenty  parts  of  water  and  less 
soluble  in  alcoholic  liquids.  It  is  used  in  medicine,  and  more  largely  in 
veterinary  medicine. 

Antimonial  Wine,  i.  e.  the  official  solution  of  tartarated  antimony  in 
sherry  wine  (two  grains  in  one  fluidounce),  may  easily  be  mistaken  for 
ordinary  sherry.  The  editor  had  a  laboratory  attendant  who  was  made 
seriously  ill  by  drinking  this  medicine,  which  he  had  pilfered.  Tartar 
emetic  is  a  constituent  of  many  proprietary  and  patent  cough  medicines ; 
and  these,  when  taken  in  excess,  may  produce  a  powerful  depressant  action 
upon  the  system. 

Symjitoms  and  Effects — When  tartar  emetic  is  taken  in  a  poisonous 
dose,  a  strong  metallic  taste  is  perceived  in  the  mouth  during  the  act  of 
swallowing.  There  is  great  heat,  with  constriction  of  the  throat  and 
difficulty  of  swallowing,  violent  burning  pain  in  the  region  of  the  stomach, 
followed  by  incessant  vomiting,  profuse  purging,  faintness,  and  extreme 
depression.  The  pulse  is  small  and  rapid,  and  sometimes  imperceptible  ; 
the  skin  cold  and  clammy,  and  covered  with  a  clammy  perspiration  ;  the 
respiration  painful.  Should  the  case  prove  fatal,  death  may  be  preceded 
by  giddiness,  insensibility,  great  prostration  of  strength,  and  sometimes 
violent  spasms  of  the  muscles  of  the  limbs,  which  may  assume  either  a 
clonic  or  a  tetanic  character.  Such  are  the  symptoms  in  an  acute  case  of 
poisoning  by  this  substance.  The  quantity  actually  required  to  destro}^ 
life  is  small.  One  drachm  taken  at  a  dose  proved  fatal  in  ten  hours,  in 
spite  of  early  and  frequent  vomiting.  (Med.  Gaz.,  vol.  45,  p.  801.)  In 
a  case  in  which  a  girl  took  a  teaspoonful  of  tartar  emetic  by  mistake, 
recovery  took  place  in  three  weeks.  She  suffered  from  enteritis,  and,  as 
an  after-effect,  her  hair  fell  off.  (Brit.  Med.  Jour.,  1876,  ii.  p.  492.)  A 
man  took  eighty  grains.  There  was  only  slight  vomiting  an  hour  after 
he  had  taken  it ;  but  this  became  subsequently  very  violent,  attended  with 
severe  cramps  in  the  legs  and  profuse  perspiration.  He  recovered  in  two 
days.  (Brit.  Med.  Jour.,  1877,  i.  p.  674.)  In  1881  a  young  man  was 
killed  in  six  hours  by  a  dose  of  fifteen  grains  of  tartar  emetic.  The  char- 
acteristic pustular  eruption  of  tartar  emetic,  often  observed  on  the  skin 
af;er  its  local  application,  was  found  on  the  mucous  membrane  of  the 
stomach.     (Friedreich's  Blatt.  f.  Gerichtl.  Med.,  1882,  p.  8.) 

On  April  18,  1876,  Mr.  Bravo,  eet.  30,  a  barrister,  was  poisoned  by 
tartar  emetic.  After  dining  with  his  wife,  and  whilst  alone  in  his  rooni 
at  6.30  P.  M.,  he  was  suddenly  seized  with  violent  sickness  and  vomiting. 
When  seen  at  10.30  P.  M.,  by  Moore,  he  was  lying  back  in  a  chair,  totally 
unconscious ;  the  breathing  was  noisy,  and  the  heart's  action  was  barely 
perceptible.  He  did  not  appear  to  suffer  pain,  and  his  appearance  was 
not  unlike  that  of  a  person  under-  the  effects  of  a  narcotic.     He  had  pre- 


154  POISONING    WITH    TARTAR    EMETIC. 

viously  complained  of  pain  in  th*e  stomach,  and  an  emetic  of  mustard  and 
water  had  been  given.  The  pupils  were  widely  dilated ;  and  he  was  un- 
able to  swallow  when  seen  shortly  afterwards  by  Harrison.  At  1.45  A.  M. 
on  the  19th,  he  first  vomited  blood.  At  3.30  A.M.,  soon  after  he  was 
seen  by  Geo.  Johnson  and  Royes  Bell,  a  little  consciousness  returned ; 
and  he  then  said,  to  account  for  his  state,  that  he  had  rubbed  his  gums 
Avith  laudanum,  and  that  he  might  have  taken  some  of  this  liquid.  Just 
before  becoming  conscious,  viz.,  at  2.45  A.  M  ,  he  vomited  blood  and 
passed  bloody  stools.  Throughout  the  19th,  after  the  return  of  conscious- 
ness, he  suffered  excruciating  pain,  and  Avas  violently  purged  and  vomited 
frequently.  On  the  20th  the  patient  was  seen  by  Gull,  at  6.30  P.  M.,  who 
found  him  pulseless  and  dying.  He  was  told  that  he  was  dying  of  poison, 
and  was  asked  how  he  came  by  it.  He  replied,  "I  took  it  myself."  "What 
did  you  take  ?"  "  Laudanum."  When  told  that  he  had  taken  more  than 
laudanum,  he  made  no  further  statement  bearing  upon  the  matter,  except 
to  repeat  a  second  time,  "I  took  it  myself."  Pain,  collapse,  vomiting, 
purging,  and  occasional  convulsions,  especially  of  the  upper  limbs,  con- 
tinued till  near  the  close,  when  the  vomiting  and  purging  ceased.  He 
died  on  the  21st  of  April,  fifty-five  hours  after  the  commencement  of 
symptoms.  At  the  autopsy,  made  next  day,  the  following  appearances 
were  observed  by  Payne :  There  was  no  appearance  of  inflammation, 
congestion,  or  ulceration  of  the  stomach,  which  contained  about  eight 
ounces  of  thick  gruel-like  matter  of  a  yellowish  color,  containing  small 
solid  lumps,  and  had  the  odor  of  alcoholic  fermentation.  The  gullet  was 
natural,  and  contained  some  of  the  same  matter  as  the  stomach.  The 
first  portion  of  the  bowels  was  very  soft,  being  torn  in  tying  it ;  but  sub- 
sequent careful  examination  showed  no  perforation  or  ulceration.  The 
surface  was  pale  and  yellowish  like  that  of  the  stomach.  The  whole  of 
the  small  intestine  w^as  like  this,  except  the  lower  part,  Avhere  there  were 
some  red  spots.  This  part  of  the  bowels  contained  yellow  pasty  matter 
without  any  admixture  of  blood.  Subsequent  examination  showed  sev- 
eral small  ulcers  in  the  caecum,  from  which  the  bleeding  had  evidently 
taken  place ;  but  there  was  no  perforation.  The  remainder  of  the  large 
intestine  was  very  deeply  blood-stained,  but  without  ulceration.  The 
contents  were  a  soft  dark-red  material,  composed  of  fecal  matter  mixed 
with  blood.  The  liver  and  spleen  were  natural,  as  v^'ere  also  the  pancreas, 
kidneys,  and  other  abdominal  organs.  The  skull  and  the  membranes  of 
the  brain  were  quite  natural,  containing  only  the  usual  amount  of  blood. 
The  brain-substance  was  also  healthy,  and  contained  no  excessive  amount 
either  of  blood  or  of  watery  fluid.  The  mouth  and  lips  were  natural,  ex- 
cept that  the  papillse  at  the  back  of  the  tongue  were  somewhat  more 
prominent  than  usual.  There  was  no  other  appearance  of  disease  in  the 
body,  except  what  has  been  noted.  From  the  first  vomit  of  the  deceased, 
Redwood  obtained  antimony  equivalent  to  ten  grains  of  tartar  emetic. 
Antimony  was  also  detected  in  the  liver  and  in  fluid  taken  from  the  large 
intestines  of  the  deceased,  but  not  in  the  contents  of  the  stomach.  Traces 
of  the  metal  were  also  discovered  in  the  urine  passed  during  life.  Red- 
wood was  of  opinion  that  at  least  twenty  grains  of  tartar  emetic  had 
been  taken  by  deceased.  A  verdict  of  wilful  murder  by  some  unknown 
person  w^as  returned,  no  tartar  emetic  being  traced  in  the  hands  of  the 
deceased  or  any  person  about  him.  It  was  also  known  that  Bravo  was 
well  read  in  medical  jurisprudence,  and  was  acquainted  with  the  poisonous 
nature  of  tartar  emetic.  Some  months  after  the  return  of  the  above  ver- 
dict, evidence  came  into  the  possession  of  the  editor — who  watched  the 
medical  aspect  of  the  case  at  the  inquest  on  behalf  of  one  of  the  persons 


APPEAKANCES.  155 

living  in  the  same  house  as  the  deceased — showing  that  Bravo  had  tartar 
emetic  in  his  possession  within  six  or  seven  weelvs  of  his  decease.  He 
had  purchased  a  large  number  of  quack  powders,  extensively  advertised 
as  a  cure  for  dipsomania,  and  received  instructions  that  these,  if  adminis- 
tered too  freely  to  his  wife,  would  cause  vomiting.  It  is  possible  that 
these  powders — each  of  them  consisting  of  half  a  grain  of  tartar  emetic 
with  a  pink  vegetable  pigment — may  have  been  taken  in  fatal  amount  by 
the  deceased,  who  was  unaware  of  their  poisonous  nature,  for  the  purpose 
of  causing  ejection  of  the  laudanum  which  he  had  admittedly  taken.  It 
is  probable  that  the  laudanum  would  delay  the  ejection  of  the  tartar 
emetic  and  thus  increase  the  liability  to  a  fatal  result. 

Appearances. — The  following  cases,  as  well  as  those  already  given, 
show  the  nature  of  the  appearances  likely  to  be  found  after  death.  Two- 
children,  a  boy  aged  five,  and  a  girl  aged  three  years,  each  swallowed  a 
powder  containing  ten  grains  of  tartar  emetic  mixed  Avith  a  little  sugar. 
It  was  stated  that,  in  twenty  minutes  after  taking  the  powders,  they  were 
seized  with  violent  vomiting  and  purging  and  great  prostration  of  strength, 
followed  by  convulsions  and  tetanic  spasms ;  there  was  also  great  thirst. 
The  boy  died  eight  hours,  and  the  girl  twelve  or  thirteen  hours  after  swal- 
lowing the  poisoning.  The  bodies  were  inspected  between  four  and  five 
days  after  death.  I  n  that  of  the  boy  there  was  effusion  of  serum  in  the  right 
pleura ;  the  lower  lobe  of  the  right  lung  posteriorly  was  redder  than 
natural,  and  the  peritoneum  was  injected  from  recent  inflammation.  The 
mucous  membrane  of  the  duodenum  was  inflamed  and  covered  with  a 
whitish-yellow  viscid  secretion  ;  this  was  observed  throughout  the  intes- 
tines, but  the  color  was  of  a  deeper  yellow  in  the  large  intestines ;  there 
was  no  ulceration.  The  peritoneal  coat  of  the  stomach  was  inflamed. 
The  mucous  membrane  of  this  organ  was  also  much  inflamed,  especially 
about  the  larger  curvature  and  at  the  cardiac  orifice  ;  there  was  no  ulcera- 
tion, but  in  one  case  there  was  a  patch  of  lymph.  The  stomach  contained 
about  two  ounces  and  a  half  of  a  dark,  bloody  fluid,  having  a  slightly  acid 
reaciion.  The  tests  used  did  not  indicate  the  presence  of  antimony.  With 
regard  to  other  appearances,  the  tongue  was  covered  with  a  white  fur 
and  appeared  soddened ;  the  throat  was  not  inflamed  ;  the  windpipe  and 
gullet  had  a  natural  appearance.  On  opening  the  head,  the  dura  mater 
was  found  congested  ;  the  longitudinal  sinus  contained  a  coagulum  of 
lymph  and  but  little  blood.  The  vessels  of  the  surface  of  the  brain  were 
much  injected  with  dark-colored  blood,  the  whole  surface  having  a  deep 
purple  color.  p]very  portion  of  the  brain,  when  cut,  presented  many 
bloody  points.  The  cerebellum  and  medulla  oblongata  were  also  congested  ; 
there  was  no  effusion  in  the  ventricles  or  at  the  base  of  the  brain.  In  the 
body  of  the  girl  the  morbid  appearances  were  similar;  and  there  were,  in 
addition,  on  the  arms,  legs,  and  neck,  patches  resembling  the  eruption  of 
scarlatina.  The  arachnoid  membrane  was  more  opaque  than  usual ;  and 
on  the  mucous  membrane  of  the  stomach,  where  the  inflammation  was 
greatest,  were  two  or  three  white  spots,  each  about  the  size  of  a  split  pea, 
which  appeared  to  be  the  commencement  of  ulceration.  (Lancet,  1846,  ii. 
p.  460.     See  also  case  of  Bravo,  p.  153  ' 

In  cases  of  chronic  poisoning  by  this  substance  the  principal  symptoms 
are  as  follows  :  Intense  nausea  ;  vomiting  of  mucous  and  bilious  liquids  ; 
great  depression  and  prostration  of  strength  ;  watery  purging  followed 
often  by  constipation  of  the  bowels  ;  small,  contracted,  and  frequent  pulse  ; 
loss  of  voice  and  muscular  strength;  coldness  of  the  skin,  with  clammy 
perspiration  ;  and  death  from  complete  exhaustion.     In  these  cases  anti- 


156 


CHEMICAL    ANALYSIS. 


mony  may  be  detected  in  the  urine  by  Reinsch's  process.  There  are 
several  cases  reported  which  show  that  tartar  emetic  has  been  thus  crimi- 
nally employed.     (See  Brit.  Med.  Jour.,  1876,  i.  p.  639.) 

It  has  been  supposed  that  the  cases  in  which  this  poison  has  proved 
fatal  have  been  few ;  but  the  author  has  elsewhere  reported  thirty - 
seven,  of  which  sixteen  were  fatal.  The  smallest  fatal  dose  was  in  a 
child,  three-quarters  of  a  grain  (Jour,  de  Chimie,  1847,  p.  472),  and  in  an 
adult,  two  grains  ;  but  in  this  latter  instance  there  were  circumstances  which 
favored  the  fatal  operation  of  the  poison.  (Guy's  Hosp.  Rep.,  1857,  p.  415  ; 
Andral's  Clinique  Med.,  1836,  p.  698.) 

Chemical  Analysis.  Tartar  Emetic  as  a  solid. — In  a  state  of  powder 
it  is  white  and  crystalline. — 1.  It  is  easily  dissolved  by  water ;  the  solu- 
tion has  a  faintly  acid  reaction  and  an  acrid,  metallic  taste.  2.  The 
powder,  dropped  into  sulphide  of  ammonium,  is  turned  of  a  deep  reddish- 
brown  color,  and  is  thereby  known  from  other  white  metallic  salts.  3. 
When  heated  in  a  reduction-tube  it  is  charred,  but  does  not  previously  melt 
like  acetate  of  lead.  The  metal  is  partially  reduced  by  the  carbon  of  the 
vegetable  acid,  and  the  decomposed  mass  has  a  grayish-blue  metallic  lustre. 
No  metallic  sublimate  is  produced  in  this  experiment  by  the  moderate  heat 
of  a  spirit-lamp.  4.  When  boiled  in  water  containing  one-sixth  of  pure 
hydrochloric  acid,  and  metallic  copper  is  immersed  in  the  lic|uid,  a  deposit 
of  antimony  takes  place  on  this  metal.  The  color  of  the  deposit  is  violet- 
red  if  the  c]uantity  is  very  small,  but  the  deposit  is  gray,  or  black  and 
pulverulent,  if  very  large.  5.  The  solution  acidulated  with  one-tenth  part 
of  hydrochloric  acid  gives  in  the  cold  a  black  deposit  on  a  surface  of  pure 
tinfoil.  This  serves  to  distinguish  antimony  from  arsenic,  which,  under 
these  circumstances,  produces  no  deposit  on  pure  tin.  On  the  other 
hand,  tartar  emetic  and  other  antimonial  compounds  give  no  deposit  when 
boiled  with  stannous  chloride  and  fuming  h^'clrochloric  acid,  unless  arsenic 
is  present  as  an  impurit}". 

Tartar  Emetic  i7i  solution — 1.  On  slowly  evaporating  a  small  c{uan- 
tity  of  the  solution  on  a  slip  of  glass,  the  salt 
will  crystallize  in  tetrahedra  and  in  deriva- 
tives of  the  octahedron  (Fig.  16).  If  ob- 
tained from  a  very  dilute  solution,  this 
crystallization  is  confused  and  resembles  that 
of  arsenic.  2.  Hydrochloric,  vitric,  or  sul- 
phuric  acid,  each  gives  a  white  precipitate, 
soluble  in  excess  of  the  acid.  This  triple 
reaction  is  very  characteristic  of  tartarated 
antimony.  3.  Ferrocyanide  of  potassium 
does  not  precipitate  the  solution,  whereby 
tartar  emetic  is  known  from  most  other  metal- 
lic poisons.  4.  Sulphuretted  hydrogen  gas 
produces  in  the  solution  a  reddish-orange 
colored  precipitate,  differing  in  color  from 
every  other  metallic  sulphide.  This  pre- 
cipitate is  soluble  in  sulphide  of  ammonium  and  is  dissolved  by  strong 
boiling  hydrochloric  acid. 

In  liquids  containing  organic  matter. — Tartar  emetic  is  precipitated 
by  tannin  in  all  its  forms,  but  not  readily  by  albumen  or  mucous  mem- 
brane ;  therefore  it  may  be  found  sometimes  dissolved  in  the  liquids  of 
the  stomach,  and  sometimes  precipitated.  These  insoluble  compounds  of 
antimony  are  soluble  in  tartaric  acid  ;  and  thus,  if  there  should  be  no 
antimony  dissolved,  it  may  easily  be  brought  into  a  state  of  solution  by 


Crystals  of  Tartar  Emttie,  magnified 
30  diaraeters. 


DETECTION    OF    TARTAR    EMETIC    IN    ORGANIC    LIQUIDS.       157 

means  of  this  acid.  The  liquid,  acidulated  with  tartaric  acid,  should  be 
boiled  and  liltered.  If  it  should  be  highly  colored  or  tar))id,  it  may  be 
concentrated  and  submitted  to  the  process  of  dialysis.  The  antimonial 
compound  may  thus  be  obtained  in  a  clear  solution.  A  current  of  sul- 
phuretted gas  may  now  be  passed  into  the  whole  or  a  portion  of  it  until 
there  is  no  farther  precipitation.  The  sulphide  is  collected,  washed,  and 
dried.  If  it  is  the  sulphide  of  antimony,  it  will  have  an  orange-red  or 
brown  color,  it  will  be  insoluble  in  a  solution  of  ammonia,  and  when  dried 
will  be  dissolved  by  a  small  quantity  of  boiling  hydrochloric  acid  (form- 
ing chloride  of  antimony),  with  the  evolution  of  sulphuretted  hydrogen 
gas.  The  boiling  should  be  continued  for  several  minutes  until  the  liquid 
is  colorless.  On  adding  this  solution,  if  not  too  acid,  to  water,  a  white 
precipitate  of  oxychloride  of  antimony  falls  down.  The  white  precipitate 
is  soluble  in  tartaric  acid.  This  is  characteristic  of  antimony.  If  the 
sulphuretted  hydrogen  is  passed  into  a  colored  organic  liquid,  the  orange- 
red  color  of  the  sulphide  can  be  only  well  seen  in  the  froth. 

[Prof.  Reese  does  not  regard  this  test  as  absolutely  characteristic  of 
antimony  unless  pure,  inasmuch  as  the  colored  precipitate  which  may  often 
be  obtained  by  the  action  of  sulphuretted  hydrogen  on  a  simple  acid  solu- 
tion of  certain  organic  substances  is  more  or  less  soluble  in  boiling  hydro- 
chloric acid,  and  this  solution  when  thrown  into  water  will  yield  a  while 
precipitate.'} 

The  following  method  of  detecting  the  metal  when  dissolved  in  any 
organic  liquid  is  based  upon  the  principle  by  which  copper  and  other 
metals  may  be  detected  under  similar  circumstances.  Acidulate  a  portion 
of  the  suspected  liquid  with  hydrochloric  acid  and  place  it  in  a  shallow 
platinum  capsule.  Touch  the  platinum,  through  the  acid  liquid,  with  a 
rod  of  pure  zinc.  Hydrogen  is  evolved,  and,  wherever  the  metals  come 
in  contact  metallic  antimony,  in  the  state  of  a  black  powder,  is  deposited 
upon  the  surface  of  the  platinum.  The  liquid  should  be  poured  off  and 
the  capsule  thoroughly  washed  with  distilled  water.  This  may  be  effected 
without  disturbing  the  black  deposit.  This  deposit  should  be'^heated  with 
strong  nitric  acid — evaporated  to  dryness — the  white  residue  dissolved  in 
strong  hydrochloric  acid,  and  this  solution,  not  too  much  diluted,  precipi- 
tated by  a  current  of  sulphuretted  hydrogen.  A  reddish-colored  precipi- 
tate indicates  antimony.  If  a  portion  of  this  hydrochloric  acid  solution  is 
added  to  water,  it  may  give  a  precipitate  of  white  oxychloride  of  antimony, 
soluble  in  tartaric  acid,  and  this  solution  may  be  precipitated  of  an  orange- 
red  color  by  sulphuretted  hydrogen.  By  this  process  antimony  in  sniaJl 
quantity  may  be  detected  in,  and  separated  from,  any  liquid  containing 
organic  matter.  If  there  is  no  deposit  under  these  circumstances,  a  rod 
of  zinc,  or  a  piece  of  tinfoil,  with  a  layer  of  thin  platinum-foil  wound  round 
it,  should  be  suspended  in  the  sufficiently  diluted  acid  liquid  for  some 
hours.  If  antimony  is  present,  it  will  be  deposited  on  both  metals  in  the 
form  of  a  black  powder. 

In  the  tissues.— ThQ  antimony  may  be  deposited  in  the  organs  in  so 
small  a  quantity  that  neither  the  sulphuretted  hydrogen  nor  the  deposition 
on  platinum  process  will  yield  any  satisfactory  results.  The  liver  or  other 
organ  should  be  cut  into  small  pieces  and  boiled  in  a  mixture  of  one  part 
of  hydrochloric  acid  and  five  parts  of  water.  After  some  time,  the  liquid 
may  be  tested  by  introducing  into  it  a  slip  of  polished  copper-foil  free  from 
antimony.  If  antimony  is  present  in  small  quantity,  the  copper  will 
acquire  a  reddish  or  violet-colored  deposit  on  its  surface ;  if  in  large  quan- 
tity, the  deposit  will  be  gray  with  a  metallic  lustre,  or  sometimes  in  the 
state  of  a  loose,  black  powder.     These  deposits,  when  heated  in  a  reduc- 


158  BUTTER    OF    ANTIMONY. 

tion-tube,  do  not  ^neld  octahedral  crystals  like  those  obtained  from  arsenic. 
A  slip  of  pure  tinfoil  may  be  suspended  in  the  cold  acid  liquid,  so  diluted 
that  the  hydrochloric  acid  forms  only  one-tenth  part  by  measure.  Either 
immediately,  or  in  the  course  of  a  few  hours,  if  antimony  is  present,  the 
tin  is  covered  with  a  black  deposit  of  the  metal.  Antimony  in  the  metal- 
lic state  is  so  easily  procured  from  a  small  quantity  of  material,  by  one  or 
other  of  the  above-mentioned  processes,  that  on  no  account  should  this  be 
omitted.  The  procuring  of  the  metal  may  be  made  subsidiary  to  the  pro- 
curing of  the  sulphide,  as  the  metal  can  be  easily  dissolved  by  boiling  the 
deposit  on  copper  with  a  solution  of  permanganate  of  potassium.  It  can 
then  be  converted  into  sulphide  and  obtained  entirely  free  from  organic 
matter.  A  reliance  on  a  small  quantity  of  a  colored  precipitate  from  sul- 
phuretted hydrogen  alone,  without  the  production  of  the  metal  in  some 
form,  would  be  most  unsatisfactory  as  chemical  evidence.  No  chemist 
would  rely  upon  the  production  of  a  yellow  sulphide  as  certain  evidence 
of  the  presence  of  arsenic,  unless  he  olDtained  the  metal  arsenic  from  that 
compound. 

[The  same  reason  exists  why  the  metal  should  be  produced  in  a  case  ol 
alleged  poisoning  by  antimony  as  in  the  case  of  poisoning  by  mercury, 
arsenic,  lead,  copper,  etc.     The  general  rule  in  such  cases  is  the  safer.] 

The  separation  of  antimony  from  the  tissues  docs  not  necessarily  indicate 
that  it  has  been  criminally  administered  or  has  caused  death  ;  but  its 
presence  there  should  be  reasonably  accounted  for,  as  antimony  may  have 
been  unlawfully  administered.  In  several  cases  of  suspected  death  from 
poison,  deposits  on  copper,  evidently  of  an  antimonial  nature,  have  been 
obtained  from  the  liver  or  tissues.  On  inquiry  it  has  been  found  that 
antimonial  medicines  had  been  taken  shortly  before  death.  It  is  best, 
however,  in  all  cases  to  shred  up  the  tissue  and  boil  it  with  dilute  hydro- 
chloric acid,  a  few  crystals  of  potassium  cblorate  being  introduced  from 
time  to  time,  till  a  clearish  yellow  solution  is  obtained.  The  solution  is 
then  warmed  with  bisulphite  of  sodium  till  it  persistently  smells  of  sulphur 
dioxide.  The  whole  is  then  allowed  to  stand  in  a  warm  place  till  the 
sulphur  dioxide  has  disappeared.  The  liquid  is  filtered  and  the  filtrate 
precipitated  with  a  stream  of  washed  sulphuretted  hydrogen  gas.  A  pre- 
cipitate of  sulphide  of  antimony  falls,  mixed  with  sulphur.  This  may 
be  dissolved  in  boiling  strong  hydrochloric  acid  and  tested  as  above  for 
antimony. 

Terchloride,  or  Butter  of  Avtimony. — This  is  a  strongly  corrosive 
poison.  It  is  used  for  browning  gun-barrels  and  in  veterinary  medicine. 
It  has  caused  death  in  several  instances.  Two  women,  mother  and 
daughter,  were  tried  (Reg.  v.  Wallis  and  Wallis,  Worcester  Sum.  Ass., 
1883)  for  the  murder  of  the  illegitimate  infant  child  of  the  5^ounger 
prisoner  by  means  of  terchloride  of  antimony,  but  were  acquitted  from 
insufficient  evidence  of  administration.  It  was  at  first  supposed  that  the 
child  had  died  from  poisoning  by  ferric  chloride,  which  was  detected  in 
the  stomach  b}^  a  medical  man.  The  editor  found  antimony  in  the  viscera, 
and  also  in  the  matters  vomited  and  passed  from  the  bowels  of  the  child. 
The  ferric  chloride  was  merely  the  impurit}^  always  met  with  in  com- 
mercial terchloride  of  antimony  The  symptoms  and  appearances  resemble 
those  produced  by  concentrated  hydrochloric  acid.  The  terchloride  gives 
a  white  precipitate  when  added  to  water.  This  is  soluble  in  tartaric  acid, 
and  the  solution  is  precipitated  of  an  orange-red  color  by  sulphuretted 
hydrogen.     It  has  caused  death  in  several  instances. 


ZINC.  159 


Zinc. 


Sulphate  of  Zinc.  White  Vitriol. — Symptoms  and  Appearances. — 
The  syiuptotiis  produced  by  an  overdose  of  sulphate  of  zinc  are  a  styptic 
taste,  pain  in  the  abdomen,  and  violent  vomiting-,  coming  on  almost  im- 
mediately, followed  by  purging.  After  death  the  stomach  has  been  found 
inflamed.  The  sulphate  appears  to  act  as  a  pure  irritant,  and  has  no 
corrosive  properties.  This  salt  may  cause  death  indirectly  as  the  result 
of  exhaustion  from  violent  vomiting,  when  an  ordinar}'  dose  has  been 
given  to  a  person  already  debilitated  by  disease.  It  does  not  appear  to 
be  a  very  energetic  poison.  In  one  case  a  lady  recovered  after  taking 
sixty-seven  grains.  (Lancet,  1856,  i.  p.  540.)  In  another,  which  occurred 
in  1872,  a  man,  set.  20,  recovered  in  a  few  days  after  taking  an  ounce  o-f 
sulphate  of  zinc  by  mistake  for  Epsom  salts.  There  was  early  vomiting 
and  purging  of  a  most  violent  kind,  with  great  prostration  of  strength. 
The  greater  part  of  this  large  dose  was  no  doubt  thus  quickly  carried  out 
of  the  body. 

Chloride  of  Zinc. — Symptoms  and  Appearances. — This,  which  is  com- 
monly sold  under  the  name  of  "  Sir  W.  Burnett's  fluid,"  is  a  corrosive  and 
irritant  poison,  and  is  much  used  as  a  deodorizer.  The  patient  experiences 
a  sense  of  heat  and  burning  in  the  mouth  and  throat,  in  the  act  of  swal- 
lowing the  liquid,  which  has  been  frequently  fatally  mistaken  for  fluid 
magnesia.  There  is  a  burning  and  griping  pain  in  the  stomach  and 
nausea,  followed  usually  by  violent  retching  and  vomiting — the  vomited 
matters  being  streaked  with  blood  and  mixed  with  much  flaky  mucus  and 
shreds  of  mucous  membrane.  This  has  produced  an  appearance  of  frothi- 
ness  about  the  mouth.  Violent  purging  has  been  observed  among  the 
symptoms.  A  stage  of  collapse  supervenes,  and  the  skin  becomes  cold  and 
livid. 

A  man,  set.  62,  took  two  fluidounces  of  soldering  fluid,  made  by  dissolv- 
ing zinc  in  hydrochloric  acid — and  hence  a  solution  of  chloride  of  zinc. 
An  emetic  was  given  without  effect,  and  he  speedily  became  collapsed. 
There  was  profuse  purging.  A  little  scanty  urine  was  drawn  off  by  a 
catheter.  He  retained  his  intellect  until  death,  four  hours  and  a  half  after 
taking  the  poison.  Crosse  found  after  death  the  tongue  white  and 
shrivelled,  and  the  mucous  membrane  of  the  mouth  as  if  charred.  The 
gullet  was  contracted,  with  the  mucous  membrane  white,  silky,  and  easily 
detached.  The  stomach  was  contracted  and  rugose,  the  mucous  membrane 
being  of  an  ashy-gray  color,  with  black  patches.  The  stomach  contained 
chloride  of  zinc  and  free  hydrochloric  acid.  The  whole  of  the  bowels  were 
hardened  and  contracted,  the  mucous  membrane  thickened  and  gray  in 
color — the  duodenum  and  upper  part  of  the  jejunum  especially  so.  (Brit. 
Med.  Journ.,  1883,  ii.  p.  820.) 

After  death  from  this  poison,  the  lining  membrane  of  the  mouth  and 
throat  has  been  found  white  and  opaque — that  of  the  stomach  has  some- 
times been  hard  and  leathery,  at  others  corrugated,  opaque,  and  of  a  dark 
Ijaden  color.  The  lungs  and  kidne\^s  are  congested.  The  chloride  is 
both  a  corrosive  and  irritant  poison,  exerting  also  a  peculiar  action  on 
the  nervous  system.  If  a  person  survives  the  acute  stage,  he  may  die 
in  the  chronic  stage  from  stricture  of  the  gullet  or  pylorus,  or  from  ema- 
ciation and  exhaustion  as  a  result  of  the  local  action  of  the  poison  on  this 
organ. 

Analysis. — In  these  two  compounds,  the  zinc  is  detected  by  their 
aqueous  solutions  giving  white  precipitates  with  a  current  of  sulphuretted 
hydrogen  gas,  while  the  sulphuric  acid  or  the  chlorine  mav  be  recognized 


160  PREPARATIONS    OF    IRON    AND    CHROMIUM. 

by  their  respective  tests.    Metallic  zinc  may  be  obtained  by  plunging  into 
a  weak  solution  of  the  salt  a  slip  of  magnesium. 

Preparations  of  Iron. 

Ferrous  SidpJi.ate.  Sulphate  of  Iron.  Copperas.  Green  Vitriol. — 
This  compound  has  been  administered  with  malicious  intention.  One 
death  from  it  took  place  in  18.37  or  1838.  It  cannot,  however,  be  an 
active  preparation  ;  for  a  girl  who  swallowed  an  ounce  of  it  recovered, 
although  she  suffered  for  some  hours  from  violent  pain,  vomiting,  and 
purging.  (Christison.)  Green  vitriol,  or  copperas,  is  sometimes  given 
as  an  abortive.  A  woman  of  the  name  of  Riley  was  indicted  (Notting- 
ham Aut.  Ass.,  1859)  for  administering  copperas  to  two  children.  She 
put  the  substance  into  gruel.  It  gave  to  the  gruel  a  greenish  color 
and  a  peculiar  taste,  which  led  to  the  discovery.  It  caused  sickness,  but 
no  other  serious  symptoms.  As  there  was  no  evidence  of  an  intent  to 
murder,  and  as  it  was  then  not  unlawful  to  administer  poison  with  any 
other  intent,  the  prisoner  was  acquitted.  This  salt  has  been  much  used 
for  criminal  purposes  in  France.  (See  Med.  Gaz.,  vol.  4Y,  p.  30T  ;  also 
Ann.  d'Hyg.,  1850,  vol.  1,  pp.  180,  516;  and  1851,  vol.  1,  p.  155;  vol.  2, 
p.  337.) 

Ferric  Chloride.  Muriate  of  Iron.  Perchloride  of  Iron — This  is 
usually  met  with  as  an  acid  solution  in  water  or  in  rectified  spirit.  These 
solutions  are  of  a  red-brown  color,  and  are  much  employed  as  medicine. 
They  are  sometimes  made  with  wood-spirit  or  methylated  spirit,  which 
gives  to  them  a  peculiar  odor.  Christison  relates  an  instance  in  which  a 
man,  by  mistake,  swallowed  an  ounce  and  a  half  of  such  a  liquid.  The 
symptoms  are  somevi^hat  like  those  produced  by  hydrochloric  acid.  He  at 
first  rallied,  but  died  in  about  five  weeks.  The  stomach  was  found  par- 
tially inflamed,  and  thickened  toward  the  intestinal  end.  The  stronger 
solution  of  the  British  Pharmacopoeia  is  very  potent  when  swallowed.  A 
patient  in  Guy's  Hospital  swallowed  in  mistake  a  fluid  drachm  of  the  solu- 
tion, and  was  strongly  purged  by  it  in  a  few  minutes. 

Comparatively  small  doses  of  these  solutions  may  seriously  affect  preg- 
nant women  ;  and  among  the  criminal  uses  to  which  they  have  been  put 
may  be  mentioned  that  of  procuring  abortion.  A  druggist  was  convicted 
(Reg.  V.  Rumble,  Lincoln  Lent  Assizes,  1863)  of  having  supplied  the  per- 
chloride to  a  woman  with  the  intent  to  procure  her  miscarriage.  The 
health  of  the  woman  was  greatly  injured  by  the  administration  of  the 
liquid.  The  editor  has  met  with  several  instances  of  the  administration  of 
ferric  chloride  to  pregnant  women  with  the  view  of  procuring  abortion ; 
and  for  this  purpose  it  is  commonly  combined  with  aloes. 

Preparations  op  Chromium. 

Bichromate  of  Potassium,  or  Bichromate  of  Potash. — Well-observed 
instances  of  poisoning  by  thic  compound,  which  is  now  extensively  used 
in  the  arts,  are  rare;  and  therefore  the  details  of  the  following  case 
(Med.  Gaz.,  vol.  33,  p.  734)  are  of  interest.  A  man,  «t.  64,  was  found 
dead  in  his  bed  twelve  hours  after  he  had  gone  to  rest ;  he  had  been  heard 
to  snore  loudly,  but  this  had  occasioned  no  alarm  to  his  relatives.  When 
discovered,  he  was  lying  on  his  left  side,  his  lower  limbs  being  a  Itttle 
drawn  up  to  his  body  ;  his  countenance  was  pale,  placid,  and  composed ; 
the  eyes  and  mouth  were  closed  and  the  pupils  dilated ;  there  was  no  dis- 
charge from  any  of  the  outlets  of  the  body  ;  and  there  were  no  signs  of 


PREPARATIONS  OF  CHROMIUM ANALYSIS.        161 

vomiting-  or  purging,  nor  any  stain  upon  the  hands  or  person,  nor  upon 
the  bed-linen  or  furniture.  The  surface  was  moderately  warm.  Some  dye- 
stutf,  in  the  form  of  a  black  powder,  was  found  in  his  pocket.  On  inspec- 
tion, the  brain  and  its  membranes  were  healthy  and  natural  ;  there  was 
neither  congestion  nor  effusion  in  any  part.  The  thoracic  viscera  were 
healthy,  as  well  as  those  of  the  abdomen,  with  the  exception  of  the  liver, 
which  contained  several  hydatids.  A  pint  of  turbid,  inky-looking  fluid  was 
found  in  the  stomach.  The  mucous  membrane  was  red  and  vascular,  par- 
ticularly at  the  union  of  the  greater  end  with  the  gullet ;  this  was  ascribed 
to  the  kuovvn  intemperate  habits  of  the  deceased.  In  the  absence  of  any 
obvious  cause  for  death,  poison  was  suspected  ;  and  on  analyzing  the  con- 
tents of  the  stomach  they  were  found  to  contain  bichromate  of  potas- 
sium. The  dye-powder  taken  from  the  man's  pocket  consisted  of  this  sa-lt 
mixed  with  cream  of  tartar  and  sand.  The  salt  does  not  appear  to  have 
acted  so  much  by  its  irritant  properties,  as  by  its  effects  on  the  nervous 
system.  This,  however,  is  by  no  means  an  unusual  occurrence,  even  with, 
irritants  far  more  powerful  than  bichromate  of  potassium.  A  boy  recov- 
ered from  the  effects  of  a  dose  of  this  salt,  but  only  after  the  lapse  of  four 
months.  The  first  symptoms  were  pain,  vomiting,  dilated  and  fixed  pupils, 
cramps  in  the  legs,  and  insensibility.  His  recovery  was  due  to  early  and 
active  treatment.  (Guy's  Hosp.  Rep.,  1850,  p.  216.)  Another  case  in 
which,  owing  to  timely  treatment,  a  man,  set.  37,  recovered  from  a  large 
dose  of  the  salt,  was  communicated  to  the  author.  It  seems  that  with 
suicidal  intent  the  man  swallowed  about  two  ounces  of  the  bichromate  in 
solution,  mixed  with  pearl-ash.  In  about  two  hours  he  was  seen  by  An- 
drews, and  he  was  then  apparently  in  a  dying  state.  He  was  suffering 
chiefly  from  severe  cramps,  the  pupils  were  dilated,  the  pulse  was  scarcely 
perceptible,  and  there  was  vomiting  and  purging,  with  greenish-colored 
evacuations.  The  stomach-pump  was  used,  and  olive  oil  and  diluents 
were  given.  In  about  nine  hours  the  urgent  symptoms  abated,  and  the 
man  complained  only  of  great  pain  in  the  shoulders  and  legs.  There  was 
no  gastric  irritation  nor  tenderness  of  the  abdomen.  He  was  discharged, 
cured,  at  the  end  of  a  week.  A  woman,  set.  24,  died  from  the  effects  of 
this  poison  taken  for  the  purpose  of  procuring  abortion.  The  symptoms 
were  those  of  an  irritant — severe  pain,  vomiting,  and  purging.  (Horn's 
Yierteljahrsschr.,  1886,  2,  s.  113.) 

This  pit,  in  a  state  of  fine  powder,  or  in  a  saturated  solution,  has  a 
local  irritant  action  on  the  skin  and  on  parts  from  which  the  skin  has 
been  removed.  (Ann.  d'Hyg.,  1864,  1,  83.)  It  produces  what  are  called 
"chronic  sores,"  affecting  the  hands  and  exposed  parts  of  the  face. 
According  to  recent  observations,  workers  in  chrome  factories — of  which 
there  are  only  six  in  the  world — suffer  from  a  peculiar  irritation  of  the 
septum  of  the  nose,  apparently  due  to  the  action  of  bichromate  of  potas- 
sium, which  leads  to  a  perforation  of  the  nasal  septum.  (Lancet,  1882,  i. 
p.  169.)  Chromic  acid  is  a  powerful  corrosive  poison,  destroying  all 
organic  textures.     (Pharm.  Jour.,  Jan.  1872,  p.  568.) 

Ghromate  of  Lead  (Chrome  Yellow)  is  a  powerful  irritant  poison.  A 
dose  of  a  few  grains  of  this  pigment  has  proved  fatal.  (See  case  of  two 
boys.     N.  Syd.  Soc.  Bien.  Retrospect,  1873-4,  p.  452.) 

Analysis. — The  bichromate  may  be  recognized  by  its  orange-red  color, 
as  well  as  by  the  intense  yellow  color  which  it  gives  to  water  when 
dissolved.  Its  solution  gives  a  deep  red  precipitate  with  nitrate  of  silver, 
a  pale  yellow  with  nitrate  of  barium,  and  a  bright  yellow  with  salts  of 
lead. 

11 


182  URANIUM. 


Uranium. 


Tbe  compounds  of  this  metal  are  now  largely  used  in  the  arts,  and  eases 
of  poisoning  b}^  it  have  occurred.  Indeed  it  has  recently  been  proposed 
to  place  it  in  the  official  list  of  poisons  in  Russia.  Uranium  salts  cause 
severe  inflammation  of  the  gastro-intestinal  mucous  membrane,  and  of 
the  kidneys,  and  are  distinguished  from  the  metallic  poisons  by  acting 
directly  on  the  walls  of  the  bloodvessels,  and  rendering  also  the  blood 
reducible  with  difficulty.  In  this  respect  they  resemble  prussic  acid.  (See 
an  abstract  of  the  researches  of  Woroschilsky  in  Pharm.  Jour.,  1890-1,  p. 
20B.) 

These  are  the  principal  metallic  irritants ;  but  the  compounds  of  tin, 
silver,  gold,  and  osmium  have  also  an  irritant  action.  Cases  of  poison- 
ing by  these  substances  are,  however,  rare.  (See  On  Poisons,  3d  edit. 
1«75.) 


VEGETABLE    IKKITANTS — ALOES.  1G3 


VEGETABLE  AND  OTHER  IRRITANTS. 


CHAPTEEXV. 

VEGETABLE       IRRITAXTS. ALOES. GELSEMIUM  SAVIN.  —  CROTON-OIL. CASTOR  OIL. COL- 

CHICl'M. HELLEBORE. VERATRIXE. CARBOLIC     ACID. RESORCIN. PETROLEL'M.  —  ANI- 
MAL   IRRITANTS  :    CANTHARIDES. NOXIOUS  ANIMAL  FOOD. FISH. MUSSELS. CHEESE. 

SAUSAGE    POISON. PORK. — TRICHINOSIS. POISONED    GAME. PTOMAINES. 

General  Remay-ks. — The  poisonous  substances  of  an  irritant  nature 
which  belong-  to  the  vegetable  kingdom  are  very  numerous  as  a  class; 
but  it  will  here  be  necessary  to  notice  only  those  which  have  either  caused 
death  or  have  given  rise  to  accidental  poisoning. 

Aloes.  Colocynth.  Gamboge.  Jalap.  Scammony. — These  different 
substances,  which  are  used  in  small  doses  as  medicines,  are  liable,  when 
taken  frequently  or  in  large  quantities,  to  excite  severe  vomiting,  purging, 
and  other  symptoms  of  irritation.  In  one  case  a  dose  of  colocynth  (three 
pennyworth)  proved  fatal  to  a  woman,  set.  22.  She  was  pregnant,  and 
had  taken  the  drug  for  procuring  abortion,  for  which  purpose  it  is  often 
used.  It  operates  as  a  violent  irritant.  (Pharm.  Jour.,  June  22,  1878, 
p.  1035.)  Christison  recorded  the  death  of  a  young  woman  from  a 
teaspoonful  and  a  half  of  the  powdered  pulp.  Roques  states  that  less 
than  sixty  grains  of  the  powder,  in  decoction,  has  proved  fatal;  whilst  re- 
covery has  taken  place  after  three  times  that  amount.  (Husemann,  Hand, 
d.  Toxicol.,  p.  62.5.) 

Hierapicra  {Holy  Bitter)  was  formerly  a  popular  aloetic  compound, 
and  one  death  is  recorded  to  have  been  produced  by  it  in  1837-8.  There 
is  reason  to  believe  that  it  is  occasionally  used  for  the  purpose  of  pro- 
curing criminal  abortion.  A  man  was  tried  and  convicted  of  this  offence 
(Reg-.  V.  White,  Aylesbury  Lent  Ass.,  1857),  and  the  noxious  properties 
of  this  compound  then  became  a  subject  of  legal  inquiry.  The  dose,  and 
the  condition  of  the  woman  to  whom  it  is  administered,  will  of  course 
affect  the  answer  to  this  question.  At  the  trial  above  mentioned,  it  was 
properly  considered  to  be  a  noxious  substance  within  the  meaning  of  the 
statute.  The  fact  that,  under  the  name  of  Pulvis  Aloes  cum  Canelld,  it 
was  formerly  admitted  into  the  British  Pharmacopceia,  cannot  justify  the 
mischievous  uses  to  which  it  may  be  put.  Hierapicra  is  a  snuff-colored 
powder,  of  an  intensely  bitter  taste.  It  consists  of  four  parts  by  weight 
of  aloes  and  one  part  by  weiy  ht  of  powdered  Canella  bark.  The  proper 
medicinal  dose  was  formerly  fixed  at  from  five  to  fifteen  grains.  Its 
injurious  effects  on  pregnant  women  are  chiefly  due  to  the  aloes.  This 
drug  specially  affects  the  rectum,  and  by  contiguity,  under  violent 
irritation  or  purging,  may  affect  the  uterus.  From  the  taste  and  color 
which  it  imparts  to  liquids,  it  is  not  probable  that  it  could  be  taken  by  a 
woman  unknowina-lv. 


164  YELLOW  Jasmine. 

Yellow  Jasmine  (Gelsemium  nitidum  seu  semper virens). 

An  alcoholic  extract  of  the  root  of  this  plant,  and  a  tincture,  are  nsed 
for  medicinal  purposes.  It  contains  one,  or  perhaps  two  alkaloids,  one  of 
which  paralyzes  and  the  other  tetanizes.     Its  solutions  are  fluorescent. 

It  has  acted  as  a  poison  and  destroyed  life,  but  its  exact  place  as  a  poison 
cannot  yet  be  satisfactorily  assigned.  In  one  case  reported  by  Wormley 
(Amer.  Jour,  of  Pharni.,  Jan.  1870)  it  appears  to  have  acted  rather  as 
an  irritant  than  a  narcotic. 

A  young  healthy  married  woman,  several  weeks  advanced  in  pregnancy, 
took  by  mistake  three  teaspoonfuls  of  fluid  extract  of  gelsemium — a  con- 
centrated tincture  of  the  root,  containing  480  grains  to  the  fluidounce. 
In  two  hours  after  taking  the  extract  she  complained  of  pain  in  the  stomach, 
nausea,  and  dimness  of  vision.  These  symptoms  were  followed  by  great 
restlessness,  ineffectual  efforts  to  vomit,  and  general  perspiration.  In  four 
hours  the  pulse  was  feeble,  irregular,  and  intermittent.  There  was  great 
prostration,  with  irregular  and  slow  breathing.  The  skin  was  dry,  the 
limbs  cold,  the  pupils  dilated  and  insensible  to  light ;  the  eyes  were  fixed, 
and  there  was  inability  to  raise  the  eyelids.  The  vital  powers  rapidly 
gave  way,  and,  viathout  convulsions,  death  occurred  in  seven  hours  and  a 
half  after  the  poison  had  been  taken.  On  inspection,  the  membranes  and 
substances  of  the  brain  and  spinal  marrow  were  normal.  The  adipose 
tissue  was  tinged  with  bilious-looking  matter.  The  lungs  were  collapsed, 
but  natural  in  appearance,  and  the  superficial  veins  M^ere  congested.  The 
heart  was  normal — the  superficial  veins  were  injected,  and  the  cavities 
were  distended  with  dark  grumous  blood,  inside  of  which  was  a  well- 
defined  fibrinous  deposit.  The  stomach  contained  a  small  quantity  of 
ingesta  ;  the  peritoneum  and  intestines  were  in  a  healthy  state.  The  left 
kidney  was  congested.  It  will  be  seen  from  this  account  that,  while  death 
took  place  rapidly,  there  was  nothing  characteristic  in  the  symptoms  and 
appearances  A  muscular  man,  twenty-eight  years  of  age,  after  a  drink- 
ing bout,  took  about  two  ounces  of  fluid  extract  of  gelsemium,  to  "quiet 
his  nerves."  When  seen,  his  face  was  flushed;  he  was  dozing,  but  could 
easily  be  roused,  and  talked  intelligently  ;  the  pupils  were  moderately 
dilated,  reacting  to  light,  and  there  was  slight  drooping  of  both  eyelids. 
The  pulse  was  strong  and  full,  and  about  100  per  minute.  An  hour  later, 
the  dipsomaniac  eluded  his  watchers,  managed  to  get  out  to  a  drug-store, 
and  procured  half  an  ounce  of  fluid  extract  of  gelsemium,  which  he  drank. 
He  was  found  twenty-five  minutes  later,  sitting  in  a  shop,  with  relaxed 
limbs  and  pale  face  ;  and  he  was  capable  of  speech.  As  he  refused  to 
swallow  an  emetic,  sulphate  of  zinc  was  administered  through  the  nose. 
Copious  vomiting  followed  this  and  a  second  dose  that  was  given.  In 
spite  of  this,  he  speedily  became  unconscious;  pulse  130;  respiration  40, 
and  entirely  thoracic  ;  pupils  moderately  dilated,  but  acting.  I3randy  was 
given  subcutaneously  and  by  the  rectum,  and,  after  faradization  of  the 
diaphragm  and  intercostal  muscles,  he  rallied  from  the  state  of  collapse 
into  which  he  had  fallen,  only  to  relapse  shortly  after,  when  the  same 
measures  were  repeated.  Hypodermic  injections,  first  of  atropine,  then  of 
carbonate  of  ammonium,  and  inhalation  of  nitrite  of  amyl,  were  employed. 
He  died  about  five  hours  after  taking  the  poison.  (Boston  Med.  and 
Surg.  Jour.,  Dec.  22,  1881.) 

Savin  (Juniperus  Sabina). — This  is  a  well-known  plant  of  a  remarkable 
odor,  the  leaves  of  which  exert  an  irritant  action  both  in  the  state  of  in- 
fusion and  powder.    They  yield  by  distillation  a  light  yellow,  acrid,  volatile 


CROTON-OIL  —  COLCIIICUM. 


165 


Fig.  17. 


Tips  of  the  leaves  of  Savin,  magnified 
30  diameters. 


oil,  on  which  the  irritant  properties  of  the  plant  depend.  The  powder  is 
sometimes  used  in  medicine,  in  a  dose  of  from  five  to  twenty  grains. 
Savin  is  not  often  taken  as  a  poison  for  the  specific  purpose  of  destroying 
life ;  but  this  is  occasionally  an  indirect  result  of  its  use  as  a  popular 
means  of  procuring  abortion.  It  acts  by  producing  violent  pain  in  the 
abdomen,  vomiting,  and  strangury.  After  death,  the  gullet,  stomach,  in- 
testines, and  kidneys  have  been  found  either  much  inflamed  or  congested. 
It  has  no  specific  action  as  an  abortive,  but  operates,  like  other  irritants, 
by  causing  a  violent  shock  to  the  system,  under  which  the  womb  may 
expel  its  contents.  Such  a  result  can  never 
be  obtained  without  placing  in  jeopardy  the 
life  of  a  woman  ;  and  thus,  when  abortion 
follows,  she  generally  falls  a  victim.  Oil  of 
savin  given  with  sulphate  of  iron  and  aloes 
in  the  furm  of  pills,  is  much  used  by  criminal 
abortionists  after  instrumental  interference, 
during  the  earlier  months  of  pregnanc3\  (Reg. 
V.  Phillips,  C.  C.  C,  Feb.  1885  ) 

The  presence  of  savin  in  powder  in  the 
stomach  and  bowels  may  be  recognized  by 
the  peculiar  odor,  and  by  the  presence  of 
microscopic  fragments  (see  Fig.  17)  of  the 
plant.  The  woody  tissue  of  the  plant  has 
the  characteristic  dots  of  coniferous  woody 
tissue.     Yew  has  a  similar  structure,  but  is 

destitute  of  the  true  savin  odor.  Yew  and  savin  are  the  chief  poisonous 
coniferse  of  this  country.  Yew  berries  are  highly  poisonous  ;  but  the 
luscious  pulp  forming  the  exterior  of  the  so-called  berry  is  innocent. 

Groton-oil. — This  is  an  oil  extracted  from  the  seeds  of  the  Croton  tiglium. 
It  is  a  powerful  drastic  purgative,  producing,  in  a  large  dose,  severe  purg- 
ing, collapse,  and  death.  A  case  occurred  in  Paris,  in  1839,  in  which  a 
man  swallowed  by  mistake  two  drachms  and  a  half  of  croton-oil.  In 
three-quarters  of  an  hour  the  surface  was  cold  and  clammy,  the  pulse  im- 
perceptible, the  breathing  difficult,  and  the  extremities  and  face  were  as 
blue  as  in  the  collapsed  stage  of  cholera.  In  an  hour  and  a  half  purging 
set  in;  the  stools  were  passed  involuntarily,  and  the  abdomen  was  very 
sensitive  to  the  touch.  The  patient  complained  of  a  burning  pain  in  the 
course  of  the  gullet.  He  died  in  four  hours  after  swallowing  the  poison. 
There  was  no  marked  change  in  the  mucous  membrane  of  the  stomach. 
(For  another  fatal  case,  see  Pharm.  Jour.,  Feb.  1863,  p.  379.) 

Castor-oil. — The  seeds  of  the  castor-oil  plant  are  occasionally  fatally 
poisonous  to  children,  who  are  attracted  by  their  beautifully  mottled  ap- 
pearance. They  act  as  a  powerful  drastic.  Three  seeds  have  destroyed 
the  life  of  an  adult  (Med.  Times  and  Gaz.,  1861,  i.  p.  555.  See  also  Ann. 
de  Thdrap.,  1872,  p.  103;  and  Ann.  d'Hyg.,  1871,  i.  p.  400.) 

Meadow-Saffron  (C'o?c/n'ci(m).^-Meadow-safFron  (Colchicum  autum- 
nale)  contains  a  poisonous  alkaloid — colchicine.  The  most  noxious  parts 
of  the  plant  are  the  cornis  (or  roots)  and  seeds,  but  the  leaves  and  flowers 
have  also  an  irritant  action. 

Symptoms  and  Appear^arices. — The  symptoms  in  cases  of  poisoning  by 
colchicum  are  generally  well  marked.  There  is  burning  pain  in  the  throat 
and  stomach,  intense  thirst,  violent-.vomiting,  and  purging  leading  rapidly 


166  POISONING    WITH    COLCHICUM. 

to  exhaustion,  coldness  and  clamminess  of  the  skin,  excessive  depression, 
and  great  weakness.  The  pulse  is  small,  weak,  and  fluttering- ;  and  death 
appears  to  take  place  from  exhaustion  without  convulsions  or  loss  of  con- 
sciousness. Among  four  cases  {infra)  presenting  these  symptoms,  one 
person  died  on  the  second,  one  on  the  fifth,  one  on  the  eighth,  and  one  on 
the  fourteenth  ^2i\.  In  another  case  of  poisoning  by  wine  of  colchicum, 
the  symptoms  did  not  come  on  for  an  hour  and  a  half;  there  was  then 
copious  vomiting  of  a  yellow  fluid,  severe  pain  with  great  tenderness  in 
the  abdomen,  tenesmus,  and  thirst.  The  patient  died  in  forty-eight  hours, 
without  being  convulsed  or  manifesting  any  sign  of  cerebral  disturbance 
A  woman  who  took  an  ounce  and  a  quarter  of  the  wine  recovered  in  about 
twenty-four  hours.  She  suflered  chiefly  from  severe  griping  pains.  The 
pupils  were  contracted,  and  the  heart's  action  was  very  feeble.  The  after- 
symptoms  were  headache  and  nausea.  (Lancet,  ]877,  i.  p.  263.)  The 
chief  morbid  appearance  was  a  patch  of  redness  on  the  mucous  membrane 
of  the  stomach,  near  the  cardiac  orifice ;  the  intestines  W'ere  slightly 
inflamed.  The  brain  was  not  examined.  (Med.  Gaz.,  vol.  10,  p.  161  ;  see 
also  Casper,  Gerichtl.  Med.)  In  a  case  of  poisoning  by  the  medicinal  ad- 
ministration of  colchicum,  three  drachms  and  a  half  of  the  wine  of  colchicum 
were  taken  in  divided  doses,  and  caused  death  on  the  fourth  day.  There 
was  no  inflammation  of  the  mucous  membrane,  but  simply  extravasation 
of  blood  into  the  mucous  follicles.  The  mucous  membrane  has  been  found 
softened  in  two  cases  of  poisoning  by  the  tincture.  In  two  other  cases 
in  which  an  ounce  and  a  half  of  the  tincture  was  taken,  and  death  ensued 
in  forty^-eight  hours,  no  morbid  appearances  were  found.  (Caspar,  Gerichtl. 
Med.,  and  see  Yierteljahrsschr.  f.  Gerichtl.  Med.,  1860,  vol.  1.  p.  1.) 

Colchicum  has  acquired  an  evil  notoriety  as  a  poison.  A  woman  (Reg. 
V.  Catharine  Wilson,  C.  C.  C,  Sept.  ]862),  after  having  been  tried  and 
acquitted  for  an  attempt  to  poison,  with  oil  of  vitriol,  the  wife  of  a  man 
with  whom  she  cohabited,  was  in  the  following  September  convicted  of 
the  murder  of  a  Mrs.  Soames,  who  had  died  suddenly  while  nursed  by  the 
prisoner  six  years  previously.  The  body  was  exhumed,  but  no  poison  was 
found  in  the  remains  ;  yet  the  medical  and  other  circumstances,  as  well  as 
the  conduct  and  correspondence  of  the  prisoner,  proved  to  the  satisfaction 
of  the  court  that  deceased  had  been  destroyed  by  vegetable  poison,  most 
probably  colchicum,  with  the  noxious  properties  of  which  she  was  proved 
to  have  been  well  acquainted.  From  the  facts  which  transpired  in  refer- 
ence to  this  trial,  it  appeared  that  the  deceased  was  one  of  four  persons 
who  had  at  difi'erent  dates  fallen  victims  to  the  acts  of  this  woman. 
1.  Peter  Mawer,  a  master  mariner  of  Boston,  died  in  October,  1854:  the 
body  was  exhumed  in  1862,  but  no  poison  was  detected.  2.  Mrs.  Jackson, 
of  Boston,  who  died  in  December,  1859  :  the  body  was  exhumed  in 
January,  18G0,  and  no  poison  detected.  3.  Mrs.  Atkinson,  of  Kirkby 
Lonsdale,  who  died  in  October,  1860:  the  body  was  exhumed  in  May, 
1862,  and  no  poison  detected.  4.  Mrs.  Soames,  above  mentioned.  All 
the.se  persons  died  suddenly  while  in  a  state  of  health,  under  similar 
symptoms,  and  without  any  apparent  natural  cause  to  account  for  death. 
The  symptoms  as  a  whole  were  not  reconcilable  with  any  known  disease; 
and  they  only  appeared  after  the  prisoner  was  proved  to  have  administered,  i 
under  some  pretence  or  other,  food  or  medicine,  the  bottle  which  she  em- 
ployed for  this  purpose  being  kept  locked  up  or  in  her  own  possession. 
The  motive  for  the  murder  in  each  case  was  the  acquisition  of  money  or 
property  of  which  the  prisoner  came  into  possession — in  Peter  Mawer's 
case  by  a  will  made  shortly  before  his  death,  and  in  Mrs.  Atkinson's  case 
by  an  act  of  robbery  afti  r  her  death.     Two   other  attempts  at  murder, 


POISONING    WITH    HELLEBORE.  1G7 

which  failed,  led  to  the  inference  that  colchicum  was  the  substance  which 
this  woman  employed,  either  in  wine  or  brandy.  In  these  four  persons 
the  symptoms  were  as  nearly  as  possible  of  the  same  character — burning; 
pain  in  the  throat  and  stomach,  intense  thirst,  violent  vomiting  and  purg- 
ing-, coldness  and  clamminess  of  the  skin,  excessive  depression,  and  great 
weakness.  The  pulse  was  small  and  weak,  and  death  appeared  to  take 
place  from  exhaustion,  without  convulsions  or  loss  of  consciousness.  In 
most  of  the  cases  the  poison  was  probably  given  in  divided  doses  ;  in  the 
last  case,  the  symptoms  appeared  regularly  every  evening  after  the  deceased 
had  taken  the  tea  prepared  by  the  prisoner.  [Grave  doubts  have,  how- 
ever, been  entertained  b}^  experts  as  to  the  kind  of  poison  administered: 
the  author's  opinion  as  to  its  being  colchicum  is  not  universally  shared  by 
toxicologists. — Editor.] 

Colchicine. — .The  noxious  properties  of  colchicum  are  owing  to  "the 
presence  of  this  alkaloid.  It  may  be  separated  from  liquids  containing 
it  by  a  process  similar  to  that  described  for  strychnine.  It  is,  however, 
but  little  known  in  toxicology. 

Hellebore. — St/mptoms  and  Appearavces  — According  to  Wilmer,  the 
roots  of  the  black  hellebore  {Helleborus  niger)  possess  the  greatest  activ- 
ity ;  but  the  leaves  are  also  highly  poisonous  when  used  in  the  form  of 
infusion.  By  long  boiling  the  poisonous  properties  of  the  plant  are  di- 
minished, probably  owing  to  the  loss  of  the  volatile  principle.  The  roots 
and  leaves  have  a  local  irritant  action,  producing  in  small  doses  violent 
vomiting  and  purging,  with  severe  pain  in  the  abdomen,  followed  by  cold 
sweats,  convulsions,  insensibility,  and  death.  The^  powdered  root,  in  a 
do.se  of  a  few  grains,  acts  like  a  drastic  purgative.  In  a  ease  reported  by 
Morgagni,  half  a  drachm  of  the  aqueous  extract  killed  a  man,  ast.  50,  in 
eight  hours.  The  symptoms  were  severe  pain  in  the  abdomen  and  violent 
vomiting.  After  death  the  whole  of  the  alimentary  canal  was  found  in- 
flamed, but  especially  the  large  intestines.  A  case  is  quoted  by  the  same 
writer  in  which  a  tablespoonful  of  the  finely-powdered  root  (taken  by 
mistake  for  rhubarb)  caused  severe  symptoms  of  irritant  poisoning,  which 
did.  not  disappear  for  four  hours.  The  man  recovered  on  the  fourth  day. 
The  experiments  performed  by  Orfila  on  animals  show  that  this,  poison 
acts  like  a  local  irritant  when  applied  to  a  wound.  Hellebore  is  a  favor- 
ite remedy  for  worms  among  quacks.  It  is  not,  therefore,  surprising  that 
it  should  be  occasionally  administered  in  an  overdose,  and  cause  death. 
Edwards  met  with  a  case  in  which  a  gentleman  had  swallowed  experi- 
mentally one  drachm  of  tincture  of  green  hellebore  (  Veratrum  viride), 
ecjual  to  twelve  grains  of  the  powder.  He  was  found  soon  afterwards  in 
a  collapsed  state,  with  sunk  features,  cold  skin,  covered  with  a  profuse 
clammy  sweat,  and  pulse  scarcely  perceptible.  He  complained  of  intense 
pain  in  the  region  of  the  stomach.  There  was  no  purging.  These  S3"mp- 
toms  were  relieved  by  treatment,  and  the  next  morning  the  patient  had 
recovered.     (Med.  Times  and  Gaz.,  1803,  1,  p.  5.) 

Veratrine. — White  hellebore  {Veratrum  album)  owes  its  noxious  prop- 
erties to  the  alkaloid  veratrine  or  veratria,  which  is  itself  a  powerful 
poison  The  alkaloid  is  prepared  from  the  cevadilla  seeds.  Callaway 
communicated  to  the  author  the  following  case  :  A  physician  prescribed 
medicinally  for  a  lady  one  grain  of  veratrine  divided  into  fifty  pills,  and 
three  were  directed  to  be  taken  for  a  dose.  Not  long  after  the  dose  had 
been  swallowed  the  patient  was  found  insensible,  the  surface  cold,  the 
pulse  failing,  and  there  was  every  symptom  of  approaching  dissolution. 
She  remained  some  hours  in  a  doubtful  condition,  but  ultimately  recov- 


168  POISONING    WITH    VERATRINE CARBOLIC    ACID. 

ered.  Supposing  the  medicine  to  have  been  well  mixed,  and  the  pills 
equally  divided,  not  more  than  one-sixteenth  of  a  grain  of  veratrine  was 
here  taken.  The  common  veratrine  of  the  shops  is  sometimes  given 
medicinally,  in  doses  of  one-sixth  of  a  grain.  Poisoning  by  veratrine  is  a 
rare  occurrence.  We  have  not  met  with  an  instance  in  which  this  alka- 
loid has  been  indubitably  administered  with  criminal  intention.  Judging 
from  its  effects  on  animals,  it  would  cause  vomiting  and  convulsions,  with 
insensibility. 

Analysis. — In  the  state  in  which  it  is  usually  seen,  it  is  a  whitish  pow- 
der, scarcely  soluble  in  boiling  water,  but  dissolved  by  alcohol,  ether,  and 
benzene.  Acids  readily  dissolve  it,  forming  salts  which  on  evaporation 
do  not  yield  crystals.  The  powder  has  a  hot,  acrid  taste,  and  if  any  por- 
tion enters  the  nostrils  it  causes  most  violent  sneezing,  lasting  for  some 
time.  Strong  nitric  acid  gives  to  the  powder  a  light-red  color,  becoming 
ochreous  after  a  time.  Hydrochloric  acid,  strong  or  diluted,  with  the  aid 
of  heat,  produces  a  beautiful  red  tint.  The  best  test  for  its  presence  is 
diluted  sulphuric  acid,  which,  on  gentle  heating,  strikes  a  rich  pink  color,, 
which  is  destroyed  by  a  solution  of  chlorine,  but  not  by  stannous  chloride. 
Strong  sulphuric  acid  turns  the  powder  yellow,  but  on  heating  the  mix-^ 
ture  the  color  deepens,  and  finally  becomes  a  deep  red ;  and  w-hen  the 
liquid  is  diluted  it  passes  to  a  dingy  yellow.  Veratrine  undergoes  no 
change  when  mixed  with  iodic  acid,  but  it  gives  immediately  w^ith  sul- 
phomolybdic  acid  a  deep  greenish-yellow  color  passing  to  a  brown-red. 

Veratrine  is  insoluble  in  water.  It  may  be  brought  into  solution  in 
organic  liquids  by  warming  with  acetic  acid.  The  liquid  is  treated  with 
potash  and  then  shaken  with  two  parts  of  benzene.  The  alkaloid,  if 
present,  is  obtained  by  decanting  and  evaporating  the  benzene  solution. 
The  tests  may  then  be  applied  to  it.  It  has  not  yet  been  detected  in  the 
tissues.  The  editor  had  a  case  referred  to  him  in  which  a  woman  died 
about  twenty  minutes  after  taking  some  gruel.  A  medical  man  thought 
that  he  detected  veratrine  in  the  viscera  and  in  the  gruel.  The  editor, 
however,  detected  strychnine  in  these  articles;  and  the  post-mortem  ap- 
pearances were  those  of  strychnine.  A  case  occurred  in  1865,  in  which 
ueath  was  attributed  to  the  action  of  veratrine  criminally  administered. 
The  deceased,  a  woman,  Avas  advanced  in  pregnancy,  and  from  the  med- 
ical evidence  she  died  from  puerperal  convulsions  and  Bright's  disease  of 
the  kidney,  with  effusion  of  blood  on  the  brain.  It  was  said  that  verat- 
rine was  detected  in  her  body  and  in  the  urine,  but  there  were  no  symp- 
toms of  poisoning  by  veratrine,  and  there  was  no  evidence  of  administra- 
tion by  any  one.  The  chemical  analysis  was  not  published,  or  it  might 
have  appeared  that  too  great  a  reliance  had  been  placed  upon  the  tests 
employed.  (Med.  Times  and  Gaz.,  1865,  ii.  p.  472.)  It  was  probably  a 
case  of  death  from  natural  causes  mistaken  for  poisoning. 

Carbolic  Acid. 

Carbolic  Acid,  Phenic  Acid,  or  Phenol,  is  a  crystalline  product  of  the 
distillation  of  coal-tar.  The  medicinal  acid  melts  at  9H°  F.  It  has  a 
characteristic  and  not  unpleasant  odor.  When  a  small  proportion  of  water 
is  added  to  the  crystals,  they  liquefy.  It  is  moderately  soluble  in  water. 
The  commercial  crystals  often  have  an  unpleasant  odor,  due  to  impuri- 
ties ;  and  they  acquire  a  red  color  on  exposure  to  light.  More  com- 
monly carbolic  acid  is  met  with  as  either  a  colorless  or  more  or  less 
brown  liquid  of  nauseous  odor,  containing  about  80  per  cent,  of  phenol ; 
or  as  a  dark- brown  liquid  chiefly  consisting  of  heavy  oil  of  tar,  with  about 


SYMPTOMS    AND    APPEARANCES FATAL    DOSE.  169 

30  per  cent,  of  the  acid.  These  are  largely  u.sed  as  disinfectants.  Applied 
to  the  skin  or  to  a  mucous  membrane,  it  coagulates  the  albununous  con- 
stituents, causing  a  severe  burning  pain  and  a  white  eschar.  A  death  is 
stated  to  have  occurred  from  the  external  use  of  the  acid  (Brit.  Med. 
Jour.,  1870,  ii.  p.  382)  ;  and  its  use  as  an  antiseptic  lotion  has  repeatedly 
produced  serious,  if  not  fatal,  results.  Deaths  from  the  internal  use  of 
carbolic  acid — usually  accidental,  but  not  infrequently  suicidal — are  now 
common.     Carbolic  acid,  so  called,  does  not  redden  litmus. 

Symptoms  and  Appearances. — When  the  poison  is  swallowed  in  solu- 
tion, or  in  the  form  of  undiluted  liquid,  the  patient  e.xperiences  a  hot,  burn- 
ing sensation  extending  from  the  mouth  to  the  stomach.  This  feeling  is 
experienced  during  the  act  of  swallowing,  and  the  lining  membrane  of  the 
mouth  is  whitened  and  hardened.  Carljolic  acid  is  rapidly  absorbed,  and 
in  the  course  of  a  few  minutes  the  system  may  be  profoundly  atfected;  In 
two  instances  the  rapidity  of  action  was  comparable  to  that  of  prussic 
acid.  Although  the  local  application  of  the  acid  to  a  part  is  commonly 
followed  by  severe  burning  pain,  this  may  be  entirely  absent  in  cases  of 
poisoning  by  this  agent,  and  even  a  local  diminution  of  sensibility  may 
be  produced.  Xervous  symptoms  are  those  most  strikingly  manifested, 
such  as  dilirium,  giddiness,  and  profound  insensibility.  Nausea  and 
vomiting  may  be  present  or  absent.  These  symptoms  may,  however,  be 
severe  and  uncontrollable.  There  is  extreme  feebleness  of  the  pulse  and 
dry,  harsh  skin,  with  lividity  of  the  surface.  The  urine,  as  was  first 
pointed  out  by  the  editor  (Guy's  Hosp.  Kep.,  18G8,  p.  40T),  is  often  of  an 
olive-green  or  even  black  hue  ;  but  this  appearance  is  more  common  in 
subacute  than  in  acute  and  rapidly  fatal  cases.  The  pupils  are  generally 
minutely  contracted.  Convulsions  and  .trismus  are  not  infrequently  oJ> 
served.  A  case  of  carbolic-acid  poisoning  can  rarely  fail  to  be  recognized. 
The  whitening  of  the  mouth,  the  brown  eschars  which  form  on  the  skin 
at  its  angles  where  the  poison  trickles  from  the  mouth,  the  odor  of  the 
breath,  and  the  profound  insensibility  and  stertorous  breathing,  with 
minutely  contracted  pupils,  rarely  leave  any  doubt  as  to  the  nature  of  the 
case.  The  editor  has,  nevertheless,  met  with  a  case  in  which  a  rather 
pure  form  of  the  acid  having  been  taken  for  suicidal  purposes  the  odor  of 
carbolic  acid  escaped  notice. 

Fatal  Period. — Death  has  several  times  occurred  within  twenty  minutes 
of  the  administration  of  the  poison,  and  in  one  case  a  man,  after  swallow- 
ing a  fluidou-nce  of  the  liquid  acid,  died  in  less  than  three  minutes. 
(Philad.  Med.  Times,  vol.  ii.  p.  284.)  In  1886,  a  man  suffering  from  dis- 
eased liver,  the  result  of  intemperate  habits,  whilst  in  his  ordinary  health, 
swallowed  by  mistake  eighty  grains  of  the  crystals,  dissolved  in  two 
fluid  ounces  of  a  dilute  solution  of  bicarbonate  of  sodium  and  sal  volatile. 
He  died  within  the  space  of  two  or  three  minutes.  Death  usually  super- 
venes within  four  hours.  Occasionally  in  fatal  eases  life  may  be  prolonged 
for  twenty-four  and  even  forty-eight  hours. 

Fatal  Dose. — This  is  unknown.  There  is  reason  to  believe  that,  if 
absorbed,  a  few  grains  of  the  poison  miirht  prove  fatal,  and  six  or  seven 
drops  have  produced  serious  results.  Eighty  grains  have  killed  an  adult 
{vide  supra).  Two  fluid  drachms  of  the  liquid  acid  have  killed  a  child 
two  years  of  age  in  twelve  hours.  (Guy's  Hosp.  Rep.,  1867,  p.  233.) 
In  one  case  a  child  six  months  old  was  killed  by  the  administration  of  a 
quarter  of  a  teaspoonful  of  the  acid  dissolved  in  glycerine — one  part  of 
acid  to  five  of  glycerine.  (Brit.  Med.  Jour.,  1882"i"  p.  748.)  Recovery 
has,  however,  taken  place  after  large  doses  have  been  taken.  A  girl,  «t. 
14,  swallowed  six  fluid  drachms  of  the  undiluted  (30  per  cent.)  acid.     In 


170  RESORCrX PYROGALLIC    ACID. 

twenty  minutes  she  was  comatose  and  breathinfi:  stertorouslj  ;  her  face 
was  livid,  the  pulse  was  small  and  irregular  ;  the  pupils  contracted,  but  not 
so  much  as  in  opium-poisoning-.  The  stomach  was  washed  out  with  soap 
and  water,  and  then  with  milk  and  water.  In  an  hour  the  lividity  dimin- 
ished and  consciousness  slowly  returned.  She  did  not  .complain  of  any 
gastric  irritation.  (Brit.  Med.  Jour.,  1882,  i.  p.  939.)  A  robust  woman, 
set.  30,  swallowed  nearly  half  an  ounce  of  an  alcoholic  solution  of  carbolic 
acid,  containing  35.8  per  cent,  of  the  poison.  It  was  ascertained  that  by 
the  use  of  the  stomach-pump  rather  more  than  half  of  the  poison  Avas  re- 
moved from  the  stomach,  but  that  at  least  92  grains  of  the  poison  were 
left  for  absorption.  The  most  prominent  symptoms  were  insensibility 
within  ten  minutes,  and  dizziness  speedily  passing  into  profound  coma, 
irregular  breathing  and  pulse,  contracted  pupils,  extreme  blueness  (cya- 
nosis) of  the  surface  of  the  body,  depression  of  the  body  temperature  to 
94°  F.,  and  haemoglobinuria,  i.  e.  the  presence  of  unaltered  blood-pigment 
in  the  urine,  which  contained  no  red  blood-corpuscles.  This  last  condition 
set  in  one  hour  after  the  poison  was  taken,  and  lasted  for  seven  hours  and 
a  half.  The  urine  reacted  for  carbolic  acid  during  two  days.  The  woman 
recovered.     (Berlin,  klin.  "VVocbenschr.,  1881,  No.  48.) 

Analysis. — Carbolic  acid  gives  a  purple  color  when  a  drop  of  solution 
of  ferric  chloride  is  added.  When  in  solution  it  yields  a  copious  precipi- 
tate of  tribromophenol  when  an  excess  of  bromine- water  is  added.  This 
precipitate,  when  washed  on  a  filter  and  treated  with  sodium  amalgam, 
again  yields  phenol  (carbolic  acid)  after  acidification. 

To  detect  carbolic  acid  in  viscera,  vomit,  urine,  etc.,  acidulate  the  sus- 
pected material  with  sulphuric  acid,  and  distil,  using  suitable  condensing 
arrangement.  The  distillate  may  have  the  odor  of  phenol.  It  is  precipi- 
tated with  an  excess  of  bromine  Avater;  the  precipitate  is  Avashed  Avith 
water  on  a  filter,  and,  while  still  moist,  treated  Avith  sodium  amalgam  in 
water  or  alcohol.  After  a  time,  on  acidifying  the  solution,  the  peculiar 
odor  of  carbolic  acid  will  be  perceived.  By  shaking  the  mixture  Avith 
ether,  pipetting  off  the  ether,  and  evaporating  it  in  watch-glasses,  oily 
streaks  of  phenol  will  be  left ;  these  may  be  tested  with  ferric  chloride  as 
described  above. 

Resorcin. 

Resorcin  is  an  antiseptic.  It  is  a  phenol,  i.  e.  a  body  closely  allied  to 
carbolic  acid,  crystallizing  in  colorless  crystals,  Avhich  are  readily  soluble 
in  water,  ether,  or  alcohol.  Applied  in  the  form  of  crystals,  it  acts  as  a 
powerful  caustic  to  the  skin.  The  commercial  resorcin,  Avhich  is  obtained 
as  a  bv-product  in  the  manufacture  of  a  pigment  knoAvn  as  eosine,  has  a 
red  color,  and  a  powerful  odor  resembling  that  of  carbolic  acid.  It  is  used 
internally  as  a  medicine.  On  one  occasion,  in  Avhich  an  overdose  of  tAvo 
drachms  Avas  given  to  a  young  Avoman,  it  produced  decided  toxic  symp- 
tom.s — insensibility,  profuse  perspiration,  blanched  lips,  loAvness  of  bod}^ 
temperature,  imperceptible  pul.-e,  and  almost  imperceptible  breathing.  The 
pupils  Avere  normal.  The  urine  Avas  olive-green  in  color.  The  patient 
recovered.  (Med.  Times  and  Gaz.,  1881,  ii.  p.  487.)  It  thus  appears  that 
resorcin  acts  like  carbolic  acid  on  the  human  organism. 

Pyrogallic  Acid  (Pyrggalltn). 

This  substance  is  largely  used  in  photography,  and  also  as  a  hair-dye. 
It  is  a  poison,  arresting  oxidation  in  the  body  by  removing  and  absorbing 
oxygen. 


PETROLEUM — ANTMAL    IRRITANTS.  171 

Petroleum. 

Under  the  term  petroleum,  or  rock-oil,  are  included  various  oils  used  for 
illuminating  purposes,  of  peculiar  odor,  which  spring-  from  the  ground  in 
various  parts  of  the  globe,  and  consist  of  mixtures  of  various  inflammable 
hydrocarbons.  The  illun)inants  which  were  in  use  prior  to  the  introduc- 
tion of  American  petroleum,  as  paraffin-oil,  solar-oil,  photogene,  etc.,  pos- 
sess analogous  composition.  Cases  of  petroleum-poisoning  are  rare  con- 
sidering the  frequent  use  of  this  well-known  substance.  The  majority  of 
eases  arise  from  drinking  out  of  bottles  supposed  to  contain  spirituous 
liquors,  although  there  have  occurred  a  few  cases  of  intentional  poisoning  ' 
by  this  liquid;  for  instance,  a  case  at  Brescia  (Jour,  de  Chim.  M4\.,  Nov. 
1806,  p.  597)  ;  and  another  in  the  province  of  Fosen,  particulars  of  which 
are  wanting.  In  general  the  poisonous  properties  of  petroleum,  such  as 
the  purified  American  variety,  cannot  be  rated  very  high ;  but  many 
varieties  of  crude  petroleum,  on  account  of  their  containing  sulphur  com- 
pounds, are  much  more  poisonous,  according  to  Bulenberg,  as,  for  instance, 
crude  petroleum  from  Canada.  In  adults  a  wineglassful  may  not  kill,  and 
in  one  case,  that  of  Mayer,  in  Antwerp,  five  fluidounces  did  not  cause 
death.  According  to  Kohler  (Physiol.  Ther.,  p.  347),  half  a  wine-bottle- 
ful  is  not  a  fatal  dose  for  an  adult.  Even  in  the  case  of  children,  among 
whom  the  editor  has  seen  several  cases,  the  fatal  dose  is  a  very  large  one ; 
and  in  the  event  of  death  supervening  it  is  due. rather  to  the  secondary 
result  of  local  action  of  the  poison  on  the  stomach  and  intestines  than  to 
the  result  of  the  absorption  of  hydrocarbons. 

In  cases  of  poisonin:^-,  generally  after  vomiting  follow  giddiness,  a  sense 
of  fulness  of  the  head,  ^vith  paiu  and  feeling  of  constriction ;  and  in  chil- 
dren, collapse,  somnolence,  pallor  of  the  face,  coldness  of  the  skin,  cold 
sweats,  and  weak  pulse  may  supervene.  Neither  the  behavior  of  the 
pulse  nor  of  the  pupils  is  constant.  In  collapse,  the  latter  are  dilated ; 
and  in  an  excited  condition  they  appear  contracted.  For  the  diagnosis, 
the  odor  of  petroleum  in  the  breath  is  generally  a  safe  guide.  Eructations 
and  vomiting  also  betray  the  presence  of  petroleum.  Finally,  the  urine 
may  acquire  a  peculiar  odor,  which  may  last  for  several  days.  In  Mayer's 
case  this  odor  resembled  that  odor  of  violets,  which  the  urine  acquires  after 
the  ingestion  of  oil  of  turpentine  and  other  essential  oils. 

Analysis. — The  detection  of  petroleum,  either  in  the  vomited  matters 
or  in  the  contents  of  the  stomach,  is  effected  by  distilling  the  suspected 
matters  and  determining  the  chemical  and  physical  properties  of  the 
distillate. 

Animal  Irritants. 

Cantiiarides.  (Spanish  Flies.) — Symptoms — When  cantharides  are 
taken  in  powder,  in  a  dose  of  one  or  two  drachms,  they  give  rise  to  the 
following  symptoms :  a  burning  sensation  in  the  throat,  great  difficulty  of 
swallowing,  violent  pain  in  the  abdomen,  with  nausea  and  vomiting  of  a 
bloody  mucus ;  there  is  also  great  thirst,  with  dryness  of  the  fauces.  As 
the  case  proceeds,  a  heavy,  dull  pain  is  commonly  experienced  in  the  loins, 
and  there  is  an  incessant  desire  to  void  urine ;  but  only  a  small  quantity 
of  blood,  or  bloody  urine,  is  passed  at  each  effort.  The  abdominal  pain 
becomes  of  a  violent  griping  kind.  Purging  supervenes,  but  this  is  not 
always  observed ;  the  matters  discharged  from  the  bowels  are  mixed  with 
blood  and  mucus,  and  there  is  often  tenesmus  (straining).  In  these,  as 
well  as  in  the  vomited  liquors,  shining  green  or  copper-colored  particles 


172  SPANISH    FLIES. 

may  be  commonly  seen  on  examination,  whereby  the  nature  of  the  poison 
taken,  if  it  has  been  taken  in  powder,  will  be  at  once  indicated.  After  a 
time,  there  is  priapism,  and  the  genital  organs  are  swollen  and  inflamed 
both  in  the  male  and  female.  When  the  case  proves  fatal,  death  is  usually 
preceded  by  faintness,  giddiness,  and  convulsions.  The  tincture  of  cau- 
tharides  produces  similar  symptoms :  they  are,  however,  more  speedily 
induced,  and  the  burning  sensation  in  the  stomach  and  constriction  of  the 
throat  are  more  strongly  marked ;  this  symptom  is  often  so  severe  as  to 
render  it  impossible  for  the  person  to  swallow  ;  and  the  act  of  swallowing 
gives  rise  to  excruciating  pain  in  the  throat  and  abdomen.  (For  the 
symptoms  and  appearances  in  a  case  in  which  three  ounces  of  the  tincture 
proved  fatal,  see  Brit.  Med.  Jour.,  1876,  i.  p.  191.) 

Appearances. — In  one  well-marked  case,  the  whole  of  the  alimentary 
canal,  from  the  mouth  downwards,  was  in  a  state  of  inflammation.  The 
mouth  and  tongue  seemed  to  be  deprived  of  their  mucous  membrane. 
The  ureters,  kidneys,  and  internal  organs  of  generation  were  also  inflamed. 
In  another  instance,  in  which  an  ounce  of  the  tincture  was  swallowed, 
and  death  did  not  occur  for  fourteen  days,  the  mucous  membrane  of  the 
stomach  was  not  inflamed  ;  but  it  was  pulpy,  and  easily  detached.  The 
kidneys  were,  however,  inflamed.  The  brain  has  been  found  congested, 
and  ulceration  of  the  bladder  is  said  to  have  been  met  with.  There  are 
few  fatal  cases  reported  in  which  the  appearances  have  been  accurately 
noted ;  indeed,  the  greater  number  of  those  persons  who  have  taken  this 
poison  have  recovered. 

The  quantity  required  to  produce  serious  symptoms,  or  to  destroy  life, 
has  been  a  frequent  subject  of  medico-legal  inquiry.  The  medicinal  dose  of 
the  tincture  is  from  five  to  ten  minims,  but  may  be  gradually  increased  to 
one  fluid  drachm  ;  of  the  powder  from  a  quarter  up  to  two  grains.  Doses 
above  these,  whether  of  the  powder  or  the  tincture,  are  likely  to  be  in- 
jurious and  to  give  rise  to  symptoms  of  poisoning.  The  smallest  quantity 
of  the  powder  "which  has  been  hitherto  known  to  destroy  life,  was  in  the 
case  of  a  young  Avoman,  quoted  by  Orfila ;  the  quantity  taken  was  esti- 
mated at  iive7ity-four  grains  in  two  doses.  She  died  in  four  days ;  but  as 
abortion  preceded  death,  this  may  have  been  concerned  in  accelerating 
that  event.  An  ounce  of  the  tincture  taken  by  a  boy,  set.  17,  caused  death 
in  fourteen  days.  This  is  the  smallest  recorded  dose  of  the  tincture  which 
has  proved  fatal.  It  must  not  be  inferred  from  this  statement  that  a 
smaller  quantity  of  the  powder  or  tincture  will  not  destroy  life.  The 
actual  dose  of  either  required  to  prove  fatal  is  unknown.  Many  more 
observations  are  required  to  determine  thfs  point.  In  Reg.  v.  Hennah 
(Cornwall  Lent  Ass.,  1877),  it  was  wrongly  inferred  that  it  would  require 
at  least  twenty-four  grains  of  the  powder  to  destroy  life.  There  is 
nothing  to  prevent  half  of  this  quantity  from  proving  fatal ;  this  is  purely 
a  matter  of  experience.  It  is  at  present  impossible  to  assign  any  definite 
quantity  as  a  minimum  fatal  dose. 

Chemical  Analysis. — For  the  detection  of  the  powder,  the  sediment 
obtained  from  the  suspected  liquids  should  be  mixed  with  alcohol  spread 
on  sheets  of  glasfe,  and  allowed  to  dry  spontaneously.  The  shining  scales 
of  the  powdered  elytra  will  then  be  seen,  on  examining  the  glass  by  reflected 
light,  either  on  one  or  both  surfaces.  As  the  powder  is  insoluble  in  water, 
some  portion  of  it  may  generally  be  obtained  by  washing  and  decantation. 
The  sediment  may  then  be  examined  on  a  glass  slide  with  the  microscope. 
If  no  portion  of  the  powdered  beetles  can  be  discovered,  the  suspected  liquids 
or  solids  should  be  evaporated  to  dryness,  and  the  dry  residue  digested  in 
successive  quantities  of  ether  until  exhausted.     This   will  dissolve  the 


NOXIOUS    ANIMAL    FOOD. 


173 


cantharidin,  the  active  principle  which  forms  Fig.  18. 

only  the  l-260th  part  of  the  elytra  of  the 
beetle.  The  ethereal  solutions  are  evaporated 
to  an  extract,  and  some  of  this  extract,  spread 
on  oil-silk,  may  be  applied  to  a  thin  portion 
of  the  skin  of  the  arm  or  to  the  lips.  The 
production  of  a  blister,  with  serum,  under 
these  circumstances,  is  considered  to  indicate 
the  presence  of  cantharidin.  By  this  method 
Barruel  discovered  cantharides  in  chocolate, 
(Ann.  d'Hyg.,  1835,  i.  p.  455.)  Chloroform 
is  even  a  more  powerful  solvent  of  canthari- 
din than  ether,  and  may  be  used  in  preference 
(Fig.  18).  As  the  extract  contains  frequently 
a  green  oil  and  fat,  which  prevent  cantharidin 
from  crystallizing,  it  has  been  recommended  to  employ  disulphide  of  carbon 
in  order  to  separate  these  impurities,  the  cantharidin  not  being  soluble  in 
the  disulphide,  while  the  fat  is  removed. 


Crystals  of  Cantharidin  from  a 
solution  in  chloroform,  magnitied 
30  diameters. 


IS'oxious  Animal  Food. 

Certain  kinds  of  animal  food  are  occasionally  found  to  produce  symptoms 
resembling  those  of  irritant  poisoning.  In  some  instances  this  poisonous 
effect  appears  to  be  due  to  idiosyncrasy;  for  only  one  person  out  of  several 
partaking  of  the  food  may  be  affected.  These  cases  are  of  importance  to 
the  medical  jurist,  since  they  may  give  rise  to  unfounded  charges  of 
criminal  poisoning.  In  the  absence  of  any  demonstrable  poison,  w^e  must 
test  the  question  of  idiosyncrasy  by  observing  whethei-  more  than  one  per- 
son is  affected,  and  whether  the  same  kind  of  food  given  to  animals  pro- 
duces symptoms  of  poisoning.  If,  with  this  latter  condition,  several 
persons  are  affected  simultaneously  with  similar  symptoms,  we  cannot 
refer  the  effects  to  idiosyncrasy  ;  they  are  most  probably  due  to  the  presence 
of  an  animal  poison.  Among  the  articles  of  food  which  have  caused 
symptoms  of  irritant  poisoning  may  be  mentioned  certain  shell-fish 
(mussels),  bacon,  sausages,  diseased  pork,  and  animal  flesh  in  a  diseased 
or  putrescent  state. 

The  flesh  of  the  most  healthy  animal  is  rendered  unfit  for  food  when  it 
is  putrescent.  It  is  not  merely  unwholesome,  but  highly  irritant,  rapidly 
causing  vomiting,  purging,  pain,  and  other  symptoms  of  a  severe  kind. 
Fortunately,  these  symptoms  lead  at  once  to  the  expulsion  of  the  noxious 
food  from  the  body,  and  the  person  then  recovers :  the  young,  the  old, 
and  the  infirm  may,  however,  be  so  prostrated  by  excessive  vomiting  and 
purging  that  they  may  sink  from  exhaustion.  Thorough  cooking  destroys 
the  noxious  effects  of  such  food.  Animal  matter  in  a  state  of  partial 
decay,  or  in  the  transition  stage  of  putrefaction,  must  also  be  regarded  as 
of  a  poisonous  nature.  In  1851,  the  family  of  a  surgeon  near  London 
were  all  affected  with  symptoms  resembling  irritant  poisoning,  after  having 
partaken  of  a  hare  which  had  been  stewed  in  a  clean  earthen  vessel.  On 
the  second  day,  the  wife  was  seized  with  vomiting  and  purging,  giddiness, 
heat  in  the  throat,  general  numbness,  and  inflamed  eyes.  Other  members 
of  the  family  vomited,  and  in  the  course  of  a  few  days  the  symptoms  dis- 
appeared. The  vomited  matter  consisted  of  portions  of  the  hare  partially 
digested,  but  in  a  state  of  putrefaction,  so  that  there  was  abundant  evi- 
dence of  sulphuretted  hydrogen  in  the  liquid.  There  was  no  mineral, 
poison,  although  the  symptoms,  it  will  be  observed,  were  rather  like  those 


174  POISONOUS    FISH  —  MUSSELS  —  CHEESE. 

occasioned  by  arsenic.  It  had  been  remarked  by  the  family  that  a  silver 
spoon,  which  had  been  used  in  serving  out  this  unwholesome  food,  was 
turned  of  a  brown  color,  no  doubt  from  the  chemical  action  of  sulphuretted 
hydrogen  ;  and  this  may  be  taken  as  a  good  domestic  test  of  the  putrefied 
condition  of  such  food.  Nature  general!}'"  applies  an  appropriate  remedy, 
in  the  fact  that  the  lood  itself  produces  copious  vomiting  and  purging. 
(See  Brit.  Med.  Jour.,  1877,  ii.  p.  450.)  Cases  of  this  kind  must  be  dis- 
tinguished from  those  in  which  jDoisoned  game  is  sold  to  the  public.  The 
game  may  be  quite  free  from  putrefaction,  but  noxious  from  the  poisoned 
grain  which  may  have  caused  death.  It  was  formerly  a  very  common 
practice  to  steep  grain  in  a  solution  of  arsenic  previous  to  sowing,  and 
pheasants,  partridges,  and  other  birds  may  be  accidentally  destroyed  by 
eating  such  grain.  In  some  instances  grouse  and  other  game  are  maliciously 
destroyed  by  the  laying  of  corn  saturated  with  arsenic  or  other  poisons 
in  the  localities  where  the  birds  abound.  There  is  no  precaution  which 
can  be  taken  by  the  purchasers  of  game,  except  by  observing  whether  the 
birds  have  or  have  not  been  shot. 

It  is  doubtful  whether  the  Sale  of  Food  and  Drugs  Act  (38  &  39  Yict. 
c.  62,  s.  6)  does  not  meet  such  cases  ;  but  no  prosecution  has  up  to  this 
time  been  instituted  under  that  statute  for  the  sale  of  poisoned  game. 

In  1887,  an  outbreak  of  poisoning  from  food  occurred  near  Carlisle,  the 
symptoms  much  resembling  those  of  arsenic  (Brit.  Med.  Jour.,  1887,  i. 
p.  123) ;  and  another  outbreak  occurred  in  the  same  j'ear  at  Winsford,  in 
Cheshire,  in  which  beside  vomiting  and  purging,  a  great  rise  of  the  body 
temperature  (to  104°  F.)  was  noticeable.  {Ibid  .,  1887,  1.  p.  521.)  These 
cases  were  supposed  to  be  due  to  ptomaines. 

Poisonous  Fish.  Mussels. — Of  all  the  varieties  of  shell-fish,  none  has 
so  frequently  given  rise  to  accidents  as  the  common  mussel.  The  symp- 
toms which  it  produces  are  uneasiness  and  sense  of  weight  in  the  stomach  ; 
a  sensation  of  numbness  in  the  extremities  ;  heat,  dr3niess,  and  constriction 
in  the  mouth  and  throat;  thirst,  shivering,  difficulty  of  breathing,  cramps 
in  the  legs,  swelling  and  inflammation  of  the  eyelids,  a  profuse  secretion 
of  tears,  and  heat  and  itching  of  the  skin,  followed  by  an  eruption  resem- 
bling nettle-rash.  These  symptoms  are  sometimes  accompanied  by  colic, 
vomiting,  and  purging.  They  may  occur  within  ten  minutes  or  a  quarter 
of  an  hour  ;  but  their  appeara4ice  has  been  dela3"ed  for  twenty -four  hours. 
There  is  generally  great  exhaustion  and  debility.  These  symptoms  have 
proceeded  from  the  eating  of  not  more  than  ten  or  twelve  mussels.  Two 
cases  reported  by  Christison  proved  fatal ;  the  one  in  three,  the  other  in 
about  seven  hours.  In  general,  however,  especially  when  there  is  free 
vomiting,  the  patients  recover.  In  the  inspection  of  the  two  fatal  cases 
above  mentioned,  no  appearance  was  found  to  account  for  death.  A  case 
in  which  two  mussels  produced,  in  a  boy  aged  10,  alarming  symptoms, 
followed  by  an  eruption  resembling  scarlatina  and  nettlerash,  is  reported. 
(Guy's  Hosp.  Rep.,  1850,  p.  213.)  The  active  agent  in  mussel-poisoning 
is  not  known  with  certainty,  but  is  by  some  asserted  to  be  an  alkaloid. 

Cheese. — The  symptoms  produced  by  cheese  have  been  those  of  irritant 
poisoning.  The  poison  is  asserted  by  Vaughan  to  be  in  some  cases  a 
ptomaine,  tyrotoxicon  (see  p.  174).  Again,  it  has  been  supposed  that  the 
poison  is  occasionally  derived  from  certain  vegetables  on  which  the  cows 
fed.  In  1858,  twenty-five  persons  suffered  from  vomiting  and  purging, 
more  or  less  violent,  owing  to  their  having  partaking  of  cheese. 

Sausage-poison. — The  symptoms  caused  by  sausage-poison  partake  of  a 
narcotico-irritant  character;  they  are  very  slow  in  appearing — sometimes 
two,  three,  or  four  days  may  elapse  before  they  manifest  themselves. 


PORK — BACON.  175 

This  poison  is  of  a  formidable  kind ;  its  effects  have  been  chiefly  observed 
in  Germany.  In  the  Medical  Gazette  for  Nov.  1842,  there  is  an  account 
of  the  cases  of  three  persons  who  had  died  from  the  effects  of  liver- 
sausajj-es,  which  liad  bcoD  made  from  an  apparently  healthy  pig  slaughtered 
only  a  week  before  The  inspection  threw  no  light  on  the  cause  of  death. 
The  poisonous  property  was  supposed  to  depend  on  a  partial  decomposi- 
tion of  the  fatly  part  of  the  sausages.  It  is  said  that  when  extremely 
putrefied  they  are  not  poisonous.  In  one  case,  a  few  slices  of  a  German 
sausage,  of  old  manufacture  but  not  putrescent,  caused  the  death  of  a 
child,  with  violent  symptoms  of  irritation  of  the  stomach  and  bowels. 
The  author  examined  a  portion  of  the  sausage:  it  contained  no  poisqnous 
matter  which  could  be  detected.  The  fatty  portions  were  rancid,  and  the 
lean  portions  very  dry.  There  was  no  doubt,  however,  that  it  had  been 
the  cause  of  the  symptoms  and  death  of  the  child.  Tripe  published  a 
complete  account  of  the  effects  produced  by  sausage-poison.  (Brit,  and 
For.  Med.  Rev.,  Jan.  18()0,  p.  197.)  It  appears  that  in  Nov.  1859, 
sausages  made  and  sold  by  a  pork  butcher  at  Kingland  were  eaten  more 
or  less  by  sixty-six  persons,  of  whom  sixty-four  were  attacked  by  violent 
symptoms  of  irritation  in  from  three  and  a  half  to  thirty-six  hours  after 
the  meal.  One  case  only  proved  fatal,  on  the  seventh  day.  No  symptoms 
appeared  in  this  man  until  after  the  lapse  of  six  hours.  It  seemed  that 
he  had  eaten  one  of  the  sausages  raw  and  three  cooked.  He  was  attacked 
with  severe  vomiting  and  purging,  followed  by  shivering  ;  there  was  pain 
in  the  abdomen,  violent  headache,  and  great  prostration.  The  pulse  was 
feeble  and  quick,  and  there  was  delirium.  These  symptoms  underwent  a 
remission,  but  he  had  a  relap.se,  became  comatose,  and  died  on  the  seventh 
day.  Latterly  he  chiefly  complained  of  pain  in  the  bowels.  On  inspection, 
Letheby  found  no  signs  of  inflammation,  or  of  the  action  of  an  irritant  on 
the  stomach.  The  small  intestines  were  much  inflamed  at  the  lower  end, 
and  the  gall-bladder  was  distended.  The  other  organs  were  healthy. 
The  viscera  contained  no  known  vegetable  or  mineral  poison.  The 
sausages  were  made  of  heifer-beef,  pork-fat,  sage,  and  pepper.  There  was 
no  evidence  of  anything  no.Kious  about  them,  and  a  chemical  analysis 
yielded  nothing  of  a  poisonous  nature.  There  could,  however,  be  no 
doubt  that  the  sausage  had  caused  the  symptoms  and  death  ;  the  food  in 
this  case  acting  as  a  narcotico-irritant  poison,  Other  persons  suffered 
from  burning  in  the  throat  and  stomach,  followed  by  vomiting  and  purg- 
ing; then  giddiness  or  confusion  in  the  head,  and  in  some  there  was  de- 
lirium. In  the  man  who  died,  the  delirium  was  well  marked  and  the 
eyes  were  red.  In  those  persons  who  recovered,  the  noxious  animal 
matter  was  probably  early  thrown  off  by  vomiting  and  purging.  It  is 
supposed  that  the  poison  is  a  ptomaine. 

Pork.  Bacon. — These  common  articles  of  food  occasionally  give  rise  to 
symptoms  so  closely  resembling  those  of  irritant  poisoning  as  to  be  easily 
mistaken  for  them.  In  some  cases  the  effect  appears  to  be  due  to 
idiosyncrasy;  but  in  others  it  can  be  explained  only  by  supposing  the  food 
to  have  a  directly  poisonous  action.  The  noxious  effects  of  pork  have 
been  particularly  shown  by  the  cases  published  by  McDevitt.  (Ed.  Med. 
and  Surg.  .Jour.,  Oct.  1836.)  As  pork  is  sometimes  salted  in  leaden  ves- 
sels, lead  may  be  found  in  it;  but  fresh  pork  has  been  observed  to  have  a 
noxious  action.  In  1864,  Kesteven  met  with  a  case  in  which  all  the  mem- 
bers of  a  family  were  attacked  with  symptoms  of  irritant  poisoning  after 
eating  a  leg  of  pork.  The  principal  symptoms  were  nausea,  vomiting, 
griping  pains  in  the  abdomen,  and  purging;  but  dogs  and  cats  fed  upon 
the  meat  did  not  appear  to  suffer.     Other  portions  of  the  animal  from 


176  PORK — BACON. 

which  the  le":  was  taken  were  eaten  by  other  families  and  no  symptoms  of 
poisoning  were  produced.  The  author  examined  the  food  without  dis- 
covering any  traces  of  the  ordinary  poisons.  These  cases  of  poisoning  by 
animal  food  have  been  examined  by  Simon  and  Gamgee.  They  have 
traced  the  injurious  effects  of  pork  to  a  diseased  condition  of  the  pig,  owing 
to  the  animal  having  been  fed  on  improper  food.  The  term,  "measly 
pork,"  is  now  known  to  consist  in  a  diseased  condition  of  the  flesh  of  the 
animal,  in  which  it  is  filled  with  a  parasite  called  cysticercus,  which  is  the 
larva  of  the  tapeworm.  (Med.  Times  and  Gaz.,  1870,  1,  p.  485.)  This 
parasite  undergoes  full  development  when  in  the  shape  of  food  it  reaches 
the  human  intestines.  These  para-sites  may  not  directly  kill  a  person  who 
eats  this  noxious  food,  but  they  favor  the  development  of  fatal  disease. 
In  reference  to  the  possible  ill  effects  from  consuming,  in  a  well-cooked 
state,  the  flesh  of  animals  afflicted  with  anthrax,  or  carbuncular  fever, 
evidence  is  still  imperfect.  An  opinion  has  been  expressed  that  boils  and 
perhaps  other  like  afflictions  are  caused  in  human  beings  by  the  consump- 
tion of  disea.sed  meat. 

A  large  amount  of  diseased  and  unAvholesome  meat  is  sold  to  the  pub- 
lic, and  of  the  various  kinds  of  flesh  used  as  food,  none  is  so  subject  to 
disease  as  pork.  Some  of  the  changes  which  it  undergoes  are  of  a  micro- 
scopical character,  and  are  not  noticed.  For  an  account  of  the  diseases 
affecting  the  flesh  of  the  pig,  their  mode  of  production  and  the  prevention 
of  accidents,  see  papers  by  Delpeach  in  the  Ann.  d'Hyg.,  1864,  vol.  1, 
pp.  5,  241.  The  parasites  found  in  the  flesh  of  this  and  other  animals  are 
apt  to  escape  de.struction  by  boiling,  roasting,  or  smoking,  and  those  are 
liable  to  suffer  most  who  habitually  eat  the  raw  or  partly-cooked  flesh.  The 
flesh  of  the  pig  containing  cysticerci  presents,  in  the  cooked  state,  the  fol- 
lowing appearances:  when  boiled  it  is  paler  than  sound  meat;  it  appears 
drver  in  patches,  and  the  mu.scular  fibres  are  more  separated  than  usual. 
When  these  are  opened  the  parasites  are  seen  in  the  interstices  as  opaque 
white  spots  of  the  size  of  a  hemp  seed  and  presenting  much  the  same 
a.spect  as  when  living.  The  caudal  bladder  attached  to  their  bodies  dis- 
appears when  the  meat  is  thoroughly  cooked  and  the  body  of  the  animal 
then  appears  isolated  in  the  middle  of  the  muscular  tissue.  It  is  friable, 
and  breaks  down  easily  under  pressure,  with  a  crackling  sound,  owing  to 
the  presence  of  calcareous  matter.  In  this  state  it  does  not  appear  to  be 
neces.sarily  productive  of  injury.  (Ann.  d'Hyg.,  1864,  1,  p.  249.)  All  the 
members  of  a  family  were  seized  with  vomiting,  purging,  and  syncope, 
after  having  eaten  a  dish  of  pork.  A  medical  man  examined  the  meat 
and  found  it  full  of  cysticeri.  A  pork-butcher  was  accused  of  having  sold 
bad  meat,  but  it  was  proved  to  have  been  some  cheap  pork  bought  of  a 
hawker  of  provisions.  (Ann.  d'Hyg.,  1864,  1,  p.  246.)  If  the  cysticerci 
did  not  cau.se  the  symptoms  in  this  case,  the  meat  had  undergone  some 
change  sufficient  to  impart  to  it  irritant  properties.  These  parasites  occur 
in  all  the  flesh}-  parts  of  the  bod^^  They  are  not  commonly  found  in  the 
fattv  portions  of  man  or  animals,  and  are  less  common  in  sheep  and  oxen 
than  in  pigs.  In  two  in.=;tances,  Ballard  and  Klein  were  able  to  trace  con- 
clusively that  the  poisonous  eff'ects  of  hams  which  had  caused  illness  and 
death  were  due  to  the  presence  of  bacilli  ;  and  these  observations  have 
been  confirmed  by  other  ob.servers. 

In  the  Supplement  to  the  Tenth  Annual  Report  of  the  Local  Govern- 
ment Board  will  be  found  instructive  ca.ses  of  meat  poisoning  which 
occurred  at  Welbeck  and  at  Nottingham,  and  investigated  by  Ballard; 
in  the  Eleventh  Supplement  the  Arlford  sausage-poisoning  case,  due, 
according  to  Klein,  to  some  soluble  poi.son  of  bacterial  origin.     The  Seven- 


TRICHINOSIS.  177 

teenth  Supplement  records  an  outbreak  of  poisoning  from  pork  pies  and 
brawn,  from  which  Klein  obtained  and  cultivated  bacilli  which  produced 
the  same  fatal  symptoms  in  mice  as  were  observed  when  the  animals  were 
fed  on  the  pie. 

Trichinosis. — The  fatal  malady  arising  from  the  introduction  of  Trichina 
spiralis  into  the  human  body  has  attracted  much  attention.  Keller  has 
published  some  important  facts  illustrating  the  symptoms  produced  and 
the  mode  in  which  this  parasite  causes  death.  He  considers  that  it  is  a 
question  well  worthy  of  the  attention  of  medical  jurists,  whether  many 
cases  of  death  from  suspected  irritant  poisoning  in  which  no  poisonous 
matter  could  be  detected  in  the  body,  may  not  have  been  really  due  to 
trichina-disease. 

The  Trichina  (from  jSpJ^,  a  hair)  spiralis,  a  flesh-worm,  is  found  chiefly 
in  the  course  of  the  fibres  of  all  the  striped  muscles  of  the  trunk  and  limbs, 
most  frequently  on  those  of  the  front  of  the  chest,  neck,  and  abdomen. 
It  has  also  been  found  in  the  muscular  fibres  of  the  heart  and  gullet.  The 
parasites  appear  in  the  form  of  very  small,  white,  ovoid  bodies  or  capsules, 
perceptible  to  the  eye  as  white  specks  in  the  midst  of  the  muscular  fibres, 
but  only  distinctly  seen  by  the  aid  of  a  magnifying-glass.  The  trichina, 
or  worm,  is  coiled  up  in  the  centre  of  each  oval  capsule,  the  greater 
diameter  of  which  is  parallel  to  the  muscular  fibre  with  which  it  is  closely 
incorporated.  The  trichina  is  a  parasite  which  passes  the  greater  portion 
of  its  existence,  in  the  chrysalis  state,  in  the  muscular  system  of  animals, 
until,  by  the  consumption  of  this  muscle  as  food,  it  finds  in  the  stomach 
and  intestines  of  another  warm-blooded  animal  a  favorable  medium  for  its 
full  development  into  an  intestinal  worm.  According  to  Virchow  and 
Zenker,  the  trichina  not  only  frequently  presents  itself  in  the  human 
organism,  but  this  organism  is  very  favorable  to  its  development.  The 
period  of  incubation  of  the  chrysalis  in  the  stomach  and  bowels  of  man, 
or  of  warm-blooded  animals,  is  from  six  to  eight  days ;  and  during  this 
time  it  there  thrives  and  propagates  to  an  almost  incredible  extent.  Keller 
states  that  in  three  or  four  days  the  females  produce  a  hundred  or  more 
young  ones,  which  begin  on  the  sixth  day  to  leave  the  parent  animal ;  and 
he  estimates  that  in  a  few  days  after  the  ingestion  of  half  a  pound  of  meat, 
the  stomach  and  intestinal  canal  of  a  person  may  contain  thirty  millions 
of  these  minute  worms.  Herbst  found  the  muscles  of  two  dogs  which 
had  been  fed  upon  parts  of  a  badger  containing  worms,  to  be  loaded  with 
these  parasites.  When  once  introduced  into  the  stomach  and  intestines, 
the  worms  leave  their  capsules,  become  free,  and  produce  young,  which 
migrate  through  the  walls  of  the  intestines  into  the  muscles  :  there  they 
become  encysted,  and  are  ultimately  found  appropriating  and  destroying 
the  muscular  substance  to  a  greater  or  less  extent.  After  a  long  residence 
in  the  muscle  they  appear  to  acquire  calcareous  cysts.  The  sudden 
liberation  of  a  large  number  of  these  worms  causes  irritation  and  inflam- 
mation in  the  bowels,  attended  by  peculiar  symptoms  resembling  in  some 
respects  those  of  chronic  poisoning. 

It  is  worthy  of  note  that  trichinae  are  more  frequently  found  in  pork 
and  articles  of  food  derived  from  it  than  in  an}^  other  kind  of  meat. 
Measly  pork  appears  to  be  sometimes  of  a  trichinous  character.  The 
vitality  of  the  parasites  is  not  destroyed  unless  the  meat  or  other  sub- 
stance in  which  they  are  located  has  been  subjected  to  the  temperature  of 
boiling  water  for  a  sufficient  time  to  insure  that  every  particle  has  been 
exposed  to  this  degree  of  heat.  Salting,  smoking,  or  partial  cooking  is 
not  sufficient  to  destroy  the  worms  in  all  parts  of  the  food,  and  they  have 
been  found  living  in  putrefied  meat.  This  may  serve  to  account  in  some 
12 


178  MILK PTOMAINES. 

cases  for  the  serious  symptoms  which  have  followed  the  use  of  pork  as 
food,  also  of  bacon,  sausages,  aud  German  sausages,  Avhich  are  generally 
made  of  raw  ham. 

The  symptoms  produced  by  the  use  of  such  food  are,  in  the  first  stage, 
those  of  intestinal  irritation,  loss  of  appetite,  sickness,  pain,  general  weak- 
ness of  the  limbs,  diarrhoea,  swelling  of  the  eyelids  and  of  the  joints,  pro- 
fuse clammy  perspiration,  and  wasting  fever.  Death  is  the  result  of 
paralysis  from  destruction  of  the  muscular  fibres,  or  of  peritonitis  and 
irritative  fever.  During  the  perforation  of  the  coat  of  the  intestines  by 
the.se  worms,  the  mucous  membrane  becomes  irritated  and  inflamed;  pus 
is  formed  on  its  surface,  and  bloody  evacuations  are  sometimes  passed. 

Mr.  Taylor  directed  attention  (Sept.  1862)  to  the  serious  symptoms 
produced  by  Canadian  partridges  eaten  as  food.  A  lady  who  had  par- 
taken of  this  food  was,  in  about  two  hours  and  a  half,  attacked  with  the 
following  symptoms  :  She  had  sickness  and  became  insensible  ;  the  skin 
was  cold  and  no  pulse  could  be  felt.  She  was  in  a  hopeless  state  for 
some  hours,  and  only  slowly  recovered.  The  birds  were  quite  fresh, 
having  been  packed  in  ice.  In  another  case  ihere  were  similar  symptoms, 
with  constriction  of  the  throat  and  great  pain.  Animals  were  made  ill 
by  this  food.  It  was  believed  that  in  these  cases  the  birds  had  not  been 
killed  by  poison,  but  that  their  flesh  had  been  rendered  poisonous  by 
some  vegetable  wliich  they  had  eaten.  It  is  stated  that  in  some  parts 
of  Australia  the  mutton  is  rendered  poisonous  by  reason  of  the  sheep 
feeding  on  poisonous  plants.  (Med.  Times  and  Gaz.,  1871,  1,  728.) 
Pheasants  which  feed  upon  the  Kalmia  shrub  are  poisonous  when  eaten 
as  food. 

Milk. — Vaughan  has  obtained  from  noxious  milk  a  substance  which  he 
terms  tyrotoxicon,  which  appears  to  be  a  definite  chemical  compound, 
diazobenzene  butyrate. 

Ptomaines. — A  class  of  bodies,  known  as  cadaveric  alkaloids  or  pto- 
mowes,  has  within  the  last  few  years  attracted  much  attention.  They  are 
found  during  the  putrefaction  of  animal  matters,  and  Selmi  has  directed 
attention  to  their  significance  in  toxicology.  The  ptomaines  are  probably 
allied  to  neurine,  an  alkaloid  obtained  from  the  brain  and  from  bile. 
Physiologically,  some  of  them  act  like  muscarine,  the  active  alkaloid  of 
the  fly-fungus.  It  is  probable  that  some  of  the  cases  of  poisoning  by 
putrid  meat  are  ascribable  to  the  formation  of  ptomaines  during  decay. 
Ptomaines  are  now  recognized  as  the  poisonous  products  of  the  growth 
of  micro-organisms.  Many  of  them  appear  to  be  proteids — albumins  and 
globulins. 


OPIUM — SYMPTOMS.  179 


NEUROTIC   POISONS. 


CHAPTER  XVI. 

OPIUM. SYMPTOMS. APPEARANCES. ITS     ACTION    ON     INFANTS. POISONING    WITH    OPIATE 

COMPOUNDS. OPIUM    HABIT. MORPHINE    AND  ITS  SALTS. MECONIC  ACID. PROCESS  FOR 

DETECTING  OPIUM  IN  ORGANIC  MIXTURES. — DIALYSIS. CHLORODYNE. COCAINE. 

Opium. 

Symploms. — The  symptoms  which  manifest  themselves  when  a  large 
dose  of  opium  or  its  tincture  has  been  taken  are  in  general  of  a  uniform 
character.  A  condition  of  pleasurable  mental  excitement,  usually  of  very 
short  duration,  is  experienced ;  but  this  is  followed  by  weariness,  head- 
ache, incapacity  for  exertion,  a  'sense  of  weight  in  the  limbs,  diminution 
of  sensibility,  giddiness,  drowsiness,  a  strong  tendency  to  sleep,  stupor, 
succeeded  by  perfect  insensibility,  the  person  lying  motionless,  with  the 
eyes  closed  as  if  in  a  sound  sleep.  In  this  state  he  may  be  easily  roused 
by  a  loud  noise  and  made  to  answer  a  question;  but  he  speedily  relapses 
into  stupor.  In  a  later  stage,  when  coma  has  supervened  with  stertorous 
breathing,  it  will  be  difficult,  if  not  impossible,  to  rouse  him.  The  pulse 
is  at  first  small,  quick,  and  irregular,  the  respiration  hurried,  and  the  skin 
warm  and  bathed  in  perspiration  ;  but  when  the  person  becomes  coma- 
tose, the  breathing  is  slow  and  stertorous,  and  the  pulse  slow  and  full. 
The  skin  is  occasionally  cold  and  pallid,  sometimes  livid.  In  the  early 
stage  the  pupils  are  contracted  ;  in  the  last  stage,  and  when  progressing 
to  a  fatal  termination,  they  may  be  found  dilated.  In  a  case  referred  to 
the  author  in  1846,  one  pupil  was  contracted  and  the  other  dilated.  In 
infants  and  children  they  are  generally  much  contracted.  They  are  com- 
monly insensible  to  light.  The  expression  of  the  countenance  is  placid, 
pale,  and  ghastly;  the  eyes  are  heavy,  and  the  lips  are  livid.  Sometimes 
there  is  vomiting,  or  even  purging  ;  and,  if  vomiting  takes  place  freely 
before  stupor  sets  in,  there  is  great  hope  of  recovery.  This  S3niiptom  is 
chiefly  observed  when  a  large  dose  of  opium  has  been  taken.  The  pecu- 
liar odor  of  opium  is  often  perceptible  in  the  breath.  Nausea  and  vomit- 
ing, with  headache,  loss  of  appetite,  and  lassitude  may  follow  on  recovery. 
In  cases  likely  to  prove  fatal,  the  muscles  of  the  limbs  feel  flabby  and  re- 
laxed, the  lower  jaw  drops,  the  pulse  is  feeble  and  imperceptible,  the 
sphincters  are  in  a  state  of  relaxation,  the  pupils  are  unaffected  by  light, 
the  temperature  of  the  body  is  low,  there  is  a  loud  mucous  raitle  in  breath- 
ing, and  convulsions  are  sometimes  observed  before  death,  but  more  com- 
monly in  children  than  in  adults.  Just  before  death  the  pupils  may  dilate. 
One  of  the  marked  effects  of  this  poison  is  to  suspend  all  the  secretions 
except  that  of  the  skin.  Even  during  the  lethargic  state  the  skin,  although 
cold,  is  often  copiously  bathed  in  perspiration. 

The  contracted  state  of  the  pupils  furnishes  a  valuable  distinctive  sign 
of  poisoning  with  opium  or  the  salts  of  moi-phine.     In  relying  upon  it,  it 


180  APPEARANCES. 

is  necessary,  however,  to  bear  in  mind  the  fact  pointed  out  by  Wilks,  that, 
in  apoplexy  seated  in  the  pons  Varolii,  the  pupils  are  also  contracted. 
He  describes  two  cases  of  this  form  of  apoplexy  which  were  mistaken  for 
poisoning  with  opium  in  consecpence  of  this  condition  of  the  pupils.  (Med. 
Times  and  Gaz.,  1863,  i.  p.  214.)  In  carbolic  acid  poisoning  the  pupils 
are  much  contracted,  though  seldom  so  minutely  as  in  opium-poisoning; 
and  there  is  coma  and  stertorous  breathing.  As  a  rule,  the  peculiar  odor 
of  carbolic  acid  in  the  breath  will  prevent  any  mistake  as  to  the  nature  of 
the  case.  The  symptoms  of  opium  above  described  usually  commence  in 
from  half  an  hour  to  an  hour  after  the  poison  has  been  swallowed. 
Sometimes  they  come  on  in  a  few  minutes,  especially  in  children  ;  and  at 
other  times  their  appearance  is  protracted  for  a  long  period.  If  morphine, 
the  active  alkaloid  of  opium,  be  given  subcutaneously,  narcotic  symptoms 
may  come  on  within  three  or  four  minutes.  It  has  been  frequently 
observed  that  a  person  has  recovered  from  the  first  sj-mptoms,  and  has 
then  had  a  fatal  relapse.  There  is  some  medico-legal  interest  connected 
with  this  state,  which  has  been  called  secondary  asphyxia  from  opium, 
although  there  appears  to  be  no  good  reason  for  giving  to  it  this  name. 

Appearances. — In  a  case  that  proved  fatal  in  fifteen  hours  the  vessels 
of  the  head  were  found  unusually  congested  throughout.  On  the  surface 
of  the  forepart  of  the  left  hemisphere  of  the  brain  there  was  an  ecchymosis, 
apparently  produced  by  the  effusion  of  a  few  drops  of  blood.  There  were 
numerous  bloody  points  on  the  cut  surface  of  the  brain  ;  there  was  no 
serum  collected  in  the  ventricles.  The  stomach  was  quite  healthy. 
Fluidity  of  the  blood  is  mentioned  as  a  common  appearance  in  cases  of 
poisoning  by  opium.  There  is  also  engorgement  of  the  lungs — most 
frequently  observed,  according  to  Christison,  in  those  cases  which  have 
been  preceded  by  convulsions.  Among  the  external  appearances  there  is 
often  great  lividity  of  the  skin.  Extravasation  of  blood  on  the  brain  is 
rarely  seen  ;  serous  eflfusions  in  the  ventricles  or  between  the  membranes 
are  sometimes  found.  The  stomach  is  so  seldom  found  otherwise  than  in 
a  healthy  state  that  the  inflammatory  redness  said  to  have  been  occasion- 
allv  seen  may  have  been  due  to  accidental  causes.  From  this  account  of  the 
appearances  in  the  dead  body,  it  will  be  perceived  that  there  is  nothing  but  a 
fulness  of  the  vessels  of  the  brain  which  can  be  looked  upon  as  specially 
indicative  of  poisoning  with  opium  ;  and  even  this  is  not  always  present. 

The  medicinal  dose  of  opium,  in  extract  or  powder,  for  a  healthy  adult 
varies  from  half  a  grain  to  two  grains.  Five  grains  would  be  a  very  full 
dose.  The  medicinal  dose  of  the  tincture  (laudanum)  is  from  five  to  forty 
minims  for  an  adult.  Persons  have  taken  very  large  doses  of  the  tincture, 
and  recovered  from  the  effects.  A  woman,  aet.  38,  is  said  to  have  recov- 
ered after  swallowing  eight  ounces.  (Lancet,  1813,  i.  p.  468.)  The 
smallest  dose  of  solid  opium  which  has  been  known  to  prove  fatal  to  an 
adult  was  in  the  case  of  a  man,  set.  32,  who  died  very  speedily  in  a  con- 
vulsive fit,  after  having  taken  two  pills,  each  containing  about  one  grain 
and  a  quarter  of  extract  of  opium.  This  quantity  is  equivalent  to  four 
grains  of  crude  opium.  (Med.  Gaz.,  vol.  37,  p.  236.)  The  smallest  fatal 
dose  of  the  tincture  in  an  adult  that  the  author  found  recorded,  is  tico 
drachms.  (Ed.  Med.  and  Surg.  Jour.,  July,  1840.)  The  editor  has 
known  less  than  a  grain  of  opium  in  solution  destroy  life  in  an  aged 
person.  In  connection  with  this  subject  it  is  important  for  a  medical 
iurist  to  bear  in  mind  that  infants  and  young  persons  are  liable  to  be 
killed  by  very  small  doses  of  opium,  and  appear  to  be  peculiarly  suscepti- 
ble to  the  effects  of  this  poison.  The  .syrup  of  poppies,  paregoric  elixir, 
Godfrev's  cordial,  Dalby's  carminative,  and  a  variety  of  soothing  sijrujjs 


OPIUM    HABIT — MORPHINE.  181 

owe  their  narcotic  effects  to  the  presence  of  opinm.  The  symptoms  and 
appearances  which  the}'  produce,  wlien  talven  in  a  lar^^e  dose,  are  similar 
to  those  caused  by  opium  or  its  tincture.  One-sixtieth  part  of  a  grain  of 
opium  has  thus  destroyed  the  life  of  an  infant.  (Brit.  Med.  Jour.,  1815, 
ii.  p.^5t0.) 

It  has  been  remarlced  that  most  cases  of  poisoning  with  opium  prove 
fatal  in  from  about  six  to  twelve  hours.  Those  who  recover  from  the 
stupor,  and  survive  longer  than  this  period,  generally  do  well ;  but  there 
may  be  a  partial  recovery,  or  a  remission  of  the  symptoms,  and  afterwards 
a  fatal  relapse.  The  symptoms,  however,  generally  progress  steadily  to 
a  fatal  termination,  or  the  stupor  suddenly  disappears,  vomiting  ensues, 
and  the  person  recovers.  Several  instances  are  recorded  of  this  poison 
having  destroyed  life  in  from  seven  to  nine  hours.  One  occurred- within 
the  author's  knowledge,  in  which  an  adult  died  in  five  hours  after  taking 
the  drug  prescribed  for  him  by  a  quack.  Christison  met  with  a  case 
which  could  not  have  lasted  above  five,  and  another  is  mentioned  by  him 
which  only  lasted  three  hours.  Barwis  communicated  to  the  author  the 
case  of  an  adult  which  proved  fatal  in  three  hours  and  a  half.  This  drug 
in  all  its  forms  is  especially  fatal  to  infants.  They  die  rapidly  from  very 
small  doses. 

Fatal  Period. — When  swallowed,  opium  may  kill  within  a  period  of 
two  hours  ;  but  more  commonly  the  patient  does  not  succumb  till  after 
the  lapse  of  from  six  to  eighteen  hours. 

Opium  Habit. — It  must  be  borne  in  mind  by  the  medical  jurist  that 
persons  may  habituate  themselves  to  the  use  of  enormous  doses  of  opium 
and  its  chief  alkaloid  morphine  (opium-eating  ;  morphine  habit).  The 
practice  of  subcutaneously  injecting  morphine  is  very  prevalent.  Sixteen 
grains  of  morphine  per  diem  is  not  a  very  unusual  quantity  to  be  habitu- 
ally used  by  a  person  given  to  this  degrading  practice,  and  even  forty- 
eight  grains  have  been  used  per  diem. 

Recently  a  unique  case  was  tried  in  which  the  plea  of  morphine-taking 
was  successfully  urged  as  a  defence  in  a  charge  of  murder  by  morphine. 
The  deceased  man.  Dr.  Lyddon,  a  hard  drinker  and  morphine-taker,  was 
found  in  a  dying  condition,  with  an  empty  bottle  near  which  had  con- 
tained the  pharmacopoeial  solution  of  hydrochlorate  of  morphine.  His 
brother  was  charged  with  administering  the  poison  to  him,  and  was  ac- 
quitted.    (Reg.  V.  Lyddon,  C.  C.  C,  March,  1891.) 

Morphine  and  its  Salts. — Morphine  (morphia)  is  the  poisonous  alkaloid 
of  opium,  of  which  it  forms  from  five  to  ten  per  cent.  The  two  principal 
salts  of  this  alkaloid  are  the  Jiijdrochlorate  and  the  acetate.  Opium  owes 
its  narcotic  properties  chiefly  to  the  presence  of  morphine  in  combination 
with  meconic  acid.  A  dose  of  one  grain  of  a  salt  of  morphine  has  de- 
stroyed life.  One-fourth  of  a  grain,  and  even  one-sixth  of  a  grain,  in- 
jected beneath  the  skin  has,  in  the  editor's  experience,  killed  an  adult. 
Ebertz  met  with  a  case  in  which  an  overdose  of  the  hydrochlorate,  sup- 
plied by  mistake  for  quinine,  destroyed  the  life  of  a  lady  in  from  forty  to 
fifty  minutes.  Symptoms  of  narcotism  appeared  in  a  quarter  of  an  hour. 
In  one  case  observed  by  the  editor,  a  dose  of  ten  grains  destroyed  the  life 
of  a  woman  in  from  half  an  hour  to  an  hour;  and,  when  subcutaneously 
injected,  the  salts  of  morphine  may  kill  in  even  a  shorter  time.  (For  a 
very  full  account  of  the  appearances  and  analysis,  see  Vierteljahrsschr. 
f  Gerichtl.  Med,  1873,  1,  p.  281.) 

In  1888,  a  child,  a^t.  2  years,  died  narcotised  twenty  hours  after  tasting 
a  ten  per  cent,  solution  of  acetate  of  morphine.  No  symptoms  were 
noticeable  for  at  least  three  hours  after  the  poison  was  taken,  though  the 


182  MORPHINE — CHEMICAL  ANALYSIS. 

child  was  seen  by  two  medical  men.  In  the  urine  drawn  off  siy  hours 
before  death  the  editor  detected  morphine. 

Morphine  and  its  salts  rapidly  destroy  life  by  absorption  when  applied 
to  a  wounded  or  ulcerated  surface.  A  woman  thus  lost  her  life  in  1867, 
by  reason  of  an  ignorant  drug-gist  applying  thirty  grains  of  morphine  to 
an  ulcerated  breast.  Morphine  is  in  part  excreted  in  the  urine,  but  ac- 
cording to  the  recent  researches  of  Tauber,  more  especially  in  the  feces, 
even  when  the  alkaloid  is  administered  hypodermically. 

Chemical  Analysis.  Opium. — There  are  no  means  of  detecting  opium 
itself,  either  in  its  solid  or  liquid  state,  except  by  its  smell,  taste,  and  other 
physical  properties,  or  by  giving  a  portion  of  the  suspected  substance  to 
an  animal,  and  observing  whether  any  narcotic  effects  are  produced.  The 
smell  is  said  to  be  peculiar,  but  a  similar  smell  is  possessed  b}^  lactucarium, 
which  contains  neither  meconic  acid  nor  morphine.  The  odor  is  a  good 
concomitant  test  of  the  presence  of  the  drug,  whether  it  be  in  a  free  state 
or  dissolved  in  alcohol  or  water,  but  it  is  not  perceptible  by  many  people 
when  the  solution  is  much  diluted.  The  taste  is  bitter.  The  analy^sis  in 
cases  of  poisoning  by  opium  is  therefore  limited  to  the  detection  of  mor- 
phine and  meconic  acid. 

Morphine. — Morphine  may  be  identified  by  the  following  properties  : 
1.  It  crystallizes  in  hexahedral  prisms,  which  are  white  and  perfect  accord- 
ding  to  their  degree  of  purity  (Fig.  19).  The  crystals  obtained  by  adding 
weak  ammonia  to  a  solution  of  morphine  in  hydrochloric  acid  vary  in 
form.  When  slowly  produced  they  sometimes  present  the  forms  repre- 
sented in  the  engraving  (Fig.  20).     2.  When   heated   on  platinum,  the 

Fig.  19. 


Crystals  of  Morphine,  from  alcohol,  magni-  Crystals  of  Morphine,  obtained  by  adding 

fled  80  diameters.  Ammonia  to  a  solution  of  the   hydrochlorate, 

magnified  124  diameters. 

crystals  melt,  become  dark  colored,  and  burn  like  a  resin  with  a  yellow 
smoky  flame,  leaving  a  carbonaceous  residue.  If  this  experiment  is  per- 
formed in  a  small  tube  it  will  be  found,  by  employing  test-paper,  that  am- 
monia is  one  of  the  products  of  decomposition.  3.  It  is  scarcely  soluble 
in  cold  water,  as  it  requires  1000  parts  to  dissolve  it;  it  is  soluble  in  500 
parts  of  boiling  water,  and  the  hot  solution  has  a  faint  alkaline  reaction. 
By  its  great  in'solubility  in  water  it  is  readily  known  from  its  salts.  It  is 
not  very  soluble  in  ether  or  chloroform,  thus  differing  from  narcotine ;  but 
it  is  dissolved  by  fifty  parts  of  cold,  and  thirty  parts  of  boiling,  alcohol. 
It  is  dissolved  Idv  absolution  of  potash  or  soda,  from  which  it  cannot  be 
easily  removed  by  ether.  It  is  soluble  in  acetic  ether,  and  this  liquid  has 
been"^  employed  for  the  purpose  of  separating  morphine  from  organic 
liquids.     4.  It  is  easily  dissolved  by  a  very  small  quantity  of  all  diluted 


TESTS  FOR  MORPHINE — MECONIC  ACID.  183 

acids,  mineral  and  veg-etable.  5.  Morphine  and  its  solutions  have  a  bitter 
taste.  G.  The  salts  of  morphine  are  not  precipitated  in  a  crystalline  form 
by  solutions  of  suiphocyanide  of  potassium,  ferricyanide  of  potassium,  or 
chromate  of  potassium.  In  this  respect  they  are  strikingly  distinguished 
from  the  salts  of  strychnine,  which  give  well-marked  crj'stalline  precipi- 
tates with  these  three  reagents.  Like  all  alkaloids,  the  morphine  in  solu- 
tion is  thrown  down  white  by  the  chioriodide  of  potassium  and  mercury 
(made  by  dissolving  six  grains  of  corrosive  sublimate  and  twenty-two 
grains  of  iodide  of  potassium  in  a  fluidounce  of  water).  This  liquid  pre- 
cipitates albumen  ;  hence  this  substance,  if  present,  should  be  removed  by 
boiling  the  liquid  before  applying  the  test. 

In  order  to  apply  the  test  for  morphine,  the  alkaloid  may  be  dissolved 
in  a  few  drops  of  a  diluted  acid,  either  acetic  or  hydrochloric.  If  the 
hydrochlorate  or  the  acetate  of  morphine  is  presented  for  analysis,  the  salt 
may  be  at  once  dissolved  in  a  small  quantity  of  warm  water.  The  tests" 
for  this  alkaloid  are  the  following :  1.  Nitric  acid.  This,  when  added 
to  a  moderately  strong  solution  of  a  salt  of  morphine,  produces  slowly  a 
deep  orange-red  color.  If  added  to  the  crystals  of  morphine  or  its  salts, 
red  fumes  are  evolved ;  the  alkaloid  is  entirely  dissolved,  and  the  solution 
acquires  instantly  the  deep  red-color  above  described,  becoming,  however, 
lighter  on  standing.  In  order  that  this  effect  should  follow,  the  solution 
of  morphine  must  not  be  too  much  diluted,  and  the  acid  must  be  strong 
and  added  in  rather  large  quantity.  The  color  is  rendered  much  lighter 
by  boiling;  therefore  the  test  should  never  be  added  to  a  hot  solution. 
2.  Iodic  acid.  A  drop  or  two  of  solution  of  iodic  acid  should  be  mixed 
with  its  volume  of  chloroform.  There  should  be  no  change  of  color.  On 
adding  a  small  quantity  of  these  mixed  liquids  to  morphine  or  its  salts, 
either  solid  or  in  solution,  the  iodine  is  separated  from  the  iodic  acid  and 
dissolved  by  the  chloroform,  which  sinks  to  the  bottom,  acquiring  a  pink 
color,  varying  in  intensity  according  to  the  quantity  of  morphine  present. 
Now  make  alkaline  with  ammonia  and  shake — the  pink  color  is  discharged 
from  the  chloroform,  and  the  supernatant  watery  solution  acquires  a  deep 
brown  color.  This  reaction  distinguishes  morphine  from  all  other  alkaloids 
and  from  other  bodies,  such  as  the  sulphocyanides  (in  saliva),  which 
liberate  iodine  from  iodic  acid.  The  presence  of  morphine  may  be  thus 
easily  detected,  in  spite  of  the  pjresence  of  organic  matter,  in  one  drop  of 
the  tincture  of  opium,  in  chlorodyne,  or  other  opiate  liquids.  If  chloro- 
form is  not  used,  iodine  may  be  detected  by  starch  paste,  which  is  turned 
blue.  3.  Sulphomolyhdic  acid.  This  is  made  by  dissolving  about  one- 
eighth  of  a  grain  of  powdered  molybdic  acid  in  a  drachm  of  warm  pure 
concentrated  sulphuric  acid  and  cooling.  The  liquid  should  be  freshly  pre- 
pared and  kept  from  contact  with  air  and  organic  matter.  When  one  or 
two  drops  are  rubbed  with  dri/  morphine  or  any  of  its  salts,  an  intense 
reddish-purple  or  crimson  color  is  produced.  This  changes  to  a  dingy  green 
and  ultimately  to  a  splendid  sapphire  hue.  4.  Sulphuric  acid  and 
bichromate  of  potassium.  When  sti'ong  sulphuric  acid  is  poured  on  pure 
morphine  in  a  solid  state,  there  is  either  no  effect,  or  the  alkaloid  acquires 
a  light  pinkish  color.  On  adding  to  this  a  drop  of  solution  of  bichromate 
of  potassium,  or  a  small  fragment  of  a  crystal,  it  immediately  becomes 
green,  and  retains  this  color  for  some  time. 

Meconic  acid — This  is  an  acid,  commonly  seen  in  scaly  white  crystals. 
It  is  combined  with  morphine  in  opium,  of  which  it  forms  on  an  average 
six  per  cent.,  and  it  serves  to  render  this  alkaloid  soluble  in  water  and 
other  menstrua.  Tests. — Many  tests  have  been  proposed  for  meconic  acid  ; 
but  there  is  only  one  upon  which  any  reliance  can  be  placed,  namely, 


18Jt  DETECTION    OF    OPIUM    IN    ORGANIC    MIXTURES. 

ferric  chloride.  This  test  produces,  even  in  a  diluted  solution  of  meconic 
acid,  a  deep-red  color  ;  and.  it  is  owing  to  the  presence  of  this  acid  that  a 
salt  of  iron  strikes  a  red  color  in  tincture  and  infusion  of  opium,  as  well  as 
in  all  liquids  containing-  traces  of  meconate  of  morphine.  The  red  color 
of  the  ferric  meconate  is  not  easily  destroyed  by  diluted  mineral  acids,  by  a 
solution  of  corrosive  sublimate,  or  by  terchloride  of  gold,  but  it  is  by  sul- 
phurous acid  and  stannous  chloride.  In  liquids  containing  tannin,  e.g.  tea 
or  beer,  the  action  of  this  test  is  obscured ;  but  a  small  quantity  of  dilute 
sulphuric  acid  will  remove  the  tannate  of  iron  and  bring  out  the  red  color 
ol  the  meconate. 

Detection  of  Opium  in  organic  mixtures. — Opium  itself  may  be  re- 
garded as  an  organic  solid  containing  the  poisonous  salt  which  we  Avish 
to  extract.  It  is  not  always  that,  in  fatal  cases  of  poisoning  by  opium  or 
its  tincture,  even  when  these  are  taken  in  large  quantity  and  death  is 
speedy,  we  can  succeed  in  detecting  meconate  of  morphine  in  the  stomach. 
The  poison  is  probably  removed  by  vomiting  or  absorption.  Although 
this  absence  of  the  poi=on  from  the  stomach  is  now  a  well-known  fact,  there 
is  a  popular  prejudice  that,  unless  found,  there  is  a  failure  of  proof  that  the 
death  was  caused  by  opium.  In  the  cases  of  young  children  who  are 
killed  b}^  a  very  small  quantity  of  this  drug,  it  is  the  exception  to  the  rule 
to  find  any  clear  evidence  of  opium,  but  more  common  to  find  morphine 
in  minute  quantity.  Its  detection  must  in  all  cases  depend  on  the  quantity 
taken,  the  rate  of  absorption,  and  the  time  during  which  the  person  sur- 
vived. At  the  trial  of  Chantrelle  (High  Court  of  Just.,  Edin.,  May,  1878), 
no  trace  of  opium  was  found  in  the  body,  but  there  was  distinct  evidence 
of  the  presence  of  morphine  and  meconic  acid  in  certain  stains  on  the 
sheets  of  the  bed  on  which  deceased  was  Ijnng.  Although  made  a  strong 
point  for  the  defence,  the  absence  of  opium  from  the  stomach  was  really 
an  unimportant  item  in  the  case.  The  evidence  tended  to  show  that  the 
poison  had  been  administered  in  the  form  of  fluid  extract — a  form  most 
favorable  to  absorption  ;  that  the  quantity  administered  was  small ;  that 
the  deceased  survived  fifteen  or  sixteen  hours,  and  that  she  had  vomited 
during  this  time.  These  conditions  are  all  consistent  with  the  rapid  re- 
moval of  opium  from  the  stomach.  The  evidence  Avhich  was  here 
wanting  was  fully  supplemented  by  the  detection  of  morphine  and  meconic 
acid  in  the  stains  on  the  sheets.  The  prisoner  was  convicted  and  executed 
in  spite  of  the  strenuous  efforts  made  to  invalidate  the  medical  evidence. 

If  the  matter  is  solid,  it  should  be  cut  into  small  slices;  if  liquid,  evap- 
orated to  an  extract ;  and,  in  either  case,  digested  with  a  large  quantity 
of  rectified  spirit  slightly  acidulated  with  acetic  acid.  The  residue  should 
be  well  pressed  in  muslin  ;  the  alcoholic  liquid  should  then  be  evaporated 
at  a  gentle  temperature  until  it  is  almost  dry.  The  residue  should  be 
digested  in  water,  filtered,  and  treated  with  acetate  of  lead  until  there  is 
no  further  precipitation.  This  liquid  should  be  warmed  and  filtered ; 
meconate  of  lead  is  left  on  the  filter,  while  any  morphine  passes  through 
under  the  form  of  acetate.  The  surplus  acetate  of  lead,  dissolved  in  the 
filtered  liquid  (containing  the  morphine),  should  now  be  precipitated  by 
a  current  of  sulphurelted  hydrogen  gas — the  black  sulphicle  of  lead  sepa- 
rated by  filtration,  and  the  filtered  liquid  evaporated  at  a  very  moderate 
temperature  to  an  extract,  so  that  any  sulphuretted  hydrogen  may  be 
entirely  expelled.  On  treating  this  extract  with  alcohol,  the  acetate  of 
morphine,  if  present  in  sufficient  quantity,  may  be  dissolved  out  and  tested. 
If  the  alcoholic  liquid  is  still  much  colored,  it  may  be  again  evaporated 
and  taken  up  by  water.  Animal  charcoal  deprives  it  of  color,  but  at  the 
same  time  it  removes  the  morphine  if  this  is  in  small  quantity.     If  there 


POISONING    WITH    CIILORODYNE.  185 

is  a  sufficient  quantity  of  pure  acetate  present,  the  addition  of  a  drop  of 
solution  of  ammonia  to  a  portion  of  tlae  liquid  on  a  slide  will  produce 
crystals  of  the  form  of  slender  jirisms.  The  remainder  may  be  tested  by 
nitric  and  iodic  as  well  as  by  sulphomolybdic  acid.  The  prismatic  crystals 
obtained  under  these  circumstances  have  nothing  peculiar  or  definite  in 
form.  At  the  Chantrelle  trial  (p.  184)  it  was  stated  by  an  analyst  that 
the  cr3^stals  furnished  better  evidence  of  the  presence  of  morphine  than 
the  color-reactions.  This  statement  is  against  all  experience  and  authority. 
Admitting  that  prismatic  crystals  of  morphine  could  be  obtained  from  a 
few  slight  stains  of  opium  on  a  sheet,  no  medical  jurist  would  rely  upon 
the  form  of  these  crystals  as  evidence  of  the  presence  of  morphine  until 
after  he  had  tested  them  by  one  or  more  of  the  acids  above  mentioned.  ^ 
This  frivolous  objection  to  the  chemical  evidence  was  exposed  and  set  aside 
in  the  cross-examination  of  the  witness.  (See  Med.  Times  and  Gaz  , 
1878,  i.  p.  565.) 

A  better  plan  is  to  treat  the  liquid  by  the  modified  plan  of  Stas  {vide 
Strychnine,  post),  taking  care  to  avoid  a  high  temperature  and  the 
presence  of  free  mineral  acids;  and  then  to  extract  with  a  mixture  of 
equal  volumes  of  acetic  ether  and  ordinary  ether,  in  which  mixture  mor- 
phine is  freely  soluble,  though  it  is  almost  insoluble  in  ordinary  ether. 
The  alkaloidal  residue  obtained  by  evaporating  the  ethereal  liquid  may  be 
tested,  as  above,  for  the  presence  of  morphine. 

The  meconate  of  lead  left  on  the  filter  and  dried  is  readily  decomposed 
by  boiling  it  with  a  small  quantity  of  diluted  sulphuric  acid;  and  in  the 
filtered  liquid,  neutralized  if  necessary  by  an  alkali,  the  meconic  acid  is 
easily  detected  by  the  iron-test.  The  detection  of  meconic  acid  is  most 
important,  for  this  has  been  found  in  no  substance  but  opium,  llorjjhine 
may  be  obtained  in  an  impure  state  as  a  precipitate  by  adding  ammonia 
to  a  concentrated  solution  of  the  opiate  extract.  It  may  be  then  purified 
by  alcohol  and  tested. 

Trial  tests  for  both  the  alkaloid  and  acid  should  be  first  applied  to  the 
organic  liquid,  which  may  for  this  purpose  be  submitted  to  diah^sis  (see 
p.  97).  The  smell  of  opium  may  be  entirely  absent.  Meconic  acid  may 
be  detected  by  the  action  of  a  ferric  salt  on  the  organic  liquid  diluted,  and 
morphine  may  be  found  by  adding  to  a  portion  of  this  liquid  a  mixture 
of  iodic  acid  and  chloroform  (see  p.  183)  The  chief  difficulty  in  the  de- 
tection of  meconic  acid  and  morphine  is  that  the  alkaloid  forms  only  one- 
tenth  part  of  opium,  is  easily  decomposed,  and  the  quantity  of  opium 
present  in  an  organic  liquid  is  generally  very  small. 

Chlorodyne. 

A  lady,  set.  23,  had  been  accustomed  to  take  the  liquid  for  the  relief  of 
pain,  in  doses  of  as  much  as  sixty  drops.  She  was  found  dead  in  bed,  and 
the  cause  of  death  was  referred  by  her  medical  attendant  to  her  having 
taken  two  doses  without  letting  a  sufficient  interval  elapse  between  them. 
(Lancet,  1871,  ii.  p.  697.)  According  to  E.  Smith,  chlorodyne  is  thus 
constituted:  chloroform  four  drachms,  hydrochlorate  of  morphine  twenty 
grains,  ether  two  drachms,  oil  of  peppermint  eight  minims,  prussic  acid 
six  drachms,  mixture  of  gum  acacia  one  ounce,  treacle  four  ounces.  (Lan- 
cet, 1870,  i.  p.  72.)  There  is  reason  to  believe  that  this  compound  is  not 
uniform  in  composition.  According  to  another  formula  the  tincture  of 
lobelia  and  capsicum  and  extract  of  liquorice  are  introduced.  Prussic  acid 
may  be  detected  in  it  by  the  action  of  the  vapor  on  nitrate  of  silver. 


186  COCOA  IX  E QUINIXE ANTIPYRETICS. 

Crystals  of  cyanide  of  silver  are  obtained  after  some  time.  Morphine  may 
be  detected  in  it  by  shaking  a  portion  with  a  mixture  of  iodic  acid  and 
chloroform  (see  p.  183). 

Cocaine. 

This  potent  alkaloid,  now  so  largely  used  in  medicine  as  an  analgesic 
(pain-killer J,  has  on  many  occasions  caused  alarming  sj'mptoms  and  in 
some  cases  death.  Even  one-sixth  of  a  grain,  hypodermically  injected, 
may  cause  toxic  symptoms.  These  are  nausea,  vomiting,  headache,  giddi- 
ness, loss  of  vision,  profuse  perspiration,  lividity,  cramps  in  the  region  of 
the  .stomach,  a  quick,  irregular,  feeble  pulse,  shallow,  gasping  respiration, 
convulsions,  paralysis,  and  in  some  cases  delirium  {vide  Jirit.  Med.  Jour., 
1888,  i.  p.  151).  A  man,  set.  40,  injected  beneath  his  skin  half  a  grain  of 
the  alkaloid  to  remedy  the  after-eifects  of  drunkenness.  Twenty  minutes 
later  he  was  found  lying  on  a  doorstep,  pale,  with  dilated  pupils,  and  the 
conjunctiva  of  the  eye  insensitive.  The  breathing  was  slow  and  difficult, 
the  pulse  140  in  the  minute.  He  was  sensible,  unable  to  articulate,  and 
could  not  swallow,  liquids  being  rejected  from  the  mouth.  The  patient 
was  in  a  serious  state  for  some  time,  but  recovered.  This  man  had  pre- 
viously had  repeated  doses  of  five  and  six-tenths  of  a  grain  administered 
by  injection  every  half-hour  till  three  grains  had  been  used,  Avithout  ill 
effects.  (Brit.  Med.  Jour.,  1887,  i.  p.  524.)  In  other  cases  alarming 
symptoms  of  depression  have  been  produced  by  the  application  of  solu- 
tions of  cocaine  to  mucous  membranes,  and  when  injected  before  surgical 
and  dental  operations.  (Brit.  Med.  Jour.,  1887,  i.  p.  676;  1888,  i.  p.  isi.) 
Generally  the  .symptoms  were  nausea  and  vomiting ;  headache,  loss  of 
vision,  and  deafness;  loss  of  taste  and  smell;  lividity  and  profuse  per- 
spiration ;  a  rapid,  irregular,  intermittent  pulse ;  shallow,  irregular,  gasp- 
ing, convulsive  breathing;  impairment  of  gait  and  speech;  muscular 
rigidity ;  convulsive  twitching.s,  and  paralysis.  The  habit  of  injecting 
cocaine  is  now  common. 

Quinine. 

That  quinine  acts  as  a  poison  in  excessive  doses  is  a  well-ascertained 
fact.  The  symptoms  are  noises  in  the  ears,  deafness,  and  excessive 
cardiac  weakness,  ending  in  death  (vide  Husemann,  in  Therap.  Monats., 
1887). 

Antipyretics. 

During  the  la.5t  decade  a  large  number  of  antipyretics  (substances  which 
lower  the  temperature  of  the  body)  have  been  introduced  into  medical 
practice,  some  of  them  as  hypnotics ;  and  most  of  them  are  capable  of  act- 
ing as  poisons.  They  can  here  be  only  briefly  referred  to.  Within  the 
editor's  experience  one  of  the  safest  of  them,  sulphonal,  produced  alarm- 
ing and  prolonged  coma  in  a  dipsomaniac. 


HYDROCYANIC    OR    PRUSSIG    ACID.  187 


CHAPTER   XVII. 

PRUSSIC    ACID. — SYMPTOMS     AND     APPEAEANCES. — TESTS     FOR     THE     ACID. — PROCESS     FOR 

ORGANIC    MIXTURES. CYANIDE    OF    POTASSIUM.  —  ESSENTIAL    OIL    OP    BITTER    ALMONDS. 

NITROBENZENE .  — NITROGLYCERINE . 

Hydrocyanic  or  Prussic  Acid. 

Symptoms. — The  solutions  of  this  acid  have  a  hot,  bitter  tas-te  and  an 
odor  resembling  that  of  bitter  almonds.  The  time  at  which  the  symptoms, 
of  poisoning  commence  varies,  but  it  is  generally  very  shortly  after  the 
poison  has  been  swallowed.  When  a  large  dose  has  been  taken,  as  from 
half  an  ounce  to  an  ounce  of  the  diluted  acid  (two  to  four  per  cent.),  the 
symptoms  usually  commence  in  the  act  of  swallowing,  or  within  a  few 
seconds.  It  is  stated  that  a  diluted  is  more  rapidly  absorbed  than  a 
stronger  acid.  It  is  rare  that  the  appearance  of  symptoms  is  delayed 
beyond  one  or  two  minutes.  When  the  patient  has  been  seen  at  this 
period,  he  has  been  quite  insensible,  the  eyes  fixed  and  glistening,  the 
pupils  dilated  and  unaffected  by  light,  the  limbs  flaccid,  the  skin  cold  and 
covered  with  a  clammy  perspiration  ;  there  is  convulsive  breathing  at 
long  intervals,  and  the  patient  appears  dead  in  the  intermediate  period  ; 
the  pulse  is  imperceptible,  and  involuntary  evacuations  are  occasionally 
passed.  The  respiration  is  slow,  deep,  gasping,  occasionally  heaving  or 
sobbing,  and  is  generally  convulsive ;  but  when  the  coma  or  insensibility 
is  profound,  it  may  be  stertorous.  This  was  observed  in  a  case  which 
occurred  to  Christison.  (Edin.  Month.  Jour.,  Feb.  1850,  p.  91.)  Con- 
vulsions of  the  limbs  and  body,  with  a  spasmodic  closure  of  the  jaw,  are 
sometimes  noticed  among  the  symptoms. 

The  following  cases  present  fair  examples  of  the  immediate  effects  of 
this  poison  in  a  large  and  fatal  dose.  A  medical  man  swallowed  seven 
drachms  of  the  common  prussic  acid.  He  survived  about  four  or  five 
minutes.  About  two  minutes  after  he  had  taken  the  poison  he  was  found 
lying  on  the  floor  senseless ;  there  were  no  convulsions  of  the  limbs  or 
trunk,  but  a  faint  flickering  motion  was  observed  about  the  muscles  of  the 
lips.  The  breathing  appeai-ed  to  cease  entirely  for  some  seconds ;  it  was 
then  performed  in  convulsive  fits,  and  the  act  of  expiration  was  remark- 
ably deep,  and  lasted  for  an  unusual  time.  When  the  dose  is  large  the 
breath  commonly  exhales  a  strong  odor  of  the  acid,  and  this  is  also  per- 
ceptible in  the  room. 

A  medical  student  took  a  drachm  and  a  half  of  Scheele's  prussic  acid 
(strength  about  four  per  cent.).  He  was  heard  to  call  out  once  or  twice, 
and  a  gentleman  sleeping  in  the  next  room  ran  to  his  assistance.  He  was 
heard  to  fall  from  the  sofa  to  the  floor,  and  when  picked  up  was  found  to 
be  already  in"sensible.  Hilton  Fagge  saw  him  a  little  later — fifteen  to 
thirty  minutes  after  the  poison  was  taken.  He  was  then  lying  on  a  sofa, 
quite  insensible.  The  limbs  were  paralyzed,  and  lay  in  any  position  in 
which  they  were  placed  ;  and  they  were  free  from  all  rigidity.  The  jaws 
were  clenched.  The  pupils  were  normal.  There  were  no  convulsions, 
nor  had  there  been  any.  The  face  was  not  livid.  The  pulse  was  very 
rapid,  the  respirations  very  infrequent.  Cold  water  dashed  on  the  face 
produced  at  each  application  deep  respiratory  efforts.     An  attempt  to 


188  APPEARANCES — ANALYSIS. 

administer  an  emetic  failed,  in  consequence  of  inability  to  swallow. 
Strong  ammonia  applied  to  the  nostrils  failed  to  produce  the  slightest 
stimulation.  After  a  time  the  breathing  became  slower — seven  respira- 
tions in  a  minute — and  it  was  distinctly  stertorous.  The  pulse  became 
slower  and  markedly  feebler ;  and  now  cold  affusion  failed  to  produce  any 
effect.  The  respirations  fell  to  four  in  a  minute,  the  face  became  blue, 
and  the  pulse  imperceptible  at  the  wrist.  Breathing  ceased  in  from  an 
hour  to  an  hour  and  a  half  after  the  poison  was  swallowed.  There  was 
a  marked  odor  of  prussic  acid  in  the  room  ;  but  it  was  not  noticed  at  first 
whether  the  breath  smelt  of  the  acid.     (Guy's  Hosp.  Rep.,  1869,  p.  259.) 

Aiypearance?;. — The  body  when  seen  soon  after  death  often  exhales  the 
odor  of  prussic  acid  ;  but  if  it  has  remained  exposed  before  it  is  seen,  and 
if  it  has  been  exposed  to  the  open  air  or  in  a  shower  of  rain,  the  odor  may 
not  be  perceptible ;  again,  the  odor  may  be  concealed  by  tobacco  smoke, 
peppermint,  copaiba,  or  other  powerful  odors.  Externally,  the  skin  is 
commonly  livid,  or  is  tinged  of  a  violet  color ;  the  nails  are  blue,  the 
fingers  clenched,  and  the  toes  contracted;  the  jaws  firmly  closed,  with 
foam  or  froth  about  the  mouth,  the  face  often  pale,  but  sometimes  bloated 
and  swollen,  and  the  eyes  have  been  observed  to  be  wide  open,  fixed, 
glassy,  very  prominent  and  glistening,  with  the  pupils  dilated  ;  but  a 
similar  condition  of  the  eyes  has  been  observed  in  other  kinds  of  violent 
death.  Intejvmlli/,  the  venous  system  is  gorged  with  dark-colored  liquid 
blood ;  the  stomach  and  intestines  may  be  in  their  natural  state ;  but  in 
several  instances  they  have  been  found  more  or  less  congested.  The 
mucous  membrane  of  the  stomach  may  be  intensely  reddened  throughout. 

The  smallest  dose  of  this  acid  which  is  reported  to  have  caused  death 
was  in  the  case  of  a  healthy  adult  woman,  who  died  in  twenty  minutes 
from  a  dose  equivalent  to  nine-tenths  of  a  grain  of  anhydrous  prussic 
acid.  (Med.  Gaz.,  vol.  35,  p.  896.)  This  corresponds  to  about  forty- 
five  minims  of  the  B.  P.  acid.  In  a  case  reported  by  T.  Taylor  (Med. 
Gaz.,  vol.  36,  p.  104),  a  stout  healthy  man  swallowed  this  dose,  i  e.  nine- 
tenths  of  a  grain,  by  mistake,  and  remained  insensible  for  fovi^  Jwurs, 
Avhen  he  vomited  and  began  to  recover.  From  the  facts  hitherto  observed, 
Ave  shall  not  be  wrong  in  assuming  that  a  quantity  of  B.  P.  acid  (at  two 
per  cent.)  above'  fifty  minims  (i.e.  one  grain  of  anhydrous  acid),  or  an 
equivalent  proportion  of  any  other  acid,  would  commonly  sufBce  to  destroy 
the  life  of  an  adult.  This  is  the  nearest  approach  that  we  can  make  to 
the  smallest  fatal  dose. 

When  a  dose  of  half  an  ounce  and  upwards  of  the  B.  P.  acid  has  been 
taken,  we  may  probably  take  the  average  period  for  death  at  from  two  to 
ten  minutes.  In  Hick's  case,  twenty  grains  of  Scheele's  acid  (containing 
five  per  cent.)  destroyed  life  in  twenty  minutes.  It  is  only  when  a  dose 
is  just  in  a  fatal  proportion  that  we  find  a  person  to  survive  from  half  an 
hour  to  an  hour.  In  this  respect,  dt-ath  by  prussic  acid  is  like  death  by 
lightning — the  person  in  general  either  dies  speedily  or  he  recovers  alto- 
gether. Before  the  access  of  insensibility  the  person  often  possesses  a 
wonderful  power  of  exertion  and  locomotion,  perhaps  in  a  state  of  half- 
consciousness.  Thus  he  may  be  able  to  cork  and  conceal  the  bottle  from 
which  he  has  swallowed  the  poison;  or  he  may  run  several  yards  before 
falling.  Due  allowance  must  be  made  for  the  performance  of  these  vol- 
untary acts.     (See  Brit.  Med.  Jour.,  1887,  i.  p.  11.) 

Chemical  Analysis. — Two  solutions  of  prussic  acid  are  met  with  in 
British  commerce — the  Briti>h  pharmacopoeinl  acid  ('B.  P.' acid),  contain- 
ing two  per  cent  of  the  acid,  and  the  so-called  Scheele's  acid,  a  stronger 
preparation  containing  about  four  per  cent.     These  solutions  are  limpid 


TESTS    FOR    PRUSSIC    ACID, 


189 


like  water,  possess  a  faint  acid  reaction,  and  the  vapor  has  a  peculiar  odor, 
which,  when  the  acid  is  concentrated,  although  not  at  first  perceptible,  is 
sufficient  to  produce  giddiness,  insensil)ility,  and  other  alarming  symp- 
toms. The  tests  which  are  best  ada|)ted  for  the  detection  of  this  poison, 
either  in  liquid  or  vapor,  are  equally  applicable  whether  the  acid  is  con- 
centrated or  diluted,  and,  so  far  as  the  detection  of  the  vapor  is  concerned, 
whether  the  acid  is  pure  or  mixed  with  other  liquids.  In  (he  simple  dqfr^^ 
the  tests  are  three  in  number — the  Silver,  the  Iron,  and  the  Sulphur  tests. 
1.  The  Silver-Test.  Nitrate  of  Silver. — This,  added  in  excess,  yields 
with  prussic  acid  a  dense  white  precipitate,  speedily  subsiding  in  heavy 
clots  to  the  bottom  of  the  vessel,  and  leaving  the  liquid  almost  clear.  The 
precipitate  is  identified  as  cyanide  of  silver  by  the  following  properties: 
a.  It  is  insoluble  in  cold  nitric  acid  ;  but  when  drained  of  water,  and  a 
sufficient  quantity  of  the  strong  acid  is  added,  it  is  easily  dissolved  on 
boiling,  b.  It  evolves  prussic  acid  when  digested  in  hydrochloric  acid.' 
c.  The  precipitate,  when  ivell  dried,  and  heated  in  a  small  reduction-tube, 
yields  cyanogen,  which  may  be  burnt  as  it  issues,  producing  a  rose-red 
flame  with  a  blue  halo.  This  is  a  well-marked  character,  and  at  once 
identifies  the  acid  which  yielded  the  precipitate  as  prussic  acid.  Five 
grains  by  weight  of  the  dry  precipitate  correspond  to  one  grain  of  anhy- 
(drous  prussic  acid,  to  twenty-five  grains  of  Scheele's  acid,  and  fifty  grains 
of  the  British  pharmacopoeial  acid. 

For  the  detection  of  prussic  acid  in  vapor,  holdover  the  liquid  a  watch- 
glass  moistened  in  the  centre  with  a  drop  of  a  solution  of  nitrate  of  silver. 
Cyanide  of  silver,  indicated  by  the  formation  of  an  opaque  white  film  in 
the  solution,  is  immediately  produced,  if  the  acid  is  only  in  a  moderate 
state  of  concentration.  One  drop  of  a  diluted  acid  containing  less  than 
l-50th  of  a  grain  of  the  anhydrous  acid  produces  speedily  a  visible  effect 
When  the  prussic  acid  is  more  diluted,  a  few  minutes  are  required;  and 
the  opaque  film  begins  to  show  itself  at  the  edges  of  the  silver  solution. 
In  this  case  the  action  may  be  accelerated  by  the  heat  of  the  hand  applied 
to  the  vessel.  If  the  vapor  is  allowed  to 
reach  the  nitrate  of  silver  gradually  and  much 
diluted  with  air,  then  instead  of  an  opaque  film 
of  cyanide  of  silver,  crystals  well  defined  un- 
der the  micro.scope  will  be  slowly  produced, 
and  these  will  constitute  an  additional  proof 
of  the  presence  of  the  acid  in  a  state  of  vapor. 
As  shown  in  the  illustration  (Fig.  21),  these 
crystals  have  the  form  of  slender  prisms  with 
oblique  terminations.  They  often  hang  to- 
gether in  groups,  and  generally  require  a  high 
magnifying  povrer  to  render  them  visible. 

2.  The  Iron- Test. — The  object  of  the  ap- 
plication of  this  test  is  the  production  of 
Prussian  blue.  Add  to  a  small  quantity  of 
the  suspected  poisonous  liquid  a  few  drops  of 
a  solution    of    ferrous    sulphate   and   a  little 

solution  of  potash.  A  dirty-green  or  brownish  precipitate  falls ;  on 
shaking  this  with  air  for  a  few  minutes,  and  then  adding  diluted  hydro- 
chloric or  sulphuric  acid,  the  liquid  becomes  blue;  and  Prussian  blue,  of 
its  well-known  color,  unaffected  by  diluted  acids,  slowly  subsides. 

3.  The  Sulphur-Test.  A  small  quantity  of  yellow  sulphide  of  ammo- 
nium is  added  to  a  few  drops  of  a  solution  of  prussic  acid,  and  the 
mixture  is  gently  warmed ;    it  becomes  colorless,  and,  on  evaporation, 


Fis.  21. 


Crystals  of  Cyanide  of  Silver  from 
the  vapor  of  prussic  acid,  magni- 
fied   24  diameters. 


190  PRUSSIC    ACID    IN    ORGANIC    LIQUIDS. 

leaves  crystals  of  sulphocyanide  of  ammonium — the  sulphocyanide  being- 
indicated  by  the  intense  blood-red  color  produced  on  adding  to  the  dry 
residue  a  solution  of  nearly  neutral  persalt  of  iron ;  this  red  color 
immediately  disappears  on  adding-  a  few  drops  of  a  solution  of  corrosive 
sublimate. 

The  great  utility  of  the  sidjjhur-test,  however,  is  in  its  application  to 
the  detection  of  the  minutest  portion  of  prussic  acid  when  in  a  state  of 
vapor.  In  this  respect  it  surpasses  in  delicacy  any  other  process  yet  dis- 
covered. In  order  to  apply  it,  we  place  the  diluted  prussic  acid  in  a 
watch-glass,  and  invert  over  it  another  watch-glass  having  in  its  centre 
one  drop  of  yelloAv  sulphide  of  ammonium.  No  change  apparently  takes 
place  in  the  sulphide  ;  but  if  the  upper  watch-glass  is  removed  after  the  j 
lapse  of  from  half  a  minute  to  ten  minutes,  according  to  the  quantity  and 
strength  of  the  prussic  acid  present,  cr3"stallized  sulphocyanide  of  ammo- 
nium will  be  obtained  on  gently  evaporating  the  drop  of  liquid  to  dryness. 
With  an  acid  of  from  three  to  five  per  cent,  the  action  is  completed  in  ten 
seconds.  The  addition  of  one  drop  of  neutral  ferric  sulphate  or  chloride 
(free  from  nitric  acid)  to  the  dried  residue  brings  out  the  blood-red  color 
instantly,  which  is  intense  in  proportion  to  the  quantity  of  sulphocyanide 
present.  (For  some  remarks  on  the  application  of  this  process  to  the  de- 
tection of  prussic  acid,  see  Med.  Gaz.,  1847,  vol.  39,  p.  tGS.) 

Prussic  Acid  in  organic  liquids.  Detection  by  vapor  without  distilla- 
tion.— The  organic  liquid  may  be  placed  in  a  short,  wide-mouthed  bottle, 
to  which  a  watch-glass  has  been  previously  fitted  as  a  cover.  The  capac- 
ity of  the  bottle  may  be  such  as  to  allow  the  surface  of  the  liquid  to  be 
within  one  or  two  inches  of  the  concave  surface  of  the  watch-glass.  The 
solution  of  Nitrate  of  silver  is  then  used  as  a  trial-test  for  the  vapor  in  the 
manner  above  described.  If  the  l-200th  of  a  grain  of  prussic  acid  is 
present,  and  not  too  largely  diluted,  it  will  be  detected  (at  a  temperature 
of  60°  F.)  by  the  drop  of  nitrate  of  silver  being  converted  into  an  opaque 
white  or  cr3^stalline  film  of  cyanide  of  silver,  the  chemical  change  com- 
mencing at  the  margin.  We  may  then  substitute  yellow  sulphide  of 
ammonium  for  the  nitrate  of  silver,  and  proceed  in  the  manner  above  de- 
scribed. In  cold  weather  it  may  be  necessary  to  place  the  bottle  in  a 
basin  of  warm  water.  If  the  solution  of  silver  is  tarnished  by  sulphur- 
etted hydrogen,  as  a  result  of  putrefaction,  the  sulphur-test  alone  should 
be  used.  B}^  this  process  prussic  acid  has  been  detected  in  the  stomach  as 
late  as  twelve  days  after  death  of  a  person  poisoned  by  it.  After  the 
stomach  has  been  exposed  for  a  few  da3'S  longer,  the  acid  has  entirely 
disappeared. 

If  traces  of  the  poison  are  thus  found,  then  the  organic  liquid  should  be 
acidulated  and  distilled  in  a  water-bath,  and  about  one-fourth  of  the  con- 
tents of  the  flask  collected  in  a  receiver  kept  cool  by  water.  (For  the  form 
of  apparatus  see  p.  130,  ante.)  The  tests  may  now  be  applied  to  the  dis- 
tilled liquid,  which  v/ill  have  the  odor  of  prussic  acid. 

[Care  should  be  used  in  the  search  by  distillation  not  to  emplo}'  sul- 
phuric acid,  because  this  acid  will  decompose  the  sulphocyanide  existing 
in  the  saliva  likely  to  be  found  in  the  stomach,  and  thereby  evolve  traces 
of  prussic  acid. 

This  point  was  made  in  the  celebrated  case  of  Paul  Schoeppe,  tried  at 
Carlisle,  Fa.  The  analyst  found  faint  traces  of  prussic  acid  by  distillation 
in  which  sulphuric  acid  had  been  used  :  Reese,  8th  Amer.  Ed.  of  Tay- 
lor's Med.  Jurisprudence,  Phila.,  1880,  p.  212  ;  vide  also  Wharton  & 
Stille,  Med.  Jur.,  1873,  p.  515.] 


CYANIDE    OF    POTASSIUM.  191 

In  the  tissues. — Soon  after. death  the  poison  may  be  easily  detected  in 
the  blood,  secretions,  or  any  of  the  soft  organs,  by  placing  them  in  a 
bottle  and  collecting  the  vapor  in  the  manner  already  described.  This  will 
])e  found  more  convenient  and  satisfactory  than  the  process  by  distillation. 
The  poison  has  been  thus  discovered,  in  experiments  on  animals,  in  the 
blood  and  even  in  the  exhalation  from  the  chest. 

If  the  Ijody  is  in  a  putrefied  state,  the  residuary  prussic  acid  may  have 
been  converted  into  fixed  sulphocyanide  of  ammonium.  In  order"to  de- 
tect this  salt  in  the  stomach  or  its  contents,  we  should  digest  the  parts 
finely  cut  up  in  hot  alcohol,  filter  the  alcoholic  liquid,  evaporate  to  dryness, 
and  take  up  an}^  crystalline  residue  with  water.  A  solution  of  a  persalt 
of  iron  added  to  this  solution  will  indicate  the  presence  of  a  sulpho- 
cyanide by  imparting  to  it  an  intensely  red  color.  The  editor  has  de- 
tected prussic  acid  as  a  sulphocyanide  in  the  blood  many  weeks  after 
the  death  of  a  person  who  died  from  prussic-acid  poisoning. 

Cyanide  of  Potassium. 

Symptoms. — This  salt  has  a  bitter  taste,  producing  first  a  sense  of  cold- 
ness on  the  tongue,  followed  by  a  feeling  of  constriction  and  burning  heat 
in  the  throat.  It  is  one  of  the  most  formidable  poisons  known  to  chem- 
ists. It  has  destroyed  life  in  a  quarter  of  an  hour.  A  dose  of  five  grains 
has  proved  fatal  in  three  instances.  In  one  case  the  person  died  in  two 
hours.  (Chem.  Xews,  Sept.  5,  1863.)  The  symptoms  which  the  cyanide 
produces  are  similar  to  those  occasioned  by  prussic  acid — insensibility, 
spasmodic  respiration,  convulsions,  with  tetanic  stiffness  of  the  jaws  and 
body.  They  appear  in  a  few  seconds  or  minutes,  and  run  through  their 
course  with  great  rapidity. 

Appearances. — In  a  case  in  which  an  inspection  of  the  body  was  made 
two  days  after  death,  there  was  no  remarkable  odor  :  the  muscles  were 
rigid  ;  the  face  and  forepart  of  the  trunk  pale  ;  the  back  livid,  except 
those  portions  which  had  sustained  pressure.  The  fingers  and  toes  were 
convulsively  bent  inwards,  the  nails  blue,  the  eyelids  half  closed,  the  lips 
pale,  the  vessels  of  the  brain  filled  with  bluish-red  blood.  On  making  a 
section  of  the  brain  and  spinal  marrow,  numerous  bloody  points  were  ob- 
served. The  lungs  were  congested  posteriorly,  and,  on  cutting  into  them, 
a  strong  odor  of  bitter  almonds  was  perceived.  A  yellowish  mucus  was 
found  in  the  stomach,  which  yielded  on  analysis  cyanide  of  potassium. 
The  mucous  membrane  was  reddened  near  the  intestinal  end.  The  poison 
was  not  detected  in  any  part  of  the  body  except  the  contents  of  the  stom- 
ach and  intestines.  (Casper's  Wochenschrift,  Oct.  4,  1845,  657.)  The 
stomach  is  sometimes  intensely  reddened. 

Cyanide  of  potassium  has  a  local  chemical  action  upon  the  skin  ;  and  if 
this  is  abraded  or  wounded  it  may  be  absorbed  and  produce  serious 
effects.  Some  accidents  of  this  kind  have  occurred  in  the  practice  of  pho- 
tography.    (Ann.  d'Hyg.,  1863,  vol.  i.  p.  454.) 

Analysis. — This  substance  is  usually  seen  in  hard  white  masses.  It  is 
deliquescent  and  very  soluble  in  water ;  the  solution,  when  pure,  is  color- 
less, and  has  a  strong  alkaline  reaction,  a  soapy  feel,  and  a  powerful  odor 
of  prussic  acid.  It  is  not  very  soluble  in  cold  alcohol.  1.  It  is  decom- 
posed by  all  acids,  and  prussic  acid  is  set  free.  2.  The  potassium  is  pre- 
cipitated by  tartaric  acid  and  by  platinic  chloride.  3.  It  gives  a  white 
precipitate  with  nitrate  of  silver,  which  will  be  found  to  possess  all  the 
properties  of  cyanide  of  silver  (ante,  p.  189).  This  precipitate  is  easily 
redissolved  by  a  slight  excess  of  a  solution  of  cyanide  of  potassium.     4. 


192  ESSENTIAL    OIL    OF    BITTER    ALMONDS. 

If  a  solution  of  ferrous  sulphate  is  added  to  a  solution  of  the  cyanide  of 
potassium,  and  after  a.^itation  the  mixture  is  treated  with  diluted  sul- 
phuric acid,  Prussian  blue  will  be  produced. 

Essential  Oil  op  Bitter  Almonds. 

This  liquid,  which  is  used  for  the  purpose  of  giving  flavor  and  odor  to 
confectionery,  owes  its  poisonous  properties  in  the  crude  state  to  the 
presence  of  prussic  acid.  It  contains  a  variable  quantity  of  this  poison, 
Avhich  has  been  found  in  it  in  a  proportion  of  from  eight  to  twelve  per  cent. 
Almond  flavor,  or  essence  of  peach-kernels,  contains  one  drachm  of  the 
essential  oil  to  seven  drachms  of  rectified  spirit.  The  bitter  almond  itself 
operates  as  a  poison.  A  boy  who  had  eaten  several  almonds  was  found 
unconscious,  c3'anotic  and  pale,  with  eyelids  closed  and  pupils  moderately 
dilated.  The  arms  were  stiffened  with  tonic  spasm  and  the  pulse  trembling. 
Vomiting  was  excited  by  emetics.  He  went  to  sleep  and  recovered  in 
eighteen  hours.  (Med.  Times  and  Gaz.,  1878,  i.  p.  37.)  Peach-kernels 
operate  in  a  similar  manner.  One  ounce  of  the  kernels  is  considered  to  be 
equal  to  one  grain  of  prussic  acid — a  fatal  dose. 

Symptoms. — The  following  may  be  taken  as  a  summary  :  insensibility  ; 
lividity  of  the  face;  eyes  glassy,  prominent,  fixed  and  staring;  pupils 
dilated  and  insensible  to  light ;  jaws  spasmodically  closed  ;  frothy  mucus 
about  the  mouth,  and  in  some  cases  vomiting;  coldness  of  the  skin  ;  heav- 
ing, intermittent  respiration,  in  some  instances  stertorous;  absence  of  the 
pulse ;  the  head,  and  sometimes  the  trunk,  spasmodically  drawn  back- 
wards;  general  relaxation  of  the  limbs;  an  odor  of  bitter  almonds  about 
the  mouth. 

Appearances. — In  one  fatal  case  no  odor  of  almonds  was  perceptible, 
nine  hours  after  death,  in  the  chest,  head,  or  heart,  nor  in  the  blood.  The 
lungs  and  heart  were  healthy.  The  vessels  of  the  brain  were  congested, 
and  there  was  a  general  effusion  of  serum  on  the  hemispheres.  The  lining 
membrane  of  the  stomach  was  much  congested.  On  opening  it  the  odor 
of  bitter  almonds  was  quite  perceptible.  (Prov.  Med.  Jour.,  Sept,  11, 
1844,  p.  364.)  The  blood  with  which  the  venous  system  is  gorged  is 
generally  liquid  and  of  a  dark  color. 

Analysis. — The  essential  oil,  which  is  sometimes  called  peach-nut  oil,  is 
colorless  when  pure,  but  it  commonly  has  a  pale-j^ellow  color  and  a  strong 
odor  of  bitter  almonds,  by  which  it  may  be  at  once  identified.  It  has  a 
hot,  burning  taste,  and  a  feeble  acid  reaction.  The  smell  and  taste  are 
generally  sufficient  for  its  identification ;  but  nitrobenzene  possesses  a 
similar  odor  and  has  been  mistaken  for  it.  It  produces,  when  dropped 
on  paper,  a  greasy  stain,  which  does  not  entirely  disappear  by  the  appli- 
cation of  heat.  It  has  a  sp.  gr.  of  1.048;  hence  it  sinks  in  water,  which 
dissolves  about  one-thirtieth  part  of  its  weight  of  it.  It  is  soluble  in 
alcohol  and  in  ether  in  all  proportions.  When  mixed  with  a  few  drops  of 
strong  sulphuric  acid,  it  forms  a  rich  crimson-red  liquid,  which,  if  exposed 
to  the  air,  acquires  a  yellow  color.  Prussic  acid  may  be  detected  in  it  by 
dissolvinij:  the  oil  in  alcohol  and  adding  solutions  of  ferrous  sulphate  and 
of  potash.  On  the  subsequent  addition  of  diluted  hydrochloric  acid, 
Prussian  blue  is  formed. 

Nitrobenzene. 

Nitrobenzene,  Nitrobenzole,  or  Essence  of  Mirha.ne,  is  a  liquid  which  is 
largely  employed  as  a  substitute  for  the  essential  oil  of  bitter  almonds  in 


NITROBENZENE SYMPTOMS    AND    APPEARANCES.  193 

perfumery  and  confectionery,  and  is  a  formidable  poison.  It  has  been 
mistaken  for  essential  oil  of  bitter  almonds,  but  its  mode  of  operation  is 
different.  In  1859  Casper  published  an  account  of  this  liquid  under  the 
name  of  "  A  new  Poison."  (Vicrteljahrsschr.  f.  Gerichtl.  Med.,  B.  16, 
p.  1.)     It  is  also  largely  employed  in  the  manufacture  of  aniline  colors. 

Symptoms. — The  cases  which  have  yet  occurred  show  that  this  is  an 
insidious  poison,  both  in  the  form  of  liquid  and  vapor.  It  produces  a 
burning-  taste  in  the  mouth,  followed  by  a  sensation  of  numbness  and  ting- 
ling in  the  tongue  and  lips.  There  is  no  immediate  insensibility,  as  in 
poisoning  by  prussic  acid.  The  eyes  are  bright  and  glassy,  the  features 
pale  and  ghastly,  the  lips  and  nails  purple,  as  if  stained  by  blackberries,  the 
skin  clammy,  and  the  pulse  feeble.  There  is  a  powerful  odor  resembling 
that  of  oil  of  bitter  almonds.  The  mind  may  be  clear  for  an  hour,  or  for 
several  hours,  after  the  poison  has  been  swallowed.  The  patient  then  be-- 
comes  suddenly  unconscious,  the  jaws  fixed,  the  hands  clenched  and  blue, 
and  the  muscles  rigid  and  convulsed.  In  one  case  there  was  vomiting  of 
a  liquid  having  the  odor  of  nitrobenzene.  The  breathing  was  slow  and 
the  pulse  scarcely  perceptible.  Reaction  set  in  in  about  eleven  hours,  and 
recovery  took  place.  (Guy's  Hosp.  Rep.  1864,  p.  192.)  In  a  fatal  case 
examined  by  Letheby,  the  appearances  were  as  follows:  The  superficial 
vessels  were  much  gorged  with  blood,  which  was  black  and  fluid.  The 
lungs  were  congested,  the  cavities  of  the  heart  were  full  of  blood,  the  liver 
was  of  a  purple  color,  the  brain  and  its  membranes  were  congested,  and 
there  was  much  bloody  serosity  in  the  ventricles.  Lehman  reported  the 
symptoms  and  appearances  in  a  fatal  case.  (Ann.  d'Hyg.,  1873,  1,  p.  444.) 
In  1876  a  man,  set.  21,  was  prescribed  three  minim  doses  of  "benzol 
rect."  three  times  a  day.  By  mistake  the  dispenser  read  the  prescription 
as  ordering  "  benzol  nit.,"  and  gave  nitrobenzene.  The  first  day  he  took 
these  doses  the  patient  was  observed  to  look  a  little  pale  and  weak,  but  he 
was  not  conscious  of  feeling  ill  till  after  taking  the  seventh  dose  at  9  A.M. 
the  next  day.  The  aggregate  amount  of  nitrobenzene  now  taken  was 
ascertained  to  be  twenty-three  minims.  At  2  P.M.,  five  hours  after 
taking  this  final  dose,  after  walking  not  more  than  forty  yards  in  the 
street  from  his  office,  he  fell  down.  He  was  just  able  to  give  his  address, 
and  then  became  insensible.  At  3.15  P.M.,  when  seen  by  Gross,  he  was 
cold,  and  the  surface  of  the  body  Avas  bluish-purple.  There  was  no  pulse, 
but  by  the  stethoscope  the  heart  could  just  be  heard  faintly  beating.  The 
lower  jaw  was  rigidl}^  closed;  but  the  limbs  were  flaccid  and  dropped 
pov^^erless  when  raised ;  the  pupils  were  widely  dilated.  No  breathing 
could  be  perceived  for  twenty  minutes  after  this.  He  was  treated  as  for 
prussic  acid  poisoning,  it  being  thought  that  the  poison  was  oil  of  bitter 
almonds.  At  7  P.M.  he  became  conscious  and  complained  of  headache. 
At  9  P.M.  the  sldn  was  still  blue.  Next  day  he  was  fairly  convalescent. 
From  the  urine  collected  on  the  morning  following  the  accident  the  editor 
extracted  a  substance  having  the  odor  of  nitrobenzene.  (Guy's  Hosp. 
Rep.,  1876,  p.  371.) 

This  compound  has  a  narcotic  action,  but  it  diff"ers  from  the  ordinarv 
narcotics  in  its  powerful  and  persistent  odor,  which  would  render  it  diffi- 
cult for  a  person  to  administer  it  unknowingly  to  another,  either  in  liquid 
or  vapor  ;  in  the  production  of  profound  coma  at  an  uncertain  interval 
after  the  stupor  ;  and  in  the  rapidly  fatal  effects  when  coma  has  followed. 
It  operates  powerfully  as  a  poison  in  vapor,  as  well  as  in  a  liquid  state. 
The  rapidly  fatal  cases  only  would  be  likely  to  be  mistaken  for  apoplexy, 
but  in  these  the  poison  would  be  detected  by  its  odor. 
13 


194    NITROGLYCERINE — SYMPTOMS  AND  APPEARANCES. 

Analysis. — Nitrobenzene,  or  Essence  of  Mirbane,  is  a  pale  lemon- 
colored  liquid  of  a  strong  odor  resembling  that  of  bitter  almonds.  It  has 
a  pungent,  hot,  disagreeable  taste.  It  gives  to  confectionery  and  to  soap 
the  smell  of  oil  of  bitter  almonds,  and  gives  a  greasy  stain  to  paper.  It 
sinks  in  water,  and  is  partly  dissolved,  imparting  to  it  a  yellowish  color. 
It  is  soluble  in  alcohol,  ether,  and  chloroform  ;  but,  when  agitated  with 
water,  it  is  in  great  part  separated  from  its  ethereal  and  chloroformic  solu- 
tions. It  burns  with  a  yellow  smoky  flame.  It  yields  no  Prussian  blue 
when  mixed  with  ferrous  sulphate,  alcohol,  and  potash,  and  then  acidu- 
lated. It  is  distinguished  from  all  other  liquids,  excepting  the  essential 
oil  of  almonds,  by  its  odor,  and  from  this  oil  by  the  following  tests  :  Pour 
a  few  drops  of  each  on  a  small  plate,  and  add  a  drop  of  strong  sulphuric 
acid.  The  oil  of  almonds  acquires  a  rich  crimson  color  with  a  yellow 
border;  the  nitrobenzene  produces  no  color.  In  order  to  separate  it  from 
organic  liquids,  they  may  be  acidulated  with  sulphuric  acid,  and  submitted 
to  distillation.  It  may  be  converted  into  aniline  by  reduction  with  zinc 
and  hydrochloric  acid,  and  submitted  to  further  tests. 

Nitroglycerine  (Glonoin). 

This  is  a  sweet,  oily,  powerfully  explosive  liquid,  M-ell  known  to 
chemists  as  a  substitution-compound  of  the  innocuous  liquid  glycerine. 
It  is  much  used  in  mining,  under  the  name  of  "blasting  oil,"  and  has  a 
sweet,  aromatic,  pungent  taste.  Mixed  with  an  infusorial  earth,  it  is 
known  as  dynamite.  The  medicinal  dose  is  one  or  two  hundredths  of  a 
grain. 

Symptoms  and  Appearances. — Field  states  that  he  found  one  drop  of 
the  liquid  dissolved  in  water  produced  insensibility  and  other  symptoms 
of  narcotic  poisoning  (Chem.  News,  Nov.  7,  1863);  and  that  one-fiftieth 
of  a  minim  produced  in  three  minutes  loud  noises  in  the  head  and  other 
distressing  symptoms.  Murrell  has  found  that  one  or  two  minims  of  a 
one  per  cent,  solution  of  nitroglycerine  produce  painful  pulsation  over 
the  whole  head;  the  pulsation  soon  affects  the  whole  body,  and  is  so 
marked  that  a  pen  held  in  the  hand  becomes  visible  jerked.  In  five 
minutes  these  symptoms  are  followed  by  intense  headache,  languor,  and 
depression.  Nitroglycerine  is  now  employed  in  medicine  in  lieu  of  nitrite 
of  amyl,  which  it  greatly  resembles  in  its  effects,  except  that  these  are 
more  lasting.  The  editor  has  seen  the  most  distressing  results  ensue 
from  an  overdose,  the  headache  being  of  an  alarming  and  fearful  character. 

Nitroglycerine  has  in  several  instances  been  the  cause  of  accidental 
death.  It  is  sweet,  colorless,  and  apparently  innocent  in  appearance  ;  and 
these  properties  render  it  liable  to  be  taken  in  mistake  for  other  liquids  of 
a  less  potent  character.  In  1865,  a  girl,  aet.  13,  died  after  drinking  some 
of  it  from  a  flask.  A  man  drank  a  considerable  quantity  of  the  liquid  in 
mistake  for  beer.  An  hour  later  he  was  blue  in  the  face  and  insensible. 
When  admitted  into  hospital  he  was  delirious  and  unconscious,  and 
speedily  became  comatose.  The  hands  were  frequently  raised  to  the  head, 
as  if  there  was  headache.  The  face  was  red  and  swollen.  He  died  six 
hours  after  swallowing  the  poison.  The  brain  and  its  membranes  were 
congested  ;  and  there  was  some  yellow  serous  fluid  in  the  ventricles  The 
lungs  were  oedematous,  the  windpipe,  stomach,  and  kidneys  reddened. 
Signs  of  irritation  were  also  noted  in  the  small  intestines.  There  were 
numerous  small  ecchymosed  spots  on  the  fundus  and  larger  end  of  the 
stomach.  In  a  third  case,  a  man  drank  some  glonoin  in  mistake  for 
brandy,  and  died  in  three  hours.     In  a  fourth  case  a  man  recovered  after 


ALCOHOL — SYMPTOMS.  195 

swallowing  a  considerable  quantity  of  the  poison.     (Schmidt's  Jahresber., 
136,  p.  164.) 

Analysis — Nitroglycerine  is  a  heavy,  oily-looking  liquid.  It  dissolves 
in  water,  but  is  insoluble  in  alcohol  and  ether.  It  explodes  violently 
when  struck  or  subjected  to  concussion.  Nitroglycerine  yields  a  red  color 
when  treated  with  aniline  and  strong  sulphuric  acid  ;  and  also  a  red  color 
when  treated  with  brucine  and  strong  sulphuric  acid  (free  from  nitric 
acid). 


CHAPTER    XVIII. 

ALCOHOL.— ETHER. — CHLOROFORM. — IODOFORM. — HYDRATE     OF     CHLORAL. — CAMPHOR. 

Alcohol. 

Symptoms. — In  general  the  symptoms  produced  in  poisoning  with 
alcohol  come  on  in  the  course  of  a  few  minutes.  There  is  confusion  of 
thought,  with  inability  to  stand  or  walk,  a  tottering  gait  and  giddiness, 
followed  by  stupor  and  coma.  Should  the  person  recover  from  this  stage, 
vomiting  supervenes.  The  insensibility  produced  by  alcohol  may  not 
come  on  until  after  some  time,  and  then  suddenly.  Christison  met  with 
an  instance  in  which  a  person  fell  suddenly  into  a  deep  stupor  some  time 
after  he  had  swallowed  sixteen  ounces  of  whiskey  ;  there  were  none  of 
the  usual  premonitory  symptoms.  In  another  instance,  a  person  may 
apparently  recover  from  the  first  effects,  then  suddenly  become  insensible, 
and  die  convulsed.  There  is  a  ghastly  or  vacant  expression  on  the  features, 
w^hich  are  sometimes  suffused  and  bloated  ;  the  lips  are  livid,  and  the 
pupils  are  dilated  and  fixed,  and  if  they  possess  the  power  of  contracting 
under  the  influence  of  light,  it  is  a  favorable  sign.  The  conjunctivae  of 
the  eyes  are  generally  much  suffused.  The  breath  has  an  alcoholic  odor. 
The  more  concentrated  the  alcohol,  the  more  rapidly  are  the  symptoms 
induced,  and  they  are  also  more  severe  in  their  character.  Diluted  alcohol 
commonly  produces  a  stage  of  excitement  before  stupor,  while  in  the  action 
of  concentrated  alcohol  there  may  be  profound  coma  in  a  few  minutes.  The 
cause  of  death  may  be  generally  traced  to  congestion  of  the  brain  or  lungs, 
or  both.  Sometimes  a  large  dose  may  be  taken  without  causing  death. 
A  child,  aet.  4,  swallowed  between  two  and  three  ounces  of  brandy.  He 
was  found  insensible,  the  breathing  was  scarcely  perceptible,  and  the  pupils 
were  widely  dilated.  Under  treatment  he  recovered  in  two  days.  (Lan- 
cet, 1872,  i'i.  p.  66.) 

The  symptoms  arising  from  apoplexy,  from  concussion  of  the  brain,  the 
effects  of  opium,  and  those  of  carbolic  acid,  have  been  sometimes  mistaken 
for  those  of  poisoning  by  alcohol,  and  persons  have  been  wrongly  charged 
with  being  drunk.  With  respect  to  concussion,  a  difficulty  can  arise  only 
in  reference  to  the  more  advanced  stage  of  poisoning  with  alcohol,  i.  e.  in 
which  there  is  profound  coma.  Intoxication  may  in  general  be  easily 
distinguished  by  the  odor  of  the  breath,  for  so  long  as  the  symptoms  con- 
tinue alcohol  is  eliminated  by  the  lungs.  If  there  should  be  no  precep- 
tible  odor  of  any  alcoholic  liquid,  the  presumption  is  that  the  symptoms 
are  not  due  to  intoxication.  When  the  alcoholic  odor  is  perceptible,  the 
symptoms  may  still  be  combined  with  the  effects  of  apoplexy  or  concus- 


196  ALCOHOL APPEARANCES    AND    ANALYSIS. 

sion — a  fact  -SA-hich  can  be  cleared  up  only  by  a  history  of  the  case,  or  a 
careful  examination  of  the  head  for  marks  of  violence.  In  poisoning  with 
opium  there  will  be  a  strong  smell  of  this  drug  in  the  breath,  the  symp- 
toms come  on  much  more  gradually,  and  are  marked  by  drowsiness  and 
stupor,  passing  into  complete  lethargy,  with  general  relaxation  of  the 
muscles  and  inability  to  walk.  In  poisoning  with  alcohol  there  is  either 
great  excitement  some  time  before  the  stupor,  which  comes  on  suddenly, 
or  the  person  is  found  in  a  state  of  deep  coma  a  few  minutes  after  having 
taken  the  poison.  In  poisoning  with  opium  the  face  is  pale  and  the  pupils 
are  contracted;  in  poisoning  with  alcohol  the  face,  under  excitement,  is 
more  commonly  flushed  and  the  pupils  are  generally  dilated.  Another 
fact  to  be  noticed  is  that,  while  perfect  remissions  are  rare  in  poisoning 
with  opium,  in  poisoning  with  alcohol  a  person  frequently  recovers  his 
senses  and  dies  subsequently.  When  coma  has  supervened,  the  patient 
may  be  aroused  by  a  loud  noise  or  a  violent  shock  in  either  case,  and  ft  is 
very  difficult  under  these  circumstances  to  draw  a  well-marked  distinction. 
The  odor  of  the  breath,  or  an  examination  of  the  fluid  draAvn  from  the 
stomach  by  the  pump,  may  then  show  which  poison  has  been  taken ;  but 
the  treatment  is  the  same  in  both  cases.  In  poisoning  with  carbolic  acid 
there  is  the  characteristic  odor  of  the  acid  in  the  breath,  a  white  furred  or 
shrivelled  tongue  and  white  or  brown  stains  about  the  angles  of  the 
mouth. 

Alcohol  may  act  as  a  poison  by  its  vapor.  If  the  concentrated  vapor 
be  respired,  it  will  produce  the  usual  effects  of  intoxication.  There  is  a 
case  on  record  in  which  a  child  two  years  of  age  was  thrown  into  an  apo- 
plectic stupor  by  the  alcoholic  vapor  of  eau  de  Cologne.  In  this  manner  a 
child  might  be  destroyed  and  no  trace  of  the  poison  found  in  the  stomach. 
Appearances. — The  stomach  has  been  found  intensely  congested  or 
inflamed,  the  mucous  membrane  presenting  in  one  case  a  bright  red,  and 
in  another  a  dark  red-brown  color.  When  death  has  taken  place  rapidly, 
there  may  be  the  special  odor  of  the  kind  of  spirits  taken  in  the  contents ; 
but  this  will  not  be  perceived  if  the  quantity  taken  was  small,  or  many 
hours  have  elapsed  before  the  inspection  is  made.  The  brain  and  its 
membrane  are  found  congested,  and  in  some  instances  there  is  effusion  of 
blood  or  serum  beneath  the  inner  membrane  {pia  viater). 

Analysis. — When  a  large  dose  has  been  taken,  and  the  case  has 
proved  rapidly  fatal,  the  contents  of  the  stomach  may  have  the  odor  of 
alcohol  or  of  the  alcoholic  liquid  taken.  The  odor,  however,  is  not  always 
perceptible,  and  it  may  be  easily  concealed  liy  other  odors.  In  a  case  of 
poisoning  with  gin,  the  liquid  drawn  from  the  stomach  by  the  pump  after 
seven  hours  had  no  odor.  The  smell  of  brandy  has  entirely  disappeared 
in  twelve  hours. 

The  contents  of  the  stomach  or  the  suspected  liquid  should  be  distilled 
in  a  water-bath  with  a  proper  condensing  apparatus  attached  (Fig.  8, 
p.  130).  If  the  liquid  has  an  acid  reaction,  it  should  be  first  neutralized 
with  a  solution  of  carbonate  of  sodium.  The  Avatery  distillate  obtained 
should  be  submitted  to  a  second  distillation  in  a  similar  retort  heated  by  a 
Avater-bath.  The  liquid  obtained  by  the  second  distillation  may  be  iden- 
tified by  its  odor,  taste,  and  inflammability.  Its  specific  gravity  should  be 
taken,  and  from  this  the  percentage  of  alcohol  may  be  deducted  by  tables. 
Alcohol  may  be  recognized  by  the  tA\-o  folloAving  tests ;  1.  Mix  a  little  of 
the  distillate  with  enough  solution  of  bichromate  of  potassium  to  give  it 
a  good  orange  color.  Now  pour  in  an  equal  volume  of  strong  sulphuric 
acid  and  gently  agitate  the  tube  so  as  to  mix  the  solutions;  if  alcohol  be 
present,  the  liquid  will  bet'ome  green  and  the  peculiar  odor  of  aldehyd  will 


ETHER — NITROUS    ETHER — CHLOROFORM.  197 

be  perceived.  2.  To  a  portion  of  the  distillate  add  some  solution  of  potash 
and  then  a  solution  of  iodine  in  iodide  of  potassium  till  a  permanent  brown 
tint  is  obtained.  Now  add  enoug-h  of  tlie  potash  solution  to  discharge  the 
color  and  warm  gently.  If  alcohol  be  present,  a  turbidity  will  appear  in 
the  solution,  but  will  disappear  as  the  boiling  point  is  approached;  and 
the  peculiar  odor  of  iodoform  will  be  perceived.  On  cooliug  and  standing 
for  some  hours,  the  iodoform  will  settle  to  the  bottom  of  the  vessel  in  the 
form  of  beautiful  resetted  crystals. 

Ether. 

Symptoms  and  Effects. — Ether,  in  moderate  doses,  has  a  hot,  burning 
taste,  and  produces  during  swallowing  a  sense  of  heat  and  constriction  in 
the  throat.  It  causes,  like  alcohol,  great  excitement  and  exhilaration, 
with  subsequent  intoxication ;  but  persons  may  become  habituated  to  its 
use,  and  thus,  after  a  time,  it  may  be  taken  in  large  quantities  with  com- 
parative impunity.  Ether  drinking  for  the  purpose  of  intoxicating  is 
common  in  Ireland.  (Br.  Med.  Journ.,  1890,  ii.  p  885.)  The  efiects  pro- 
duced on  the  system,  when  a  large  dose  has  been  taken,  are  similar  to 
those  occasioned  by  alcohol.  Ether  as  a  liquid  has  not,  as  far  as  is 
known,  directly  destroyed  the  life  of  a  human  being;  but  when  its  vapor 
has  been  breathed  it  has  caused  death  in  several  instances.  (See  On 
Poisons,  3d  edit.,  p.  639;  also  Brit.  Med.  Jour.,  1877,  ii.  p.  692  ;  1875,  i. 
p.  585.) 

Analysis. — When  ether  has  been  taken  as  a  liquid  it  may  be  separated 
from  the  contents  of  the  stomach  b}^  the  process  described  for  alcohol.  It 
is  well  known  by  its  odor  and  inflammability. 

Spirit  of  Nitrous  Ether. — This  compound  is  well  known  under  the 
name  of  sweet  spirit  of  nitre.  It  may  be  regarded  as  a  solution  of  nitrous 
ether  in  rectified  spirit.  In  1878  a  child,  about  three  years  old,  drank 
between  three  and  four  ounces  of  sweet  spirit  of  nitre.  He  was  soon 
afterwards  found  in  a  state  of  complete  collapse — cold,  pulseless,  and  in- 
sensible; both  pupils  were  widely  dilated  and  fixed,  and  the  breathing  was 
hardly  perceptible.  Before  this  the  child  had  vomited  undigested  food, 
with  a  smell  of  spirit,  and  the  bowels  had  been  opened.  In  spite  of  some 
reaction  under  treatment,  there  was  no  sign  of  recovery:  the  breathing 
became  stertorous,  and  the  child  died  twelve  hours  after  swallowing  the 
liquid.  On  inspection  there  was  a  strong  smell  of  spirit;  the  mucous  coat 
of  the  stomach,  as  well  as  that  of  the  duodenum,  was  inflamed.  The 
membranes  of  the  brain  were  highly  congested,  the  vessels  containing  a 
large  quantity  of  dark-colored  blood.  The  operation  of  this  liquid  resem- 
bled that  of  a  mixture  of  alcohol  and  ether.  This  is  the  only  fatal  case 
which  we  have  met  with. 

Chloroform. 

Symptoms. — Chloroform,  when  swallowed,  acts  very  uncertainly.  As 
it  is  a  liquid  very  sparingly  soluble  in  water,  and  much  more  soluble  in 
alcoholic  liquids,  it  is  not  surprising  that  the  greater  or  less  fulness  of  the 
stomach,  and  the  nature  of  its  contents  when  the  poison  is  swallowed, 
greatly  influence  the  result.  The  author  regarded  it  as  a  not  very  active 
poison.  In  this  opinion  the  editor  cannot  concur,  since  he  has  collected 
the  reports  of  sixty-two  cases,  of  which  no  less  than  nineteen  proved  fatal, 
or  thirty  per  cent.  Eliot  has  tabulated  fifty-six  undoubted  published  cases. 
(New  York  Med.  Rec,  1885,  ii.  p.  29.)     The  effects  of  chloroform  when 


198  CHLOROFORM. 

swallowed  do  not  greatly  differ  from  the  severe  effects  of  the  inhaled 
liquid,  except  that  the  symptoms  are  more  intensified  and  last  longer.  A 
man,  at.  53,  of  robust  constitution,  but  given  to  drink,  swallowed  about 
one  and  a  half  fluidounces  of  chloroform  with  suicid-al  intent.  Six  hours 
later  he  was  found  in  an  unconscious  condition.  When  seen  by  Brasch 
his  face  was  flushed,  the  mucous  membranes  slightly  cyanotic,  the  eyes 
closed,  the  breathing  Cjuiet,  20  per  miuute,  but  occasionally  embarrassed, 
owing  to  falling  back  of  the  tongue.  From  time  to  time  he  vomited  and 
passed  feces  involuntarily.  The  pulse  was  small,  80  per  minute,  the 
cornea  insensitive,  the  pupils  not  contracted  and  not  reacting  to  light  or 
other  stimuli.  The  patient  was  absoluteh'  insensible,  and  couJd  not  be 
roused.  One-thirteenth,  and  a  cjuarter  of  an  hour  later  one-thirty-second 
of  a  grain  of  str3'chnine  was  injected  subcutaneously.  The  pulse  became 
stronger,  the  patient  began  to  move  his  hands  and  arms  and  to  open  his 
eyes  for  a  moment  or  two  ;  he  spoke,  though  unintelligibly,  and  vomited 
mucus  mixed  with  food.  The  vomited  matter  did  not  smell  of  chloroform. 
Ten  hours  after  swallowing  the  poison  the  man  recovered  consciousness, 
and  complained  of  thirst,  a  feeling  of  internal  heat,  and  nausea.  The 
vomiting  continued,  and  next  day  there  was  great  pain  in  the  region  of 
the  liver,  which  was  enlarged  and  tender.  The  .skin  and  conjunctivae  were 
jaundiced,  the  feces  slightly  bloodstained.  Towards  the  end  there  was 
great  difficulty  in  passing  water,  and  even  Avith  the  catheter  only  a  few 
drops  of  turbid  yellowish  urine  could  be  drawn  off.  The  patient  became 
gradually  weaker,  and  died  sixtj^-seven  hours  after  swallowing  the  poison 
of  paralysis  of  the  heart  and  pulmonary  oedema.  The  temperature  was 
normal  throughout,  the  intelligence  clear  to  the  last.  No  jjoiit-mortem 
examination  seems  to  have  been  made.  (Deutsch.  Med.  Zeitung,  April  7, 
1890;  Br.  Med.  Jour.,  1890,  i.  p.  1089.) 

Chloroform-poisoning  is  nearly  always  the  result  of  accident  or  suicide; 
but  in  1886,  a  woman  Avas  tried  for  the  alleged  murder  of  her  husband  by 
means  of  chloroform  and  Avas  acquitted.  (Reg.  v.  Adelaide  Bartlett,  C.  C. 
C,  April,  1886.) 

The  pungent  odor,  sweet  taste,  and  intense  burning  sensation  which  its 
contact  with  the  mucous  membranes  instantaneously  produces,  would 
render  the  homicidal  administration  of  chloroform  by  the  mouth  difficult, 
except  the  persons  Avere  first  chloroformed  by  inhalation.  That  persons 
can  be  successfully  chloroformed  during  sound  sleep  has  repeatedly  been 
put  to  the  test.  (Hussey,  Med  Times  and  Gaz.,1880,  ii.  p.  251:  Dolbeau, 
Ann.  d'Hyg.,  1874,  t.  1,  p.  168;  Quimby,  Boston  Med.  Jour.,  June  17, 
1880;  Eliot,  New  York  Med.  Rec.  1885,  ii.  p.  29  ) 

The  most  prominent  svmptoms  of  chloroform-poisoning  are,  after  a 
transient  state  of  excitement  or  inebriation,  muscular  relaxation,  abolition 
of  sensation  and  consciousness — Avhich  may  supervene  Avithin  five  minutes, 
though  it  is  usually  longer  delayed — and  profound  narcosis  with  sterto- 
rous respiration.  The  pupils  of  the  eye  may  be  contracted  or  dilated. 
Reflex  excitability  is  eventually  abolished.  Usually,  if  the  stomach  be 
evacuated,  the  patient  recovers  ;  and  fortunately  chloroform  commonly 
excites  vomiting.  But  no  vomiting  may  be  excited  by  even  a  large  dose 
(Canada  Lancet,  1874,  vi.  p.  209) ;  and  death  may  result  under  such  cir- 
cumstances. Chloroform  appears  to  destroy  life  by  paralyzing  the  action 
of  the  heart  or  lungs,  or  both  organs. 

A  boy,  set.  4,  SAvallowed  a  drachm  or  two  of  chloroform,  laid  his  head 
on  his  mother's  lap  soon  afterwards,  and  then  lost  all  consciousness.  In 
about  tAventy  minutes  he  was  insensible,  cold,  and  pulseless.  Mustard 
poultices  applied  to  his  legs  produced  no  impression  or  sensbility.     The 


CnLOROFOKM    VAPOR.  199 

breathing  was  sometimes  natural,  at  other  times  stertorous.  He  died  in 
three  hours.  This  is  the  amalled  fatal  done,  recorded.  Hoffmann  met  with 
a  case  where  35-40  grammes,  or  (5-7  fluid  drachms,  proved  fatal  to  an 
adult.  This  is  the  smallest  fatal  dose  recorded  in  the  case  of  an  adult. 
One  fluidounce  has  in  several  cases  killed  an  adult.  Death  has  ensued  at 
periods  ranging  from  one  hour  to  eight  day.s.  The  post-mortem  appear- 
ances are  congestion,  inflammation,  and  even  ulceration  of  the  lining 
membrane  of  the  stomach;  conuestiou  of  the  mucous  membrane  of  the 
bowels,  and  sometimes  congestion  of  the  lungs  and  of  the  brain.  The 
blood  is  sometimes  unusually  fluid,  and  the  post-mortem  staining  of  the 
heart  well  marked.  There  is,  however,  nothing  characteristic,  except  the 
odor  of  chloroform  in  the  alimentary  canal. 

H.  C.  Wood,  Jan.,  nearly  killed  a  patient  by  the  deep  injection  of  half  a 
drachm  of  chloroform.     (Therapeutics,  2d  edit.,  p.  280.) 

Chloroform  Vapor — This  vapor,  when  respired  in  a  concentrated  form; 
is  speedily  fatal  to  life.  If  it  is  diluted  with  a  certain  proportion  of  air,  it 
produces  insensibility  with  entire  loss  of  mu.scular  power,  and  the  patient 
rapidly  recovers  after  the  vapor  is  withdrawn.  Cases  of  death  from  the 
inhalation  of  the  vapor  fo:  surgical  purposes  have  been  numerous,  and  the 
symptoms  and  post-moi'tem  appearances  are  not  always  well  marked.  In 
some  instances  death  haa  taken  place  within  two  minutes  from  the  com- 
mencement of  inhalation.  In  one  in  which  only  thirty  drops  had  been 
inhaled  in  vapor  the  patient  died  in  one  minute,  and  in  another  so  small 
a  quantity  as  fifteen  or  twenty  drops  proved  speedily  fatal.  Its  fatal 
effects  do  not  depend  so  much  on  the  absolute  quantity,  as  on  the  propor- 
tion in  which  it  is  breathed  in  a  state  of  mi.xture  with  atmospheric  air.  It 
has  been  stated  that  the  average  proportion  of  this  vapor  for  medicinal 
purposes  should  not  exceed  .3  j  per  cent.,  and  that  4|^  is  the  maximum  quan- 
tity to  be  taken  with  safety.  The  proportion  should  be  only  slowlv  in- 
creased. The  vapor  should  not  be  given  after  a  full  meal,  or  while  the 
person  is  in  a  sitting  or  erect  posture.  (Brit.  Med.  Jour.,  1875,  ii.  p. 
178.)  The  vapor  of  this  liquid,  operating  throuy-h  the  lungs,  has  de- 
stroyed life  more  rapidly,  and  in  a  smaller  dose,  than  any  other  poison 
known.  Its  fatal  operation  is  sometimes  suddenly  manifested  after  the 
withdrawal  of  the  vapor.  It  is  thought  that  20  minims  in  the  blood  at 
one  time  would  prove  fatal.  It  is  to  a  fatty  condition  or  flabbv  heart  that 
the  fatal  effects  are  usually  and  often  incorrectly  ascribed.  The  theory  of 
a  flal)by  heart  is  quite  unnecessary  to  explain  the  fatal  results  occasionally 
produced  by  chloroform  vapor,  even  when  administered  by  experienced 
persons. 

A  case  is  reported  of  the  murder  of  a  woman  by  her  lover  by  means  of 
inhaled  chloroform.  The  man  subsequently  shot  himself  There  is  reason 
to  think,  however,  that  this  was  a  case  of  attempted  simultaneous  suicide. 
(Casper's  Handb.  d.  Gerichtl.  Med.,  6  Auf.  ii.  p.  557.) 

The  recent  report  of  the  Second  Hyderabad  Chloroform  Commission 
(Lancet,  1890,  i.  p.  149)  shows  that  when  animals  are  aneesthetized  by 
chloroform,  or  by  ether,  respiration  fails  before  the  pulse  ceases,  contrarV 
to  what  was  previously  supposed  to  occur.  The  researches  of MacWilliam 
are  in  conflict  with  those  of  Claude  Bernard,  endorsed  by  the  Second 
Hyderabad  Commission.  He  finds  that  chloroform  exerts  a  direct  influ- 
ence on  the  heart,  and  that  the  mode  of  cardiac  failure  under  chloroform 
is  a  more  or  less  sudden  dilatation  and  enfeeblement  of  the  organ.  He 
further  states  that  death  from  cardiac  failure  occurs  where  the  respirntion 
continues  for  several  minutes  after  the  heart  has  stopped.  (Brit.jMed. 
Jour.,  1890,  ii.  pp.  890,  948.) 


200  IODOFORM HYDRATE    OF    CHLORAL. 

In  cases  of  alleged  robbery  and  rape  it  has  been  sometimes  stated  that 
the  person  assaulted  was  rendered  suddenly  insensible  by  chloroform ; 
but  chloroform  vapor  does  not  produce  immediate  insensibility  unless  it 
also  produces  asphyxia  aud  death.  There  can  be  no  doubt  that  several 
false  charges  of  rape  have  been  made  against  medical  men  and  dentists 
under  the  alleged  use  of  this  vapor.  In  general  the  statement  of  the 
woman  alone  has  been  sufficient  to  show  the  falsehood  of  the  charge. 

[It  is  doubtful  if  crime  could  be  .successfully  committed,  as  is  frequently 
charged,  by  producing  unconsciousness  through  inhalation  of  chloroform, 
without  the  knowledge  of  the  recipient.  The  late  Dr.  Stephen  Rogers 
raised  that  question  before  the  New  York  Medico-Legal  Society  in  1871, 
and  challenged  the  production  of  one  authenticated  case  Avhere  chloroform 
had  been  or  could  be  administered  without  the  knowledge  of  the  party 
inhaling  it.  The  question  is  sometimes  discussed,  but  the  safer  opinion 
is,  that  all  such  charges  are  wholly  false  and  impossible.] 

Analysis. — Chloroform  is  a  heavy,  colorless  liquid,  sp.  gr.  1.5,  neutral 
in  its  reaction,  sinking  in  water  in  heavy,  oily-looking  globules,  and  only 
to  a  slight  extent  dissolving  in  this  liquid.  It  has  a  peculiar  fragrant 
odor.  It  is  very  volatile,  but  not  readily  combustible.  It  may  be  separ- 
ated from  other  liquids  by  distillation  at  a  low  temperature.  It  boils  at 
142°  F.  and  evolves  a  vapor  which,  at  a  red  heat,  yields  chlorine  and 
hydrochloric  acid.  On  this  effect  is  founded  a  process  for  the  detection 
of  chloroform  in  the  blood  when  it  has  proved  fatal  in  the  form  of  vapor. 
The  editor  has  by  this  method  succeeded  in  detecting  chloroform  in  the 
blood  of  a  man  twenty-four  hours  after  death  from  the  administration  of 
chloroform  as  an  anaesthetic  vapor.  (See  Princ.  and  Pract.  of  Med. 
Jurisp.,  vol.  i.  p.  406.)  In  organic  liquids  it  may  be  converted  into 
chloride  by  the  action  of  alcoholic  potash,  and  the  chlorides  may  then  be 
estimated  by  precipitation  with  nitrate  of  silver.  Chloroform  is  miscible 
in  all  proportions  with  alcohol,  but  not  with  diluted  spirit.  Proof  spirit 
dissolves  15  per  cent,  by  volume  of  chloroform  ;  whereas  spirit  of  25  per 
cent,  under  proof — the  minimum  statutory  strength  of  brandy — takes  up 
only  2  per  cent 

Iodoform. 

This  antiseptic  is  a  poison.  Schede,  Kocher,  and  others  have  published 
cases  where  severe  and  even  fatal  symptoms  have  followed  its  external 
application.  Many  cases  have  still  more  recently  been  reported  where 
toxic  .symptoms  were  developed  after  its  use  as  a  surgical  dressing.  These 
symptoms  were,  in  two  cases,  drowsiness  and  stupor  ;  in  one,  those  of 
meningitis;  and  delirium  in  a  fourth  case,  which  terminated  fatally. 

Symptoms  and  Appeaj^ances. — The  symptoms  usually  observed  after 
poisonous  doses  are — faintness,  headache,  giddiness,  confusion  of  ideas, 
drowsiness,  burning  pain  in  the  stomach,  delirium,  convulsions,  insen- 
sibility, general  paralysis,  a  small  pulse  sometimes  quickened  and  some- 
times diminished  in  frequency,  and  the  skin  cold  and  livid,  bathed  in  per- 
spiration.    (Brit.  Med.  Jour.",  1882,  i.  pp.  903,  913.) 

Hydrate  of  Chloral. 

This  substance,  in  doses  of  from  twenty  to  thirty  grains,  operates  as 
a  sedative  and  narcotic.  In  very  large  doses  it  has  caused  dangerous 
symptoms,  followed  by  sudden  death.  Medical  men  who  have  taken  it 
incautiouslv  have  died  from  its  effects.     Two  instances  of  this  kind  are 


HYDRATE    OF    CHLORAL SYMPTOMS.  201 

reported  in  the  Med.  Times  aud  Gaz.  (1871,  i.  p.  307).  No  remarkable 
symptoms  have  preceded  dissolution.  The  person  has  passed  at  once 
from  sleep  into  death.  Hunter's  syrup  of  chloral  contains  20  grains  in 
each  fluid  drachm. 

Symptoms. — This  compound  produces  after  a  short  interval  deep  sleep, 
and,  when  carried  far  enough,  complete  loss  of  consciousness  and  sensi- 
bility. A  lady  took  six  doses  of  thu'ty  grains  each,  and  fell  into  a  sound 
sleep.  Every  attempt  failed  to  arouse  her,  and  she  slept  into  death. 
The  principal  post-mortem  appearance  was  great  congestion  of  the  cerebral 
vessels.  (Med.  Times  and  Gaz.,  1871,  i.  p.  1^2.)  A  lady  took,  in  three 
doses,  at  intervals  of  four  hours,  seventy  grains  of  chloral.  In  two  hours 
after  the  last  dose  she  suffered  from  severe  cramps  in  the  legs,  a  feeling  of 
suffocation,  swimming  in  the  head,  and  inability  to  regulate  her  move- 
ments. Four  hours  after  the  last  dose,  her  face  was  flushed,  the  eyelids 
were  closed,  and  the  conjunctivge  injected;  pulse  120  and  bounding.  She 
was  with  difficulty  roused.  She  recovered  in  about  sixteen  hours.  (Med. 
Times  and  Gaz.,  1870,  ii.  p.  435.)  A  man  took  thirty  grains  and  became 
unconscious  almost  immediately  after  swallowing  it — the  face  and  hands 
turned  livid  and  cold,  and  breathing  took  place  only  at  long  intervals ; 
indeed,  for  about  five  hours  death  seemed  to  be  impending.  He  recovered. 
(Lancet,  1870,  ii.  p.  402.)  A  dose  of  one  hundred  and  sixty  grains  was 
given  by  mistake  to  a  middle-aged  man.  He  recovered.  Another  case 
of  recovery  after  a  similar  dose  has  been  reported.  (Brit.  Med.  Jour., 
1878,  ii.  p.  437.)  A  lady  swallowed,  in  the  form  of  syrup,  one  hundred 
and  sixty  grains  of  hydrate  of  chloral  at  eight  o'clock.  About  three  or 
four  hours  afterwards  she  was  seen  in  a  state  of  unconsciousness,  lying  on 
her  back  :  pulse  80,  regular  but  small ;  respirations,  28  per  minute  ;  pupils 
moderately  contracted,  but  not  altogether  insensible  to  light.  She  had 
vomited,  and  a  frothy  mucus  oozed  from  her  mouth.  She  was  tempo- 
rarily roused  by  ammonia.  She  could  not  swallow.  The  stomach-pump 
was  used  and  the  stomach  freely  washed  out.  Coffee  was  given  by  the 
rectum.  Electricity  was  employed  for  an  hour  and  a  half,  when  she 
recovered  her  consciousness,  and  stated  what  she  had  taken.  She 
recovered. 

jS^.  Smith  met  with  two  instances  in  which  sudden  death  followed  ordi- 
nary doses,  and  in  another  case  a  drachm  and  a  half  thrown  into  the 
rectum  produced  in.sensibility  and  death.  (Lancet,  1871,  ii.  p.  4fJ6.)  It 
has  been  observed  in  reference  to  this  drug,  that  during  the  sleep  produced 
by  it  the  pupil  is  contracted,  but  that  it  immediately  dilates  on  the  person 
awaking.  In  other  cases,  the  pupil  has  been  found  dilated  and  insensible 
to  light.  These  facts  show  that  there  is  considerable  uncertainty  in  the 
action  of  this  drug,  even  when  similar  doses  have  been  given.  A  slight 
overdose  may  cause  sudden  death  by  syncope  (Lancet,  1873,  i.  p.  640)  ; 
and  ordinary  doses  long  continued  may  seriously  affect  mind  and  body. 
(Lancet,  1873,  i.  p.  789.)  After  an  ordinary  dose  of  twenty  or  thirty 
grains,  a  patient  has  slept  for  a  quarter  of  an  hour,  and  has  then  awakened 
with  a  sense  of  deadly  faintness,  the  lips  livid,  the  face  pale,  the  pulse 
scarcely  perceptible,  and  a  feeling  of  intense  exhaustion  and  impending 
dissolution,  mingled  with  delirium,  lasting  for  five  or  ten  minutes.  It 
appears  to  exert  a  depressing  action  on  the  heart,  and  in  cases  of  heart 
disease  it  may  thus  cause  sudden  death.  (Lancet,  1871,  ii.  p.  32.)  One 
case  proved  suddenly  fatal  by  causing  paralysis  of  the  heart.  (Lancet, 
1871,  i.  pp.  227,  440,  473.)  In  1889,  a  man  was  convicted  of  murder  by 
hydrate  of  chloral,  which  he  gave  to  his  victim  in  drink.  There  is  no 
doubt  that  the  poison  was  given  to  stupefy  with  a  view  to  robbery,  and 


202        CAMPHOR SYMPTOMS  AND  APPEARANCES. 

that  death  was  not  contemplated.  (Re,^.  v.  Pardon,  Manchester  Ass., 
March,  1889  ;  Lancet,  1889,  i.  p.  598.)  (For  the  effects  of  chronic  poison- 
ing by  this  substance,  see  Lancet,  1873,  i.  p.  695.)  Death  has  ensued  so 
•late  as  ten  and  even  thirty-five  hours  after  administration. 

Fatal  Dose. — It  is  difficult  to  assign  a  minimum  fatal  dose.  A  dose  of 
thirty  grains  proved  fatal  in  thirty-five  hours  to  a  young  lady  aged 
twenty,  while  there  have  been  two  cases  of  recovery  in  which  doses  of 
one  hundred  and  sixty  grains  were  taken,  and  one  in  which  a  man  recov- 
ered after  taking  one  hundred  and  eighty  grains  dissolved  in  syrup. 
(Brit.  Med.  Jour.,  1815,  ii.  p.  T78.)  Kecovery  in  these  cases  was  no 
doubt  greatly  owing  to  treatment.  The  editor  met  with  a  case  in  which 
a  young  man  barely  survived  a  dose  of  seventy  grains ;  he  afterwards 
became  idiotic,  and  never  entirely  recovered.  A  patient  may  die  in  a  few 
minutes,  but  more  commonly  survives  for  a  few  hours. 

Analysis. — The  hydrate  of  chloral  is  a  white,  crystalline  solid,  of  a 
peculiar  lemon-like  odor,  and  has  a  pungent,  bitter  taste.  When  heated  on 
platinum,  it  melts  and  is  entireh^  volatilized  without  combustion.  It  is 
not  inflammable.  Heated  in  a  closed  tube  it  melts  and  does  not  rapidly 
solidify.  It  is  distilled  over  in  a  liquid  form,  and  after  a  time  it  sets  into 
groups  of  crystals  in  the  glass  tube.  It  is  ver}^  soluble  in  water.  The 
solution  is  not  acid,  has  no  bleaching  properties,  and  gives  only  a  faint 
niilkiness  on  boiling  with  a  solution  of  nitrate  of  silver.  It  is  dissolved 
by  strong  sulphuric  and  nitric  acids  without  any  change  of  color.  Potash 
and  ammonia  added  to  the  solution  convert  it  instantly  into  chloroform, 
which  may  be  recognized  by  its  peculiar  odor.  It  is  b}-  this  conversion 
that  hydrate  of  chloral  may^  be  detected  in  the  contents  of  the  stomach. 
One  hundred  parts  will  yield  seventy-two  parts  of  chloroform.  The 
liquid  should  be  rendered  alkaline  with  potash,  and  the  mixture  heated  in 
a  flask  by  a  water-bath.  The  vapor  which  escapes  may  be  tested  for 
chloroform  by  the  process  described  at  p.  200.  Proctor  thus  detected  it  in 
a  case  of  suicidal  poisoning. 

The  quantity  of  hydrate  of  chloral  present  in  a  strong  solution,  e.g.  a 
draught,  may  be  approximately  determined  by  placing  a  measured 
quantity  of  the  solution  in  a  graduated  and  stoppered  burette  and  shak- 
ing with  a  solution  of  soda.  On  allowing  the  mixture  to  stand,  the 
chloroform  formed  by  the  decomposition  of  the  hydrate  of  chloral  will 
form  a  dense  layer  at  the  bottom.  Approximateh^  each  minim  of  chloro- 
form separated  represents  two  grains  of  hydrate  of  chloral.  B}^  adding 
a  solution  of  soda  of  known  strength  to  a  definite  volume  of  a  solution 
of  chloral,  and  when  the  chloral  is  decomposed  titrating  the  uncombined 
soda,  the  percentage  of  hydrate  of  chloral  in  a  dilute  solution  may  be 
determined  with  considerable  accuracy. 

Camphor. 

Symptoms  and  Appearances. — Camphor  operates  on  the  brain  and 
nervous  system.  In  one  case,  a  woman  swallowed  in  the  morning  about 
tiventy  grains  dissolved  in  rectified  spirit  of  wine  and  mixed  with 
tincture  of  myrrh.  In  half  an  hour  she  was  suddenly  seized  with 
languor,  giddiness,  occasional  loss  of  sight,  delirium,  numbness,  tingling 
and  coldness  of  the  extremities,  so  that  she  could  hardly  walk.  The 
pulse  was  quick  and  respiration  difficult ;  but  she  suffered  no  pain  in  any 
part.  On  the  administration  of  an  emetic  she  vomited  a  j^ellowish 
liquid  smelling  strongl)^  of  camphor.  In  the  evening  the  symptoms 
were  much  diminished,  but  she   had   slight  convulsive   fits  during  the 


TOBACCO  — NICOTINE.  203 

night.  The  next  day  she  was  convalescent ;  the  difficulty  of  breathino^, 
however,  continued  more  or  less  for  several  weeks.  This  is  the  smallest 
dose  of  camphor  which  appears  to  have  been  attended  with  serious 
symptoms  in  an  adult.  Camphor  has  proved  fatal  to  infants  and  chil- 
dren, the  symptoms  being  chiefly  vomiting  and  purging,  with  violent 
convulsions. 

A  case  of  poisoning  by  camphor  would  be  recognized  by  the  odor  of 
the  breath,  a  symptom  which  would  attract  the  attention  of  a  non-prol'es- 
sional  person.  The  presence  of  this  substance  in  the  stomach  would  be  at 
ouce  indicated  by  its  odor. 


CHAPTER   XIX. 

TOBACCO       (nICOTIANA      TABACOM).  NICOTINE. COCCULUS      INDIC0S. PICROTOXIN. 

CALABAR     BEAN. MUSHROOMS. 

Tobacco  (Nicotiana  tabacum).     Nicotine. 

Symptoms. — The  effects  Avhich  tobacco  produces,  when  taken  in  a  large 
dose,  either  in  the  form  of  powder  or  infusion,  are  well  marked.  The 
symptoms  are  faintness,  nausea,  vomiting,  giddiness,  delirium,  loss  of 
power  in  the  limbs,  general  relaxation  of  the  muscular  system,  trembling, 
complete  prostration  of  strength,  coldness  of  the  surface,  cold,  clammy 
perspiration,  convulsive  movements,  paralysis,  and  death  In  some  cases 
there  is  purging,  with  violent  pain  in  the  abdomen  ;  in  others  there  is 
rather  a  sense  of  sinking  or  depression  in  the  region  of  the  heart,  passing 
into  syncope,  or  creating  a  feeling  of  impending  dissolution.  With  the 
above-mentioned  symptoms  there  is  dilatation  of  the  pupils  with  insensi- 
bility to  light,  dimness  of  sight  Avith  confusion  of  ideas,  a  small,  weak, 
and  scarcely  perceptible  pulse,  difficulty  of  breathinjr,  and  involuntary 
discharge  of  urine.  Tobacco  owes  its  poisonous  properties  to  the  presence 
of  a  volatile  alkaloid,  nicotine. 

Nicotine. 

This  is  a  liquid  alkaloid,  a  deadly  poison,  and,  like  prussic  acid,  it 
destroys  life  in  small  doses  with  great  rapidity.  It  has  the  powerful  odor 
of  tobacco.  It  is  volatile,  and  may  be  procured  by  distillation.  The 
author  found  that  a  rabbit  was  killed  by  a  single  drop  in  three  minutes 
and  a  half.  (Guy's  Hosp.  Rep.,  1858,  p.  355.)  A  celebrated  case  of 
poisoning  by  this  alkaloid  which  occurred  in  Belgium  in  1851,  was  the 
subject  of  a  trial  for  murder — case  of  the  Count  Bocarme.  (Ann.  d'Hyg., 
1851,  t.  2,  pp.  147,  167.)  In  another,  which  proved  fatal  in  from  three 
to  five  minutes,  the  appearances  observed  were  a  general  relaxation  of  the 
muscles,  prominent  and  staring  eyes,  bloated  features,  great  fulness  with 
lividity  about  the  skin  of  the  neck.  There  \vas  no  odor  resembling  nico- 
tine or  tobacco  perceptible  about  the  body.  When  the  body  was  examined 
between  two  and  three  days  after  death,  putrefaction  had  occurred.  The 
swelling  of  the  neck  was  found  to  arise  from  an  effusion  of  dark  liquid 
blood,  especially  in  the  course  of  the  veins.  The  scalp  and  the  mem- 
branes of  the  brain  were  filled  with  dark-colored  blood.     The  lun2rs  were 


20J:  LEVANT    NUT. 

engorged,  and  of  a  dark  purjile  color.  The  cavities  of  the  heart  were 
empty,  with  the  exception  of  the  left  auricle,  which  contained  two  drachms 
of  dark-colored  blood.  The  stomach  contained  a  chocolate-colored  fluid, 
in  which  nicotine  was  detected:  the  mucous  membrane  was  of  a  dark 
crimson-red  color  from  the  most  intense  congestion.  There  was  no  odor 
excepting  that  of  putrefaction.  The  liver  was  congested  and  of  a  purplish- 
black  color.  The  blood  throughout  the  body  was  black  and  liquid,  but  in 
some  parts  it  had  the  consistency  of  treacle.  (Guy's  Hosp.  Rep.,  1858, 
p.  355.)  The  insidious  nature  of  this  poison  is  proved  by  the  fact  that, 
in  1877,  a  child,  £et.  3,  died  from  using  an  old  wooden  pipe  for  blowing 
soap-bubbles.  It  had  been  used  by  his  father  for  smoking,  but  had  been 
put  by  for  a  year.  He  had  washed  it  before  giving  it  to  his  son.  The 
child  was  quite  well  at  the  time,  but  in  an  hour  he  was  seized  with 
drowsiness  and  sickness,  and  died  with  the  symptoms  of  narcotic  poison- 
ing. The  child  had  imbibed  sufficient  nicotine  from  the  pipe  to  destroy 
life. 

Levant  Nut  (Cocculus  indicus). 

Symptoms  and  Effects. — This  is  the  fruit  or  berry  of  the  Anamirta 
Cocculus  {Levant  Nut),  imported  from  the  East  Indies.  The  berry 
contains  from  one  to  two  per  cent,  of  a  poisonous  bitter  substance 
{Picrotoxin).  The  shell  or  husk  contains  no  picrotoxin,  but  a  non- 
poisonous  principle  called  Menispermin  (see  Fig.  22).  The  seeds,  ia 
powder  or  decoction,  give  rise  to  nausea,  vomiting,  and  griping  pains, 
followed  by  stupor  alid  intoxication.  There  are  only  two  well-authenti- 
cated instances  of  this  substance  having  proved  fatal  to  man. '    Several 

men  suffered  from  this  poison  in   1829, 
Fig.  22.  near  Liverpool :  each  had  a  glass  of  rum 

strongly  impregnated  with  Cocculus  in- 
dicus. One  died  that  evening;  the  rest 
recovered.  (Traill's  Outlines,  146.)  Of 
the  second  case,  the  following  details 
have  been  published:  A  boy,  set.  12, 
a,  Berrv  of  Cocculus  Indicus,  natural  size,  was  persuaded  by  his  Companions  to 
*' ^^Vr&muiunaTke^nei!''*'' "'"'^^^'^     swallow  forty  grains   of   a  composition 

c,  The  kernel,  containing  picrotoxin.  UScd    for     poisoning     fish.       It    Contained 

Cocculus  indicus.  In  a  few  minutes  he 
perceived  an  unpleasant  taste  with  burning  pain  in  the  gullet  and  stomach, 
not  relieved  by  frequent  vomiting — as  well  as  pain  extending  over  the 
whole  of  the  abdomen.  In  spite  of  treatment,  a  violent  attack  of  gastro- 
enteritis supervened,  and  there  was  much  febrile  excitement,  followed  by 
delirium  and  purging,  under  which  the  patient  sank  on  the  nineteenth 
day  after  taking  the  poison.  On  inspection,  the  vessels  of  the  pia  mater 
were  congested  with  dark-colored  liquid  blood.  There  was  serous  effusion 
in  the  ventricles  of  the  brain,  and  the  right  lung  was  congested  In  the 
abdomen  there  were  all  the  marks  of  advanced  peritonitis.  The  stomach 
was  discolored,  and  its  coats  were  thinner  and  softer  thau  natural. 
(Canstatt's  Jahresbericht,  1844,  5,  298.)  Porter,  ale,  and  beer  owe  their 
intoxicating  properties  in  some  instances  to  a  decoction,  or  extract,  of 
these  berries.  (For  some  remarks  on  this  adulteration  of  beer  and  other 
liquids,  and  a  process  for  separating  the  poisonous  principle,  picrotoxin, 
by  amylic  alcohol,  see  Chem.  News,  March,  1864,  p.  123.)  [The  late 
Dr.  Fish,  of  Philadelphia,  reported  several  cases  of  accidental  poisoning 
by  this  sub.stance  occurring  or  treated  in  the  Philadelphia  Hospital.  Some 
of  them  proved  fatal  in  half  an  hour,  the  patient  dying  in  convulsions: 


CALABAR    BEAN,  205 

Wharton  &  Still^,  Med.  Jur.,  1873,  vol.  2,  p.  596  ]  Cocculus  inclicus 
operates  readily  as  a  poison  on  animals,  and  it  has  thus  been  frequently 
used  for  the  malicious  destruction  of  fish  and  game.  In  one  in:?tance 
referred  to  the  author,  there  was  reason  to  believe  that  270  young-  pheas- 
ants had  been  poisoned  by  grain  soaked  in  a  decoction  of  this  substance. 
Barber's  poisoried  wheat  for  the  destruction  of  birds  owes  its  poisonous 
properties  to  Cocculus  indicus.     (See  On  Poisons,  3d  edit.,  p.  679.) 

Calabar  Bean  (Physostigma  yenenosum). 

The  Calabar  bean  is  a  large  leguminous  seed  of  a  dark  color,  resembling 
a  garden  bean,  but  much  thicker  and  more  rounded  in  its  form.  It  is 
brought  from  the  western  coast  of  Africa,  and  is  there  employed  by  the 
natives  as  an  ordeal  bean  when  persons  are  suspected  of  witchcraft.  The 
bean  owes  its  properties  to  the  presence  of  an  alkaloid  called  rhysostig- 
mine,  or  Eserine,  which  is  used  in  surgery  for  contracting  the  pupils  of 
the  eye. 

Desiring  to  try  the  effects  of  this  seed  on  himself,  Christison  took  the 
eighth  part  of  a  seed,  or  six  grains,  one  night  before  going  to  bed.  There 
was  slight  sense  of  numbness  of  the  limbs  during  the  night,  but  in  the 
morning  no  urgent  symptoms  of  any  kind.  He  then  chewed  and 
swallowed  the  fourth  part  of  a  bean  (twelve  grains).  In  twenty  minutes 
he  was  seized  with  giddiness  and  a  general  feeling  of  torpor  over  the 
whole  frame.  He  immediately  swallowed  an  emetic,  and  thus  emptied 
the  stomach  The  giddiness,  weakness,  and  faintness  increased  to  such  a 
degree  that  he  was  obliged  to  lie  down  in  bed.  In  this  state  he  was  seen 
by  two  medical  friends,  who  found  him  prostrate  and  pale,  the  heart  and 
pulse  extremely  feeble  and  tumultuously  irregular,  the  mental  faculties 
intact,  with  extreme  faintness  threatening  dissolution,  but  no  apprehension 
of  death  on  the  part  of  the  patient.  There  was  no  uneasy  feeling  of  any 
kind,  no  pains  or  numbness,  no  prickling,  nor  even  any  sen.se  of  suffering 
from  the  great  feebleness  of  the  heart's  action.  There  was  the  will,  but 
not  the  povYcr  to  vomit ;  and  the  limbs  became  chill,  with  a  vague  feeling 
of  discomfort.  Stimulants  Avere  employed :  and  warmth  and  pulsation, 
with  a  power  of  moving,  gradually  returned.  Two  hours  after  the  poison 
had  been  taken  he  felt  drowsy,  and  slept  for  two  hours  more ;  but  with 
such  activity  of  mind  that  he  had  no  consciousness  of  having  been  asleep. 
The  tumultuous  action  of  the  heart  continued.  After  this  the  symptoms 
gradually  disappeared,  and  the  next  dav  he  was  quite  well.  (Pharm.  Jour., 
i855,  p.  474.) 

In  1864,  fifty  children  were  poisoned  at  Liverpool  by  reason  of  their 
having  eaten  these  beans.  The  sweepings  of  a  ship  from  the  west  coast 
of  Africa  had  been  thrown  on  a  heap  of  rubbish  ;  the  children  found  the 
beans  and  ate  them.  A  boy,  aet.  6,  who  ate  six  beans,  died  in  a  very 
short  time.  The  principal  symptoms  were  severe  griping  pains,  constant 
vomiting,  and  contracted  pupils.  In  addition  to  these  symptoms,  the 
face  was  pale  and  the  eyes  were  bright  and  protruding.  In  attempting 
to  walk  the  children  staggered  about  as  if  they  were  drunk.  In  1864, 
two  children,  aged  six  and  three  years  respectively,  ate  the  broken  frag- 
ments of  the  kernel  of  one  nut.  In  about  forty  minutes  they  complained 
of  sickness.  One  child  held  his  head  drooping,  appeared  sleepy,  and  his 
hands  were  powerless.  He  staggered  and  was  scarcely  able  to  walk.  He 
complained  of  severe  pain  in  the  stomach,  and  made  ineffectual  attempts 
to  vomit.  Milk  was  given,  and  he  then  vomited.  The  child  became  quite 
prostrated ;  the  pulse  was  feeble  and  slow,  and  the  pupils  were  slightly 


206  POISONOUS    FUNGI. 

contracted.  Some  pieces  of  the  nut  were  rejected  by  vomiting.  The 
other  child  had  pain  in  the  abdomen,  and  was  listlesss,  sleepy,  and  de- 
pressed. He  vomited  freely,  some  portions  of  nut  being  ejected.  He 
could  neither  stand  nor  walk.  His  face  was  pale,  the  eyes  were  piercing, 
but  the  pupils  and  pulse  were  natural.  In  this  case  there  was  .purging. 
The  children  recovered  on  the  third  day.  (Edin.  Month.  Jour.,  1864,  p. 
193.)  In  cases  in  which  it  has  proved  fatal  to  animals  it  has  caused  much 
irritation  and  congestion  of  the  stomach  and  bowels.  (DragendorfF. ) 
Frasei'  relates  the  case  of  two  maid-servants  who  were  poisoned  by  tasting 
through  curiosity  some  of  the  embryos  of  the  bean.  (Edin.  Med.  Jour., 
1863,  2,  p.  131.)' 

The  editor  has  himself  noticed  a  very  marked  diminution  of  respiratory 
depth  from  the  hypodermic  use  of  the  salts  of  physostigmine  (eserine), 
the  active  alkaloid  of  the  bean.  The  very  contracted  pupil  of  the  eye  is 
a  characteristic  of  poisoning  by  this  alkaloid. 

Poisonous  Mushrooms  (Fungi). 

No  branch  of  toxicology  has  given  rise  to  greater  differences  of  opinion 
than  the  study  of  poisoning  by  fungi.  Some  authors  have  considered 
nearly  every  kind  of  mushroom  as  unfit  for  food  ;  whilst  others,  again, 
seem  to  regard  nearly  every  species  as  edible  with  safety.  In  inquiring 
into  the  causes  of  these  discrepancies  of  opinion,  it  will  be  found  that 
whilst  some  species  of  fungi  are  undoubtedly  to  be  regarded  as  poisonous, 
since  they  contain  an  integral  poisonous  constituent  or  constituents  which 
may  be  isolated  in  a  greater  or  less  state  of  purity,  others  produce  injuri- 
ous effects  only  under  certain  conditions,  such  as  idiosyncrasy  of  the  indi- 
vidual, decomposition  of  the  fungus,  etc.  The  morel  and  Hevella  escidenta 
are  highly  esteemed  kinds  of  mushrooms,  and  yet  Keber  relates  the  history 
of  six  persons  who,  after  partaking  of  these  fungi,  were  attacked  with 
vomiting  and  diarrhoea  which  lasted  for  sixty  hours.  (PreussischeYerein- 
zeitung,  1846,  No.  32.  See  also  Arch,  f."  Exp.  Path.  v.  Pharm.,  1885, 
xix.  p.  403;  Med.  Ciiron.,  iii.  p.  219.)  Poisonings  by  the  common  edible 
mushroom  (Agariciis  campestris)  are  rare,  except  when  the  mushrooms 
are  decayed. 

Symptoms  and  Effects. — The  noxious  species  of  mushrooms  act  some- 
times as  narcotics,  and  on  other  occasions  as  irritants.  It  would  appear 
from  the  reports  of  several  cases  that  when  the  narcotic  sjanptoms  are 
excited  they  come  on  soon  after  the  meal  at  which  the  mushrooms  have 
been  eaten,  and  they  are  chiefly  manifested  by  drowsiness,  giddiness,  dim- 
ness of  sight,  and  debility.  The  person  appears  as  if  intoxicated,  and 
there  are  sometimes  singular  illusions  of  sense.  The  pupils  are  dilated. 
Spasms  and  convulsions  have  been  occasionally  witnessed  among  the 
symptoms,  chiefly  in  fatal  cases.  In  some  instances  these  have  been  of  a 
tetanic  character,  with  great  difficulty  of  breathing.  (Brit.  Med.  Jour., 
ii.  1874,  p.  464  )  When  the  drowsiness  passes  off,  there  is  generally 
nausea  and  vomiting;  but  sometimes  vomiting  and  purging  precede  the 
stupor.  If  the  s3'mptoras  do  not  occur  until  many  hours  after  the  meal, 
they  partake  more  of  the  characters  of  irritation,  indicated  by  pain  and 
swelling  of  the  abdomen,  vomiting,  and  purging.  In  a  case  of  poisoning 
by  mushrooms,  there  was  slight  vomiting  about  an  hour  and  a  half  after 
the  meal,  but  no  violent  symptoms  until  after  the  lapse  of  ten  hours. 
Several  cases  in  which  the  symptoms  did  not  appear  for  fourteen  hours 
are  reported.  (Med.  Gaz  ,  vol.  25,  p.  110.)  In  some  instances  the  symp- 
toms of  poisoning  have  not  commenced  until  thirty  hours  after  the  meal ; 


POISONOUS    FUNGI.  207 

and  in  these,  narcotism  followed  the  pymptonis  of  irritation.  It  might  be 
supposed  that  these  variable  effects  were  due  to  different  properties  in  the 
mushrooms ;  but  the  same  i'ungi  have  acted  on  members  of  the  same 
family,  in  one  case  like  irritants,  and  in  another  like  narcotics.  In  most 
cases  recovery  takes  place,  especially  if  there  is  early  vomiting.  In  the 
instances  which  have  proved  fatal  there  has  been  greater  or  less  inflamma- 
tion of  the  stomach  and  bowels,  with  congestion  of  the  vessels  of  the 
brain.  (Med.  Gaz.,  vol.  46,  p.  307;  vol.  47,  p.  673;  and  Jour,  de  Chim. 
M4A:,  1853,  p.  694.) 

In  the  Guy's  Hosp.  Rep.,  1865,  p.  382,  are  recorded  two  fatal  cases — 
in  a  mother  and  daughter,  who  died  from  the  effects  of  the  Amanita  citrina, 
a  yellow-colored  fungus,  gathered  in  mistake  for  mushrooms.  The  woman 
fried  the  fungi,  and  they  were  eaten  for  supper.  No  symptoms  appeared 
for  seven  hours.  The  child,  when  seen  by  a  medical  man,  was  feverish 
and  thirsty  and  the  pupils  were  strongly  dilated.  There  was  severe  pain 
in  the  stomach  and  a  sense  of  constriction  in  the  throat.  It  became  con- 
vulsed and  insensible  and  died  forty-one  hours  after  eating  the  fungi. 
The  mother  and  another  child  suffered  from  similar  symptoms;  the  mother 
partially  recovered,  but  had  a  relapse  and  died  on  the  fifth  day.  No  in- 
spection of  the  bodies  was  made. 

One  fatal  case  of  poisoning  by  fungi  was  attended  with  symptoms  of 
irritation  resembling  those  caused  by  arsenic.  There  was  no  loss  of  con- 
sciousness or  sensibility.  A  boy,  set.  13,  fried  and  ate  for  breakfast  at 
8.30  A.M.  two  fungi  which  he  had  found  growing  under  a  tree.  He 
returned  to  his  work  without  any  complaint.  At  noon  he  had  his  dinner 
of  pork  and  vegetables.  At  1  P.M.  he  returned  to  work,  where  he 
remained  until  6  P.M.,  working  the  whole  time  without  any  complaint. 
Soon  after  he  reached  home  he  complained  of  feeling  ill,  and  vomited 
violently.  Purging  then  followed,  with  severe  spasmodic  pain  in  the 
abdomen.  These  symptoms  continued  throughout  the  night  until  6  A.M.; 
the  bowels  then  ceased  to  act.  At  11.30  A.M.  he  was  suffering  from  con- 
stant pain  in  the  bowels,  occasionally  aggravated ;  there  was  tenderness 
over  the  abdomen  generally,  but  especially  over  the  course  of  the  trans- 
verse colon,  with  vomiting  every  ten  minutes,  great  thirst,  warm,  per- 
spiring skin,  pulse  90,  and  great  depression.  At  3  A.M.  on  the  second  day 
he  was  again  seen.  Vomiting  and  purging  had  returned.  There  was 
great  exhaustion,  the  pulse  was  imperceptible,  the  action  of  the  heart 
feeble.  He  was  lying  in  bed  on  his  back,  with  his  knees  drawn  up. 
Sensibility  and  consciousness  were  perfect.  He  complained  of  great  pain 
in  the  stomach ;  there  was  tenderness  over  the  abdomen,  but  no  increase 
in  size.  In  another  hour  he  died,  i.  e.  about  forty-four  hours  after  eating 
the  fungi,  and  about  thirty-four  after  the  first  setting  in  of  the  symptoms. 
Others  partook  of  the  fungi,  but  in  small  quantit}^  and  they  did  not  suffer. 
On  inspection,  the  heart  on  the  right  side  contained  a  little  fluid  blood. 
The  left  ventricle  was  contracted  and  empty.  The  lungs  were  healthy 
and  there  was  only  cadaveric  congestion.  The  lining  membrane  of  the 
stomach  and  small  intestines  was  throughout  injected ;  the  bluish-red  ap- 
pearance diminishing  in  intensity  as  it  approached  the  caecum.  There 
were  a  few  ecchymosed  patches  near  the  intestinal  end  of  the  stomach. 
The  organ  contained  six  ounces  of  a  brownish  liquid  resembling  thick 
gruel.  The  large  intestines  were  empty  and  pale,  and  the  spleen  was  con- 
gested ;  the  other  organs  were  healthy.  (Med.  Times  and  Gaz.,  1863,  2, 
p.  536.)  In  many  of  its  features,  and  in  the  absence  of  narcotic  symp- 
toms, this -case  resembled  a  case  of  acute  poisoning  by  arsenic;  the  fact 
that  nearly  ten  hours  elapsed  before  the  symptoms  of  irritation  com- 


208  POISONOUS    FUNGI THEIR    EFFECTS. 

nienced,  and  that  there  was  no  blood  in  the  matters  discharged  by  vomit- 
ing and  purging,  were  the  most  marked  dilierences. 

In  1871,  two  children  died  from  the  efil'ects  produced  by  noxious  fungi. 
Several  other  persons  were  placed  in  a  precarious  condition  from  the  same 
cause.  Some  fowls  died  Jrom  eating  portions  of  the  mushrooms.  Two 
children,  a  boy,  ast.  8,  and  a  girl,  ast.  10,  cooked  some  mushrooms  for 
breakfast.  The  boy  ate  greedily  of  them,  but  permitted  the  girl  to  take 
only  one  mushroom.  The  symptoms  produced  in  both  children  were 
similar,  except  that  the  boy  had  them  in  a  severer  and  fatal  form,  and  the 
girl  recovered.  Three  or  four  hours  after  the  meal  the  girl  was  seized 
Avith  violent  pains  in  the  head  and  abdon)en  ;  she  vomited  several  times 
in  the  course* of  the  day,  was  restless,  thirsty,  and  had  occasional  muscu- 
lar twitchings  of  the  hands.  During  the  night  the  symptoms  increased  in 
severity,  and  she  slept  but  little.  Next  day  there  was  slight  diarrhoea. 
AVhen  admitted  into  hospital,  fifty-four  hours  after  the  mushrooms  were 
eaten,  all  her  s^niiptoms  had  nearly  subsided.  The  boy  was  then  collapsed, 
and  died  twenty  minutes  afterwards.  His  stomach  was  found  empty  and 
contracted  ;  its  mucous  coat  pink,  with  minute  injection,  and  coverecl  with 
a  thick  layer  of  dryish  epithelium,  The  liver  was  f^tty.  (Guy's  Hosp. 
Rep.,  1872,  p.  228.)  Cases  of  poisoning  by  fungi  are  reported  in  Huse- 
mann's  Jahresbericht,  1872,  p.  534.  A  case  in  which  a  woman  died  in- 
twenty  hours  from  eating  ordinary  mushrooms  was  comTnunicated  to  the 
author  by  Smith,  of  Shepton  Mallet,  in  Aug.  1873.  The  symptoms  re- 
sembled those  already  described. 

A  man,  aet.  43,  and  his  daughter,  set.  5,  suffered  severely  from  eating 
the  Amanita  paviheriva.  The  earliest  symptoms  appeared  in  two  hours 
and  a  half  after  the  meal.  They  were  thirst,  faintness,  delirium,  nausea, 
paleness  of  the  face,  and  cold  extremities.  After  eleven  hours  there  was 
stupor,  with  tenderness  of  the  abdomen.  In  the  child  there  was  cyanosis 
of  the  legs,  with  contracted  pupils.  It  was  remarked  that  even  fourteen 
hours  after  the  fungi  had  been  eaten  portions  of  them  were  discharged  by 
vomiting  from  the  action  of  emetics.  Both  recovered.  An  analysis  of 
cases  of  mushroom-poisoning  shows  that  when  the  symptoms  are  referable 
to  the  presumably  decayed  state  of  the  fungi,  these  produce  violent  gastro- 
intestinal symptoms  ;  and  that,  as  a  rule,  ther^e  symptoms  appear  only  after 
the  lapse  of  some  hours,  and  then  the  course  of  the  case  is  not  unlike  one  of 
cholera.  The  flv-fungus  {Amamta  muscaria)  contains  a  definite  alkaloid 
{Muscarine),  and  when  this  fungus  is  eaten,  generally  in  mistake  for  the 
golden  mushroom  {Amanita  Csesarea),  the  symptoms  appear  within  half  an 
hour  or  an  hour,  though  occasionally  at  a  much  later  period  ;  and  they  are 
of  a  cerebral  character — the  gastro-intestinal  s3'mptoms  being  either  only 
secondary  or  altogether  absent.  Thus  there  is  a  state  of  excitement  and  in- 
eljriation,  trismus,  etc.  Ponfick  has  made  the  extraordinary  statement  that 
an  infusion  of  the  ordinary  mushroom  is  poisonous.  This  is  contrary  to 
common  experience  ;  and  the  children  of  rural  districts  often  eat  with  im- 
punity large  quantities  of  uncooked  mushrooms. 

Poisoning  with  mushrooms  is  usually  the  result  of  accident  or  mistake. 
They  are  not  taken  for  the  purpose  of  suicide,  and  the  author  met  with 
only  one  instance  in  which  it  was  alleged  they  were  intentionally  given 
to  destroy  life.  In  Aug.  1873,  a  gardener  in  the  metropolitan  district  was 
committed  on  a  charge  of  murder  for  causing  the  death  of  a  young  woman 
by  giving  her  poisonous  mushrooms.  The  accused,  it  was  alleged,  had  a  mo- 
tive for  the  act,  but  he  denied  tha*  he  knew  the  mushrooms  to  be  poison- 
ous.    The  deceased  fried  them,  ana  had  some  for  breakfast.     She  suflered 


POISONING    WITH    HENBANE.  209 

severe  pain,  and  died  the  same  evening.  Other  persons  who  partook  of 
them  were  also  taken  ill,  but  recovered. 

This  form  of  homicide  would  be  very  difficult  to  establish.  It  would  be 
necessary  to  show  that  the  mushrooms  were  really  poisonous,  and  to  the 
knowledge  of  the  accused.  None  might  be  forthcoming,  so  that  there 
would  be  no  botanical  evidence  of  their  poisonous  nature.  But  as  persons 
have  died  from  taking  edible  mushrooms,  it  might  be  alleged  that  there 
was  nothing  criminal  in  the  act,  and  that  the  death  was  owing  to  idiosyn- 
crasy. 

Ai^ah/sis. — The  discovery  of  portions  of  the  undigested  mushrooms  in 
the  matter  vomited,  or  a  description  of  the  food  eaten  or  in  the  stomach 
after  death,  will  commonly  lead  to  a  recognition  of  this  form  of  poisoning. 
One  of  the  most  poisonous  fungi,  Amanita  muscaria,  or  the  fly-mush- 
room, renders  the  water  in  which  it  has  been  boiled  so  poisonous  that 
animals  are  killed  by  it,  while  the  boiled  fungus  is  itself  inert.  The  liquid 
procured  from  it  is  used  as  a  fly-poison,  whence  the  name  of  the  fungus. 
It  is  an  autumnal  fungus,  of  a  rich  orange-red  color,  and  owes  its  deadly 
properties  to  an  alkaloid  {Muscarine). 

Much  has  been  said  and  written  on  the  methods  of  distinguishing  the 
edible  from  the  noxious  fungi,  but  instances  have  occurred  in  which  the 
former  have  produced  .symptoms  of  poisoning  and  have  destroyed  life. 

These  fungi  can  be  recognized  only  by  their  special  botanical  characters. 
Berkeley  says,  "No  general  rule  can  be  given  for  the  determination  of  the 
question  whether  fungi  are  or  are  not  poisonous.  Color  is  quite  inde- 
cisive, and  some  of  the  most  dangerous  fungi,  and  amongst  them  the 
Agaricus  phalloides,  are  void  of  any  unpleasant  smell  when  fresh,  though 
the  most  wholesome  may  be  extremely  offensive  when  old.  Experience 
is  the  only  safe  test,  and  no  one  should  try  species  incautiously  with 
whose  character  he  is  not  thoroughly  acquainted." 


CHAPTER    XX. 

HENBANE ATROPA    BELLADONNA,    OK    DEADLY    NIGHTSHADE. — POISONING    BY    ATROPINE. 

DATUKA    STKAMONIU.M,    OR    THORN-APPLE. 

Henbane  (Hyoscyamus  niger). 

Symptoms  a7id  Appearances. — The  seeds  (Fig.  23),  roots,  and  leaves 
of  this  plant  are  poisonous.  When  the  dose  is  not  sufficient  to  destroy 
life,  the  symptoms  are — general  excitement,  fulness  of  the  pulse,  flushing 
of  the  face,  weight  in  the  head,  giddiness,  loss  of  power  and  tremulous 
motion  of  the  limbs,  somnolency,  dilatation  of  the  pupils,  double  vision, 
nausea,  and  vomiting.  After  a  time  these  symptoms  pass  off",  leaving  the 
patient  merely  languid.  When  a  large  quantity  of  the  root  or  leaves  has 
been  eaten — an  accident  which  has  occurred  from  the  plant  having  been 
mistaken  for  other  vegetables — more  serious  effects  are  manifested.  In 
addition  to  the  above  symptoms  in  an  aggravated  form,  there  will  be  loss 
or  incoherency  of  speech,  delirium,  confusion  of  thought,  insensibility, 
coma,  and,  sometimes,  a  state  resembling  insanity ;  the  pupils  are  dilated 
and  insensible  to  light ;  there  is  coldness  of  the  surface,  cold  perspiration, 
loss  of  power  in  the  legs,  alternating  with  tetanic  rigidity,  and  convulsive 
14 


210  POISONING    AVITH    BELLADONNA SYMPTOMS. 

Fig.  23.  movements  of  the  muscles  ;  the  pulse  is  small,  frequent, 

and  irregular,  the  respiration  deep  and  laborious.     (Med. 

G-az.,  vol.  47,  p.  641.)     Occasionally  there  is  nausea,  with 

vomiting-  and  purging.     Death  may  take  place  in  a  few 

hours  or  days,  according  to  the  severity  of  the  symptoms. 

The  special  effect  of  this  poisonous  plant  is  manifested  in 

its  tendency  to  produce  a  general  paralysis  of  the  nervous 

system.    According  to  White,  the  biennial  is  more  powerful 

than  the  annual  plant.     He  reports  the  case  of  a  woman, 

«-  ffit  34,  who  swallowed,  by  mistake  for  a  black  draught,  an 

^  "^    f  ounce  and  a  half  of  tincture  of  hyoscyamus.      Symptoms 

®  came  on  in  ten  minutes,  the  most  marked  among  them  being 

Seeds  of  Henbane.  i    ^      i  r  ^  1.1  •  -i  -i-x  j 

a,  i\atiua!  size,     a  complete  loss  of  powcr  to  move  her  legs  ;  msensibihty  and 
^, Magnified 30     delirium  followed:  and  it  was  six  davs  before  she  began  to 

diameters.  .      t      1  ''  t  -m     r,,r.    •• 

recover.  She  entirely  lost  her  memory.  Lancet,  1873,  ii. 
p.  8.)  The  recent  researches,  however,  of  Gerrard  show  that  the  yield  of 
alkaloids  in  the  biennial  does  not  greatly  differ  from  that  of  the  annual 
plant.     (Year  Bk.  of  Fharm.,  1890,  p.  347.) 

The  poisonous  properties  of  henbane  are  due  to  the  presence  of  two  alkar 
loids  {Hyoi^cyamine  and  Hyoscine).  These,  with  atropine,  the  active  alka- 
loid of  belladonna,  are  perhaps  the  only  three  known  natural  vegetable 
alkaloids  that  cause  excessive  dilatation  of  the  pupil  of  the  eye. 

Deadly  Nightshade  (Atropa  belladonna).     Atropine. 

Sj/mptomif. — The  symptoms  which  are  produced  by  the  leaves,  berries, 
seeds,  and  root  of  belladonna  are  of  a  uniform  charactei',  and,  as  a  sum- 
mary, they  may  be  thus  described  :  Heat  and  dryness  of  the  mouth  and 
throat,  nausea,  vomiting,  giddiness,  indistinct  or  double  vision,  delirium, 
great  excitement,  and  convulsions  followed  by  stupor  and  lethargy.  The 
pupils  are  much  dilated,  and  the  eyes  are  insensible  to  light.  In  two 
cases  Avhich  occurred  to  Tiifnell,  the  pupils  were  contracted  during  sleep, 
although  dilated  in  the  waking  state.  (Dublin  Med.  Press,  Jan.  5,  1853  ; 
Jour,  de  Chim.  Med.,  1853,  p.  695.)  A  woman  took  by  mistake  an  ounce 
of  belladonna  liniment  instead  of  her  medicine,  and  in  about  twenty  min- 
utes had  passed  into  a  state  of  insensibility.  Copious  draughts  of  mustard 
and  water,  and  salt  and  water,  were  administered  without  provoking  vom- 
iting. She  was  in  a  state  of  coma ;  the  extremities  were  warm  ;  the  abdo- 
men was  slightly  hard  ;  breathing  was  regular ;  pulse  70,  fairly  good. 
There  was  inability  to  swallow  ;  the  pupils  were  natural,  but  not  sensitive 
to  strong  light.  Three  hours  later  her  condition  was  not  much  changed  : 
the  coma  was  not  so  complete ;  there  was  some  struggling,  incontinence 
of  urine,  and  the  pupils  unaltered.  One-fourth  of  a  grain  of  morphine  was 
injected  subcutaneously.  Eight  hours  later,  coma  had  passed  off",  and  was 
succeeded  by  delirium.  Jerking  of  the  tendons  was  present;  she  could 
swallow  freely.  The  next  day  all  the  symptoms  had  disappeared,  except- 
ing some  dryness  of  the  mouth  and  throat.  It  is  noticeable  that  through- 
out the  pupils  were  unaffected.     (Brit.  Med.  Jour.,  1884,  i.  p.  377.) 

Several  deaths  from  the  poisonous  effects  of  the  berries  occurred  in  1846. 
The  following  case  was  admitted  into  Guy's  Hospital :  A  boy,  aet.  14,  ate, 
soon  after  breakfast,  about  thirty  belladonna  berries.  In  about  three  hours 
he  had  the  sensation  of  his  face  being  swollen  ;  the  throat  became  hot  and 
dry,  the  vision  was  impaired,  objects  appeared  double,  and  they  seemed  to 
revolve  and  run  backwards.  His  hands  and  face  were  flushed,  and  the 
eyelids  swollen  ;  there  were  occasional  flashes  of  light  before  his  eyes.    He 


BELLADONNA SYxMPTOMS.  211 

tried  to  eat,  but  could  not  swallow  on  account  of  the  slate  of  his  throat. 
In  endeavoring  to  walk  home  he  stumbled  and  staggered;  and  he  felt 
giddy  whenever  he  attempted  to  raise  his  head.    His  parents  thought  him 
intoxicated  ;  he  was  incoherent,  frequently  counted  his  money,  and  did 
not  know  the  silver  from  the  copper  coins.     His  eyes  had  a  fixed,  bril- 
liant, and  dazzling  gaze;  he  could  neither  hear  nor  speak  plainly,  and 
there  was  great  thirst ;  he  caught  at  imaginary  objects  in  the  air,  and 
seemed  to  have  lost  all  knowledge  of  distance.     His  fingers  were  in  con- 
stant motion  ;   there  was  headache,   but  neither  vomiting  nor  purging. 
He  did  not  reach  the  hospital  until  nine  hours  had  elapsed,  when  the 
symptoms  were  much  the  same  as  those  above  described.     He  attempted 
to  get  out  of  bed  with  a  reeling,  drunken  motion  ;  his  speech  was  thick 
and  indistinct.     The  pupils  were  so  strongly  dilated  that  there  was  merelv 
a  ring  of  iris  visible,  and  the  ey^s  were  quite  insensible  to  light.     The  eye- 
lids did  not  close  when  the  hand  was  passed  suddenl^^  before  them.     He 
had  evidently  lost  the  power  of  vision,  although   he  stared  fixedly  at  ob- 
jects as  if  he  saw  them.     The  nerves  of  common  sensation  were  unaffected. 
When  placed  on  his  legs  he  could  not  stand.     The  pulse  was  90,  feeble  and 
compressible  ;  the  mouth  was  in  constant  motion,  as  if  he  were  eating  some- 
thing.    His  bladder  was  full  of  urine  on  admission.     He  continued  in  this 
state  for  two  days,  being  occasionally  conscious,  when  by  a  free  evacua- 
tion of  the  bowels  some  small  seeds  were  passed  ;  these  were  examined 
and  identified  as  the  seeds  of  belladonna.     The  boy  gradually  recovered, 
and  left  the  hospital  on  the  sixth  day  after  his  admission.     The  progress 
of  recovery  was  indicated  by  the  state  of  the  pupils,  which  had  only  then 
acquired  their  natural  size  and  power  of  contraction.     In  three  other  cases 
which  occurred  at  the  same  time,  the  berries  having  been  baked  in  a  pie, 
pains  in  the  limbs,  drowsiness,  insensibility,  and  convulsions  were  among 
the  symptoms.     In  two  instances  of  poisoning  by  the  berries,  related  by 
Moll,  the  symptoms  bore  a  strong  resemblance  to  those  of  delirium  tre- 
mens, but  among  them  were  some  peculiar  to  the  action  of  belladonna, 
namely,  'heat  and  dryness  of  the  throat,  loss  of  power  of  swallowing,  inco- 
herent speech,  double  vision,  and  strange  spectral  illusions,  with  occasional 
fits  of  wild  and  ungovernable  laughter.     On  the  following  morning  both 
these  patients  recovered  51s  if  from  a  dream  ;  but  they  suffered  for  some 
time  from  languor,  thirst,  and  dryness  of  the  throat,  and  the  pupils  also 
continued  dilated.     (Casper's  Wochenschrift,  1846,  p.  26.)     Two  cases, 
showing  the  poisonous  effects  of  the  berries  on  children,  are  quoted  in  the 
Edin.  Med.  and  Surg.  Jour.,  vol.  29,  p.  452.     The  following  case,  which 
occurred  in  Nov.  1871,  is  remarkable  lor  the  fact  that  a  woman  recovered 
from  a  large  dose  of  the  extract.     A  nurse  gave  by  mistake  to  a  lady  whom 
she  was  attending  a  belladonna  liniment  containing  three  drachms  of  the 
extract  mixed  with  soap  liniment.     She  vomited  slightly,  suffered  from 
dryness  of  the  throat,  difficulty  of  swallowing,  drowsiness,  delirium,  dilated 
pupils,  fixed  staring  of  the  eyes,  loss  of  power,  and  difficulty  of  speech. 
Paralysis  of  the  extremities  came  on,  with  great  pain  in  the  back.    Emetics, 
with  brandy  and  cayenne  pepper,  were  employed  with  success.    The  woman 
recovered,  but  not  until  after  five  weeks  from  the  time  of  swallowing  the 
liniment.     A  child,  nearly  four  years  old,  swallowed  only  two  or  three 
drops  of  a  liniment  containing  belladonna.    The  child  went  to  sleep  for  an 
hour,  v/hen  it  was  seized  with  tremblings  and  convulsions,  dilated  pupils, 
delirium,  and  other  symptoms  of  belladonna-poisoning.     It  recovered  only 
after  three  days,  this  being  indicated  among  other  signs  by  the  normal 
state  of  the  pupils.     (Guy's  Hosp.  Gaz.,  June,  1878.)     In  another  case, 
in  which  a  lady  swallowed  four  o.unces  of  belladonna  liniment,  in  addition 


212  BELLADONNA APPEARANCES    AND    ANALYSIS. 

to  the  usual  symptoms  speech  was  lost.  There  was  complete  paralysis  of 
the  legs,  and  a  difluset!  scarlet  rash  appeared  on  the  neck  and  the  upper 
part  of  the  chest.  She  fell  into  a  state  of  deep  sleep,  and,  on  her  recovery 
in  three  or  four  days,  her  life  appeared  to  be  a  complete  blank.  (Brit.  Med. 
Jour.,  18T6,  ii.  p.  678.)     Such  cases  are  common. 

This  poison  readily  acts  through  the  unbroken  skin.  In  one  case  equal 
parts  of  mercurial  ointment  and  extract  of  belladonna  were  applied  to  the 
scrotum  of  a  man.  On  the  second  day  all  the  symptoms  of  poisoning 
came  on,  with  flushed  face  and  pupils  dilated  and  insensible  to  light.  (Brit. 
Med.  Jour.,  1877,  i.  p.  164.)  The  editor  has  seen  severe  cases  of  poison- 
\n<r  resulting  from  the  application  of  atropine  ointment  to  ulcers. 

Appearances. — The  appearances  observed  in  several  fatal  cases  of  poi- 
soning with  the  berries  were  as  follows :  the  vessels  of  the  brain  were 
congested  with  liquid  blood  ;  the  stomach  and  intestines  were  pale  and 
flaccid;  there  were  some  red  spots  towards  the  cardiac  end.  In  other 
fatal  cases,  of  which  the  appearances  have  been  reported,  the  vessels  of  the 
brain  and  its  membranes  were  found  distended  with  thick  black  blood. 
Red  spots  have  also  been  observed  around  the  throat  and  gullet,  and  con- 
gested patches  of  a  dark  purple  color  on  the  coats  of  the  stomach.  In 
some  instances  the  mucous  membrane  has  been  completely  dyed  by  the 
juice  of  the  Ijerries.  A  boy,  set.  5,  after  having  eaten  a  quantity  of  bella- 
donna berries,  went  to  bed,  was  very  restless,  vomited  once,  and  died  in 
convulsions  about  fifteen  hours  after  having  taken  the  poison.  On  inspec- 
tion, the  eyes  were  half-open,  with  an  intense  lustre,  and  the  pupils 
dilated  ;  the  mouth  was  spasmodically  closed,  and  the  sphincter  of  the 
))0wel  relaxed.  The  cerebral  vessels  Avere  distended  with  dark-colored 
blood;  the  substance  of  the  brain,  cerebellum,  and  medulla  oblongata  pre- 
sented numerous  bloody  points.  In  the  throat  and  gullet  there  Avere 
several  patches  of  i-edness.  In  the  stomach  there  was  some  fluid  with 
three  open  berries ;  the  mucous  membrane  was  of  a  reddish-blue  color  in 
various  parts.     (Canstatt's  Jabresb.,  1854,  p.  295.) 

Analysis. — The  indigestible  nature  of  the  leaves,  fruit,  and  seeds  will 
commonly  lead  to  their  detention  in  the  matters 
vomited  or  passed  by  the  bowels,  or  in  the  contents 
of  the  viscera  after  death.  The  seeds  of  belladonna 
are  ver}^  small,  and  can  be  distinguished  by  the  micro- 
scope from  the  seeds  of  other  poisonous  plants.  They 
are  of  a  somewhat  oval  shape  and  of  a  dark  color. 
Under  a  low  magnifying  pywer  they  present  a  honey- 
combed surface  (Fig.  24).  In  henbane  the  surface  of 
a  the  seeds  presents  more  irregular  depressions,  resemb- 

®  p      <5  ling  those  seen  on  certain  corals  or  madrepores.     The 

Seeds  of  Belladonna.        Coloring  matter  of  the  berry  is  of  a  deep  purple  hue  ; 
o.  Natural  size.  jt  is  turned  ffreeu  by  alkalies  and  red  by  acids.     The 

6, Magnified 30 diameters.      ,  in   i       i  i       xi     •     i     ..       •      t     i,  j. 

'     ®  leaves  would  be  known  by  their  botanical  characters, 

and  a  decoction  or  infusion  of  them  by  the  liquid  causing  dilatation  of 
the  pupil. 

Atropine. — Atropine  is  the  name  given  to  the  active  alkaloid  of  bella- 
donna ;  it  is  a  powerful  poison.  It  has  been  asserted  that  atropine  does 
not  exist  pre-forined  in  the  belladonna  plant,  but  that  it  is  a  product  of  the 
chemical  processes  employed  upon  a  kindred  base,  hyoscyamine,  found  in 
the  plant.  Schulte  has  shown  that  in  the  young  plant  hyoscyamine  only 
is  found  ;  and  in  old  plants  both  hyoscyamine  and  atropine.  (See  Pharm. 
Jour.,  1890-1,  p.  207.)  From  a  medico-legal  point  of  view  this  fact  is  not 
of  much  importance.      Symptoms  of  poisoning  have  been  produced  by  the 


rOISONING    AVITII    ATROPINE.  213 

application  of  a  weak  solution  of  ati'opine  to  the  eyes.  Bowles  found 
that  about  l-fiOth  of  a  grain  repeated  twice  in  half  an  hour,  making  l-30th 
of  a  grain,  dropped  into  the  eye,  produced  in  two  adults,  after  some  hours, 
loss  of  vision,  giddiness,  soreness  of  the  throat,  loss  of  power  of  swallow- 
ing, and  widely  dilated  pupils.  The  latter  symptom  remained  for  eight 
days.  (Brit  Med.  Jour.,  187G,  i.  p.  533  )  One-eighth  of  a  grain  injected 
beneath  the  skin  for  the  relief  of  sciatica  caused  all  the  symptoms  of  poi- 
soning with  belladonna.  (Pharm.  Jour.,  May,  18G2,  p.  583  )  One  grain 
used  hypodermically  nearly  proved  fatal  at  Guy's  Hospital ;  and  in  the 
following  case  (Med.  Times  and  Gaz.,  ISliS,  ii.  p.  34)  a  man  who  swal- 
lowed, by  mistake,  a  grain  of  sulphate  of  atropine  in  solution,  had  a  nar- 
row escape.  In  an  hour  afterwards  the  following  symptoms  were  ol)- 
served:  the  pupils  were  enormously  dilated,  so  tliat  the  iris  of  each  eye 
was  scarcely  visible;  the  eyes  moved  restlessly  from  side  to  side.  The 
pulse  was  very  quick,  and  the  patient  appeared  as  if  intoxicated.  In 
another  hour  his  hands  were  cold,  the  pulse  weak,  and  there  was  loss  of 
power  in  ihe  limbs.  He  became  restless,  incoherent,  and  unconscious  of 
preceding  events.  There  was  also  delirium.  In  a  later  stage  there  was 
morbid  sensitiveness  to  sounds  and  objects:  the  tongue  was  furred  and 
the  skin  dry  and  hot.  The  pupils  continued  dilated  for  a  week,  and  for 
several  days  there  was  a  partial  paralysis  of  the  bladder.  He  recovered 
in  a  fortnight. 

A  fatal  case  of  poisoning  by  sulphate  of  atropine  is  recorded  by  Green- 
way.  A  man,  set.  45,  swallowed  by  mistake  a  teaspoonful  of  solution  of 
sulphate  of  atropine  equal  to  half  a  grain  of  the  sulphate.  The  usual 
symptoms  of  poisoning  followed,  but  it  is  remarkable  that  the  patient  did 
not  die  until  the  sixth  dav.  (Brit.  Med.  Jour.,  1878,  ii.  p.  516.)  Cases 
of  atropine-poisoning  of  a  mild  character  are  common  in  hospital  practice, 
in  consequence  of  atropine  lotions,  intended  for  the  eye,  being  accidentally 
taken  by  children  and  others. 

In  1880,  a  boy,  £et.  12,  was  admitted  to  Guy's  Hospital,  who  on  the 
previous  day  had  eaten  some  ripe  belladonna  berries  whilst  on  a  country 
excursion.  On  returning  home  he  went  to  bed  as  usual,  but  awoke  at  2 
A.  M.  in  much  the  same  condition  as  on  his  admission  at  5  A.  M.  He 
was  then  delirious  and  in  such  violent  convulsions  that  he  was  unable  to 
sit  still  a  moment.  He  talked  most  incoherently.  He  apparently  could 
not  swallow,  as  he  put  water  in  his  mouth  and  spat  it  out  again,  the 
effort  throwing  him  into  severe  convulsions.  At  10  A.  M.  the  delirium 
and  convulsions  still  continued;  there  was  a  marked  flushing  on  the  legs 
and  face,  and  the  latter  was  somewhat  swollen.  The  throat  was  red,  and 
he  showed  aversion  to  water.  The  pupils  were  widely  dilated.  The 
delirium  continued,  with  convulsions,  all  day  and  during  the  next  night, 
though  occasionally  he  spoke  rationnllv.  He  was  flushed,  and  appeared 
like  a  child  in  the  early  stage  of  a  scarlatina  rash  At  noon — about  forty- 
two  hours  after,  as  was  supposed,  the  berries  were  eaten — one-third  of  a 
grain  of  morphine  was  injected  hypodermically.  The  boy  soon  slept,  and 
next  day  awoke  well 

In  1850,  Sells  forwarded  to  the  author,  for  examination,  the  stomach  of 
a  young  man  who  had  poisoned  himself  by  taking  lia  ^rai??.sof  atropine.  He 
took  the  dose  on  going  to  bed.  He  was  heard  to  snore  heavily  during  the 
night,  and  was  found  dead  about  seven  in  the  morning,  lying  on  his  right 
side,  the  surface  livid,  the  limbs  rigid  and  contracted,  and  with  a  little 
brown  matter  issuing  from  the  mouth.  The  pupils  were  much  dilated. 
The  mucous  memorane  of  the  stomach  presented  a  diffused  redness,  which 


21-1  POISONING    WITH    STRAMONIUM. 

mipht  have  arisen  from  some  brandy  Avhich  he  had  swalloAved.  ISo  trace 
of  the  poison  could  be  detected  in  the  stomach  or  the  contents. 

A  medical  man  was  charged  with  attempting  to  poison  his  wife  and 
Qther  persons  with  atropine,  which  it  was  alleged  had-  been  placed  in  a 
rabbit  pie.  (Reg.  v.  Sprague,  Exeter  Aut,  Ass.,  1865.)  The  evidence 
failed  to  show  at  the  trial  that  the  prisoner,  or  any  other  person,  could 
have  mixed  poison  with  the  pie,  much  less  such  a  poison  as  this,  which, 
in  the  dose  of  one  or  two  grains,  either  destroys  life  or  produces  illness 
continuing  for  some  time.  The  symptoms,  as.  described,  resembled  those 
caused  by  noxious  food,  and  ditfered  in  many  respects  IVom  those  of 
poisoning  by  atropine.  The  only  fact  on  which  this  chemical  theory 
seemed  to  rest  was  that  the  pupils  of  the  eyes  of  those  who  ate  of  the  pie 
and  were  taken  ill  were  dilated,  and  a  portion  of  the  extract  of  the  scrap- 
ings of  the  pie-dish  is  said  to  have  caused  a  dilatation  of  the  pupil  of  the 
analyst.  (Med.  Times  and  Gaz.,  1865,  ii.  p.  168;  Chem.  News,  1865,  ii. 
p.  72.)  It  is  stated  that  the  supposed  poison  was  separated  from  the 
baked  leg  of  a  rabbit,'  by  soaking  it  in  dilute  hydrochloric  acid,  but  the 
whole  of  the  scientific  theory  rested  upon  the  dilatation  of  the  pupils,  and 
this,  although  presumptive,  is  not  positive  evidence  of  atropine  having 
been  administered. 

The  criminal  administration  of  atropine  is  a  rare  event  in  this  country. 
A  trial  for  murder  by  this  alkaloid  took  place  at  the  Manchester  Lent 
Assizes,  1872  (Reg.  v.  Steele).  The  prisoner,  who  was  a  nurse  in  the 
workhouse,  was  charged  with  administering  atropine  to  the  senior  surgeon, 
and  thereby  causing  his  death.  The  deceased  was  taken  suddenly  ill  after 
his  breakfa'st,  and  clied  in  about  twelve  hours  Avith  the  usual  symptoms  of 
poisoning  with  atropine.  The  poison,  a  solution  of  atropine  in  spirit,  was 
detected  "in  the  body,  and  also  in  a  licjuid  found  in  the  room.  Milk  was 
the  vehicle  through  which  it  was  taken.  The  milk  as  sent  from  the 
kitchen  contained  nothing  injurious,  but  that  found  in  deceased's  room 
was  tasted  by  two  of  the  nurses,  and  both  suffered  from  poisoning 
by  atropine.  The  prisoner  had  access  to  this  room,  and  it  was  alleged 
that  she  had  a  strong  motive  for  this  criminal  act,  but  there  was  no  direct 
proof  to  show  that  she  put  the  poison  into  the  milk,  and  she  was  acquitted. 

Avaly.ns. — Atropine  is  a  white  crystalline  alkaloid,  sparingly  soluble  in 
water,  but  readily  dissolved  by  alcohol,  ether,  and  dilute  acids.  Jt  does 
not  readilv  crystallize,  but  forms  readily  crystallizable  salts.  It  may  be 
detected  in,  and  separated  from,  organic  liquids  by  the  process  of  Stas 
(see  p.  221,  post). 

The  test  usually  employed,  in  addition  to  the  general  tests  for  alkaloids, 
is  a  physiological  one — the  effect  produced  on  the  pupil  of  the  eye  by 
small  quantities  of  liquid  or  extract  containing  traces  of  atropine.  The 
pupil  becomes  largely  dilated  and  does  not  respond  to  light.  There  is 
nothing  conclusive  in  this  result,  unless  there  is  also  evidence  from  symp- 
toms that  belladonna  has  been  actually  taken  or  administered. 

Thorn-apple  (Datura  stramontom). 

Symptoms  and  Appeo^ronces. — The  symptoms  produced  by  stramonium, 
Avhether  the  leaves  or  seeds  are  used,  are  as  follows  :  Soon  after  the  poison 
has  been  taken  there  is  giddiness,  dimness  of  sight,  a  sense  of  fainting, 
insensibilitv,  fixed  and  dilated  pupils,  flushed  countenance,  and  a  slow, 
great,  and  full  pulse.  Sometimes  there  is  restlessness,  with  a  hot  and  red 
skin,  a  wild  and  stariilg  countenance,  the  breathing  hurried  and  gasping, 
incessant  talking  without  distinct  articulation  ;  and  there  are  attempts  to 


NUX    VOMICA STRYCHNINE.  215 

drive  away,  or  p-rasp  at,  ima.ii-inarT  objects.  There  is  picking  at  the  Ijed- 
clothes,  with  paroxysms  of  excessive  laughter,  and,  if  ttie  person  can  walk, 
it  is  with  a  staggering  gait,  and  he  falls  to  the  ground  as  if  intoxicated  or 
completely  exhausted.  The  seeds  of  two  varieties  of  datura  were  used  by 
the  Thugs  of  India  for  rendering  their  victims  powerless  and  insensible. 

Ap2^earances. — In  a  well-marked  case  of  poisoning  with  stramonium 
seeds,  in  which  death  took  place  in  less  than  eight  hours,  the  following 
appearances  were  found:  Great  congestion  of  the  vessels  of  the  brain  and 
its   membranes,  the  brain   firm  and   highly  injected,   the  choroid  plexus 
turgid,  the  ventricles  contained  serum,  the  sub- 
stance of  the  lungs  congested,   and  the  heart  Fig.  2.'5. 
flaccid.       The    stomach   contained    about    four         -«.,-,»_       /; 
ounces  of  digested  food  mixed  with  eighty-nine            ^  ^--^       ^  ^,       ^^ 
seeds  of  stramonium.     There  were  two  patches 

of  extravasation  in  the  mucous  coat — one   on      ^  /^ 

the  larger  curvature  and  the   other  near    the  ^|    . 

l)ylorus.     Many  seeds  and  fragments  were  also        \^' 
found  in  the  intestines.     (Lancet,   1847,  ii.  p. 
298.)     In    another   case   there    were  marks  of 
diffused  inflamjiiation  about  the  cardiac  end  of  ^^    Q" e^ 

the  stomach.  >^ 

Analysis. — The    seeds    of  stramonium,     from        Seeds  of  Datura  stramonium. 
1  ■    T  ■  T        .      1  ^    n  ,1  1  u,  ^aturaJ  size. 

which  accidents  have  most  frequently  occurred,  6,  Magaiiied  ao  diameters. 

are    flattened,    kidney-shaped,    but    half    oval, 

rough,  and  of  a  dark-brown  or  black  color.  They  are  liable  to  be  mistaken 
for  the  seeds  of  capsicum.  Of  the  dry  Datura  stramonium,  there  are  about 
eight  seeds  to  a  grain.  They  are  of  an  oblong  kidney-shape,  and  of  a 
dark-brown  or  black  color,  the  illustration  (Fig.  25)  shows  their  appear- 
ance under  a  low  power  of  the  microscope.  The  leaves  of  the  common 
Datura  stramonium  are  well  characterized  by  their  peculiar  shape. 


CHAPTER  XXI. 

NUX   VOMICA. STRYCHNIXE. SYMPTOJIS    AXD  APPEAKAXCES. CHEMICAL    AND    MICROSCOPI- 
CAL   ANALYSIS    OF    NUX    VOMICA    AND    STRYCHNINE. PROCESS    FOR    ORGANIC  MIXTURES. 

DIALYSIS. BRUCINE. 

Nux  YoMicA.     Strychnine,  or  Strychnia. 

Symptoms. — At  a  variable  interval  after  taking  either  nux  vomica  or 
strychnine  in  a  poisonous  dose,  the  person  experiences  a  sense  of  un- 
easiness and  restlessness,  accompanied  by  a  feeling  of  impending  suffoca- 
tion. There  is  a  shuddering  or  a  trembling  of  the  whole  frame,  with 
twitching  and  jerkings  of  the  arms  and  legs.  Tetanic  convulsions  then 
commence  suddenly  with  great  violence,  and  nearly  all  the  muscles  of  the 
body  are  simultaneously  affected.  The  limbs  are  stretched  out  involun- 
tarily, the  hands  are  clenched;  the  head,  after  some  convulsive  jerking,  is 
bent  backwards,  and  the  whole  of  the  body  becomes  as  stiff  as  a  board. 
As  the  convulsions  increase  in  frequency  and  severity,  the  body  assumes 
a  bow-like  form  (opisthotonos),  being  arched  in*  the  back  and  resting  on 
'  the  head  and  heels.     The  head  is  firmly  bent  backwards,  the  soles  of  the 


216  NUX    VOMICA  —  SYMPTOMS. 

feet  incurvatcd  or  arched,  or  everted,  and  the  legs  sometimes  separated 
The  abdomen  is  hard  and  tense,  and  the  chest  spasmodically  fixed,  so  that 
respiration  appears  to  be  arrested.  The  face  assumes  a  dusky,  livid,  or 
congested  appearance,  with  a  drawn,  wild,  or  anxious  aspect ;  the  ejeballs 
are  prominent  and  staring,  and  the  lips  are  livid.  The  intellect  is  clear, 
and  the  sufferings,  during  this  violent  spasm  of  the  voluntary  muscles,  are 
severe.  The  patient  in  vain  seeks  for  relief  in  gasping  for  air  and  requir- 
ing to  be  turned  over,  moved,  or  held.  The  muscles  of  the  lower  jaw, 
which  are  the  first  to  be  affected  in  tetanus  from  disease,  are  generally  the 
last  to  be  affected  by  this  poison.  The  jaw  is  not  always  fixed  during  a 
paroxysm.  The  patient  can  frequently  speak  and  swallow,  and  a  great 
thirst  has  been  observed  among  the  symptoms.  In  some  cases  of  poison- 
ing Avith  nux  vomica  the  jaw  has  been  fixed  by  muscular  spasm  ;  but, 
unlike  the  lockjaw  of  disease,  this  has  come  on  suddenly  in  full  intensity 
with  tetanic  spasms  in  other  muscles,  and  there  have  been  intermissions 
which  are  not  usually  witnessed  in  the  tetanus  of  disease. 

The  sudden  and  universal  convulsion  affecting  the  voluntary  muscles 
has  sometimes  been  so  violent  that  the  patient  has  been  jerked  off  the 
bed.  After  an  interval  of  from  half  a  minute  to  one  or  two  minutes,  the 
convulsions  subside,  there  is  an  intermission,  the  patient  feels  exhausted, 
and  is  bathed  in  perspiration.  It  has  been  noticed  in  some  of  these 
cases  that  the  pupils  during  the  paroxysm  are  dilated,  while  in  the  inter- 
mission they  are  contracted.  The  pulse  during  the  spasms  is  so  quick  that 
it  can  scarcely  be  counted,  and  the  temperature  of  the  body  is  much 
elevated.  Slight  causes,  such  as  an  attempt  to  move,  a  sudden  noise,  or 
gently  touching  the  patient,  will  frequently  bring  on  a  recurrence  of  the 
convulsions.  In  cases  likely  to  prove  fatal,  they  rapidly  succeed  each 
other,  and  increase  in  severity  and  duration,  until  at  length  the  patient 
dies,  utterly  exhausted.  The  tetanic  symptoms  produced  by  strychnine, 
when  once  clearly  established,  progress  rapidl}^  either  to  death  or  recovery. 
The  person  is  conscious,  and  the  mind  is  commonly  clear  to  the  last.  He 
has  a  strong  apprehension  of  death.  The  duration  of  the  case,  when  the 
symptoms  have  set  in,  is  reckoned  by  minutes,  while  in  the  tetanus  of 
disease,  when  fatal,  it  is  reckoned  by  hours,  days,  and  even  weeks.  As 
a  general  statement  of  the  course  of  these  cases  of  poisoning,  Avithin  two 
hours  from  the  commencement  of  the  symptoms  the  person  either  dies 
or  recovers,  according  to  the  severity  of  the  paroxysms  and  the  strength 
of  his  constitution.  Death  sometimes  takes  places  in  a  paroxysm. 
(Lancet.  1861,  i.  p.  572.) 

In  1885  (Reg.  i;.  Day,  Taunton  Winter  Ass.),  a  farmer  was  tried  for 
the  murder  of  a  female  relative  by  strychnine,  but  was  acquitted,  no  red 
strychnine  having  been  traced  to  the  prisoner,  although  a  red  substance 
was  deposed  to  as  having  been  seen  in  the  gruel  which  was  the  vehicle  in 
which  the  poison  was  administered.  This  is  the  only  instance  which  the 
editor  has  met  with  of  the  criminal  administration  of  strychnine  as  a  red 
substance.     (See  Vermin-killers,  p.  218,  post.) 

In  1888,  a  gardener  murdered  his  wife  and  son  by  means  of  pills  con- 
taining strychnine  substituted  for  ordinary  purgative  pills  (Reg.  v.  Bowes, 
C.  C.  C,  Jan.  1888).  The  editor  has  known  extract  of  nux  vomica  sold 
and  taken  in  mistake  for  extract  of  sarsaparilla,  with  fatal  result. 

The  lime  at  which  the  si/mptoms  commence  appears  from  the  recorded 
cases  to  be  subject  to  great  variation.  In  poisoning  with  nux  vomica  they 
are  generally  move  slow  in  appearing  than  in  poisoning  with  strychnine. 
Until  they  set  in  suddei>ly,  the  patient  is  capable  of  walking,  talking,  and 
going  through  his  or  her  usual  occupations.     In  a  case  which  occurred  to 


STRYCHNINE FATAL    DOSE.  217 

Pellarin,  a  man  swallowed  about  300  grains  of  mix  vomica,  and  no  symp- 
toms appeared  for  two  hours.  He  died  speedily  in  a  violent  convulsive 
tit.  (Ann.  d'Hyg.,  1860,  t.  2,  p.  431.)  Macredy  reports  a  case  of  poison- 
ing by  a  grain  and  a  half  of  strychnine,  followed  by  two  fluidounces  of 
tincture  of  opium,  where  the  symptoms  of  strychnine-poisoning  did  not 
manifest  themselves  till  after  the  lapse  of  eight  hours.  The  patient  re- 
covered. (Edin.  Med.  and  Surg.  Jour.,  1883,  p.  757.)  Generally,  in  poi- 
soning by  strychnine  the  symptoms  appear  in  from  five  to  twenty  minutes. 

Appearances  after  Dea'th. — In  general  the  body  is  relaxed  at  the  time 
of  death  and  stiffens  afterwards  ;  but  the  commencement  and  duration  of 
the  rigid  state  depend  on  various  conditions.  In  some  cases  the  body  is 
found  rigid  and  arched  (opisthotonos),  with  incurvated  toes.  (Ueg.  v. 
Day,  p.  207.)  Among  the  internal  appearances  which  have  been  met 
with  in  different  cases  are  congestion  of  the  membranes  and  substance  of 
the  brain,  as  also  of  the  upper  part  of  the  spinal  marrow,  with  congestion 
of  the  lungs.  The  heart  is  contracted  and  empty ;  but  its  right  cavities 
in  some  instances  have  been  distended  with  liquid  blood.  The  blood  has 
been  found  black  and  liquid  throughout  the  body.  The  mucous  membrane 
of  the  stomach  has  occasionally  presented  slight  patches  of  ecchymosis  or 
congestion,  probably  depending  on  extraneous  causes,  such  as  the  process 
of  digestion,  the  presence  of  food  or  of  alcoholic  liquids.  In  most  in- 
stances the  stomach  and  intestines  have  been  found  quite  healthy,  and  it 
is  not  in  the  nature  of  this  poison  either  to  inflame  or  to  irritate  the  mucous 
membrane.  Of  the  appearances  observed  in  poisoning  Avith  strychnine, 
there  are  none  which  can  be  considered  characteristic.  Congestion  of  the 
membranes  of  the  brain  and  spinal  marrow  is  probably  the  most  common. 

Fatal  Dose. —  The  sixteenth  part  of  a  grain  of  strychnine  killed  a  child 
between  two  and  three  years  of  age  in  four  hours.  The  smallest  accu- 
rately recorded  fatal  dose  in  an  adult  was  in  the  case  of  Dr.  Warner. 
Half  a  grain  of  the  sulphate  of  strychnine  here  destroyed  life.  (On  Poi- 
soning by  Strychnia,  pp.  138,  139.)  So  powerful  are  the  effects  of  this 
drug  in  certain  cases  that  ordinary  medicinal  doses  cannot  be  borne.  The 
editor  has  known  one-twelfth  of  a  grain  produce  poisonous  symptoms. 
Hare  states  that  many  deaths  are  recorded  from  one-quarter  to  one-half  a 
grain  dose  (Boston  Med.  and  Surg.  Jour.,  Nov.  20,  1884,  p.  482);  but  the 
editor  has  been  unable  to  verify  this  statement.  Symptoms  of  its  poison- 
ous action  have  frequently  been  unexpectedly  produced.  Fraser  states 
that  its  action  is  most  powerful  through  the  skin.  He  found  that  when 
applied  to  rabbits  hypoderniically,  from  one-twentieth  to  one-fiftieth  of  a 
grain  produced  violent  tetanic  convulsions,  followed  by  death  in  a  few 
minutes. 

With  respect  to  mix  vomica,  three  grains  of  the  alcoholic  extract  have 
destroyed  life.  The  smallest  fatal  dose  of  nux  vomica  in  powder  was  in 
a  case  reported  by  Hoffmann  (Med  Rat.  Syst.,  ii.  175).  Thirty  grains 
of  the  powder  given  in  two  doses  of  fifteen  grains  each,  proved  fatal. 
The  poison  was  given  by  mistake  for  Peruvian  bark  to  a  patient  laboring 
under  quartan  fever.  This  is  about  equivalent  to  the  weight  of  one  full- 
sized  seed,  and  to  only  one-third  of  a  grain  of  strychnine  in  the  two  doses. 

In  fatal  cases  death  generally  takes  place  within  two  hours  after  the 
taking  of  strychnine.  One  of  the  most  rapidly  fatal  cases  recorded  is 
that  of  Dr.  Warner:  the  symptoms  commenced  in  five  minutes,  and  he 
died  in  twenty  minutes.  In  the  case  of  J.  P.  Cook,  the  symptoms  com- 
menced in  an  hour  and  a  quarter,  and  terminated  fatally  in  tweyity  minutes. 
In  poisoning  by  nux  vomica,  death  may  occur  within  two  hours.  Chris- 
tison  mentions  a  case  in  which  a  man  died  \xi  fifteen  minutes  Q.{iQV  taking 


218  VERMIN-KILLERS. 

ii  dose.  This  is  probably  the  shortest  period  known.  The  longest  period 
at  which  death  has  occurred  was  six  hours  after  administration  of  the 
poison.  The  editor  met  with  a  case  where  death  occurred  in  five  hours 
and  a  half.  (C.  C.  C,  Reg.  v.  BarloAV,  18*15  ;  see  Rep.  of  Trials  for 
Murder  by  Poisoning,  by  Browne  and  Stewart,  p.  268.) 

Vermin  and  Insect-killers. — Although  it  is  ditficult  to  procure  strych- 
nine at  a  druggist's  shop,  the  poison  is  extensively  sold  to  the  public  in 
threepenny  and  sixpenny  packets,  under  the  name  of  Yermin-killers. 

Butler''s  Vermin-killer  consists  of  a  mixture  of  flour,  soot,  and  strych- 
nine. The  author  found  the  sixpenny  packet  to  weigh  about  a  drachm, 
and  to  contain  from  two  to  three  grains  of  strychnine.  As  the  poison  is 
mechanically  mixed  with  the  other  ingredients  (flour  and  coloring  matter), 
and  is  probably  manufactured  on  a  large  scale,  the  proportion  of  strych- 
nine is  liable  to  variation.  The  threepenny  packet  contains  about  half  the 
above  quantity  of  strj^chnine,  but  this  is  quite  sufficient  to  destroy  the  life 
of  an  adult.  In  place  of  soot,  Prussian  blue  is  sometimes  used  as  a  color- 
ing substance.  The  editor  finds  that  there  are  two  kinds  of  Butler's  Ver- 
min-killer in  commerce :  in  one  the  poisonous  ingredient  is  carbonate  of 
barium,  and  in  the  other  strychnine.  A  sixpenny  packet  of  the  latter 
weighed  forty-two  grains,  and  yielded  two  grains  and  a  quarter  of  strych- 
nine. Another  sixpenny  packet  weighed  sixty-two  grains,  and  contained 
one  grain  and  three-quarters  of  strychnine.  Battlers  Vermin-killer  is  a 
powder  similar  to  that  of  Butler's,  containing  a  fatal  proportion  of  strych- 
nine as  it  is  sold  in  packets.  The  editor  found  a  threepenny  packet  of 
Battle's  Yermin-killer  to  weigh  twelve  grains,  and  to  contain  one  grain 
and  a  quarter  of  strychnine;  and  a  sixpenny  packet  weighed  twenty-five 
grains,  and  contained  two  grains  and  a  half  of  strychnine.  These  powders 
are  a  fertile  source  of  poisoning,  either  through  accident  or  design  ;  they 
are  openly  sold  by  ignorant  people  to  others  still  more  ignorant,  and  are 
much  used  for  suicidal  purposes.  Artificial  ultramarine  has  been  some- 
times improperly  used  instead  of  Prussian  blue  or  indigo  for  coloring 
vermin-killers.  A  powder  of  this  kind  is  prepared  in  Bristol.  Since  the 
color  of  the  powder  is  at  once  discharged  by  any  acid  (such  as  that  of  the 
gastric  juice  and  ordinary  articles  of  food),  the  recognition  of  such  a 
powder  may  entirely  fail.  The  editor  has  met  with  a  red  vermin-killer  in 
commerce,  containing  50  per  cent,  of  strychnine,  colored  with  four  per 
cent,  of  vermilion.  Bed  strychnine — the  crystals  of  the  alkaloid  super- 
ficially colored  by  a  secret  trade  process: — is  expressly  made  for  the  New 
South  Wales  market;  and,  in  1884,  a  quantity  of  this  colored  strvchnine 
found  its  way  into  English  commerce.  Arsenic  and  strychnine  are  used 
together  in  some  vermin-killers. 

Chemical  Analysis. — Niix  vomica  is  well  known  as  a  flat,  round  kernel, 
about  the  size  of  a  shilling,  with  radiating  silky  fibres,  slightly  raised 
in  the  centre.  It  is  of  a  light-brown  color,  and  covered  with  fine  silky 
fibres  (see  Figs.  26  and  2*7,  p.  219).  It  is  very  hard,  brittle,  tough,  and 
difficult  to  ])ulverize.  The  powder  is  of  a  gray-brown  color,  like  that  of 
liquorice,  and  has  an  intensely  bitter  taste;  it  is  sometimes  met  with  in  a 
coarsely  rasped  state.  It  yields  to  water  and  alcohol,  strychnine,  brucine, 
and  some  other  vegetable  substances.  Heated  on  platinum-foil,  it  burns 
with  a  3"ellow  smoky  flame.  Nitric  acid  turns  it  of  a  dark  orange-red 
color,  which  is  destroyed  by  stannous  chloride.  These  properties  are 
sufficient  to  distinguish  it  from  various  medicinal  powders  which  it  re- 
sembles in  color  ;  but  the  presence  of  any  silky  hairs  or  fibres  revealed  by 
the  microscope  (Fig.  28)  would  at  once  distinguish  it  from  all  other 
powders.     They  may  be  obtained  from  the  contents  of  the  stomach  or  any 


STRYCHNIN  E CII  EMI  C  A  L    ANALYSIS. 


219 


liquid  article  of  food  by  washing  and  decantation.     They  are  quite  insolu- 
ble in  water.     The  aqueous  infusion  or  decoction  of  nux  vomica  is  deeply 


Fiff.  26. 


Fig.  27. 


j^ 


""V^^f°^ 


Seeds  of  Nux  Vomica,  natural  size,    a,  Convex  surface;  6,  concave  surface;  c,  hilum  or 

umbilicus. 

reddened  by  nitric  acid,  and  is  freely  precipitated  by  tincture  of  galls. 
Ferric  sulphate  gives  with  it  an  olive-green  tint. 


Fis;.  28. 


Fiff.  29. 


Hairs  of  Nux  Vomica,  magnified 
124  diameters. 


Various  forms  of  Crystals  of  Strychnine, 
as  ttiey  were  obtained  from  an  alcoholic 
solution,  magnitied  124  diameters. 


St7ychvine. — This  alkaloid  may  be  readily  obtained  crystallized  from 
an  alcoholic  solution.  The  crystalline  form  is  subject  to  great  variation, 
according  to  the  strength  of  the  solution,  rapidity  or  slowness  of  evapora- 
tion, the  presence  of  foreign  matters,  etc.  It  is  commonly  seen  in  oeta- 
hedra,  sometimes  lengthened  into  prisms  of  a  peculiar  shape,  bevelled  at 
the  ends,  and  crossing  each  other  at  angles  of  60°  (see  Fig.  29).  There 
are  as  many  as  six  or  eight  varieties  of  crystals,  so  that  too  much  impor- 
tance must  not  be  attached  to  this  branch  of  the  analysis.  As  strychnine 
is  procured  from  the  solutions  of  its  salts  by  the  addition  of  ammonia,  it 
is  usually  deposited  in  long  slender  prisms  (Fig.  30). 

1.  Strychnine  is  white,  of  an  intensely  bitter  taste,  even  when  it  forms 
only  the  1-30, 000th  part  of  a  watery  solution,  or  even  much  less.  2.  When 
heated  on  platinum,  it  melts  and  Inirns  like  a  resin,  with  a  black,  smoky 
flame.  3.  It  is  not  perceptibly  dissolved  by  cold  water,  requiring  7000 
parts  for  its  solution.  4.  It  is  easily  dissolved  Ijy  acids,  and  it  is  precipi- 
tated from  its  concentrated  solutions  by  potash  or  by  ammonia,  in  which 
it  is  insoluble.  5.  Strong  nitric  acid  often  imparts  to  commercial  strych- 
nine a  pale  reddish  color,  owing  to  the  presence  of  brucine.  6.  Sulphuric 
acid  produces  no  apparent  change  in  it;  but  when  to  this  mixture  either  a 
small  crystal  of  bichromate  of  potassium,  of  ferricyanide  of  potassium,  a 


220 


STRYCHNINE  IN  ORGANIC  MIXTURES. 


small  quantity  of  black  oxide  of  manganese,  or  peroxide  of  lead,  is  added, 
a  series  of  beautiful  colors  (blue,  purple,  and  violet)  appear,  passing 
rapidly  to  a  cherry-red  tint.  Among  these  substances  black  oxide  of 
manganese  will  be  found  preferable  for  use. 


Crystals  of  Strychnine  obtained  by 
adding  ammonia  to  the  sulphate, 
magnilied  124  diameters. 


Crystals  of  rhromale  of  Strychnine, 
magnified  124  diameters. 


Horsely  suggested  that  a  solution  of  strychnine  should  be  suflScientlv 
concentrated,  and  then  precipitated  b}- chroniate  of  potassium  :  the  cr^'stals 
may  be  examined  microscopically  ;  they  are  generally  seen  in  tufts  of 
radiated  prisms  of  a  yellow  color  (Fig.  31).  On  being  touched  with  strong 
sulphuric  acid,  the  color-reactions  of  strychnine  are  at  once  brought  out. 
Chloride  of  gold  is  a  delicate  precipitant  of  strychnine.  The  precipitate, 
collected  and  dried,  may  be  dissolved  in  concentrated  sulphuric  acid,  and 
any  of  the  color-tests  then  applied  to  it.  Iodic  acid  is  not  decomposed  by 
strychnine  or  its  salts,  and  sulphomolybdic  acid  gives  to  it  slowly  only 
a  pale  blue  color.  It  is  thus  readily  distinguished  from  morphine.  In 
testing  solutions  of  strychnine,  the  presence  of  alcohol  should  be  avoided. 

In  organic  viixtures,  a  modification  of  the  process  originally  suggested 
by  Stas  may  be  employed  for  the  separation  of  the  alkaloid.  The  principle 
of  its  operation  consists  in  dissolving  the  strychnine  out  of  the  tissue  or 
organ,  very  finely  cut  up,  by  means  of  rectified  spirit  mixed  with  a 
small  quantity  of  tartaric  or  acetic  acid,  at  a  gentle  temperature.  The 
liquid  is  strained,  the  residue  well  pressed  and  washed  with  alcohol ;  and 
the  acid  solution  of  strychnine  thus  obtained  is  evaporated  to  dryness  at  a 
low  temperature.  The  residue  is  exhausted  with  absolute  alcohol,  filtered, 
and  the  filtrate  again  evaporated  to  dryness  at  a  low  temperature.  The 
residue  is  now  taken  up  with  water,  filtered,  and  the  liquid  is  neutralized 
by  an  alkali — potash,  carbonate  of  sodium,  or  ammonia,  the  latter  being 
in  some  respects  preferablo — and  a  slight  excess  of  alkali  is  added.  The 
alkaline  liquid  is  then  shaken  in  a  long  stoppered  tube,  with  twice  its 
volume  of  ether  or  chloroform,  or  a  mixture  consisting  of  four  parts  of 
ether  and  one  of  chloroform.  These  liquids  dissolve  the  stiwchnine  set 
fi'ee  by  the  alkali.  The  ethereal  solution  is  separated  from  the  watery 
liquid  by  a  pipette  or  by  a  .stoppered  tube,  and  submitted  to  .spontaneous 
evaporation,  when,  if  stiwchnine  be  present,  the  alkaloid  will  be  obtained, 
but  generally  associated  with  oily  and  other  organic  matters,  which  may 
interfere  with  the  production  of  crystals.  The  impure  residue  left  by 
the  ether  is  heated  in  a  water-bath,  with  a  few  drops  of  strong  sulphuric 
acid;  this  destroys  the  organic  matter.  ATater  is  added,  and  the  acid 
liquid  is  filtered  through  paper,  made  alkaline  liy  potash,  and  again  treated 
with  ether,  when  strychnine  will  be  obtained  in  small  and  slender  prisms. 


POISONING    WITH    BRUCINE.  221 

The  crystals,  after  an  examination  by  the  niicro>cope  fsec  Fig-.  30,  p.  220), 
are  treated  with  sulphuric  acid  and  peroxide  of  luanganese,  and  the  color- 
reactions  of  strychnine,  if  the  alkaloid  is  present,  will  appear.  By  this 
method  strychnine  has  been  detected  in  the  liver  of  a  person  who  died 
from  this  poison,  although  the  organ  was  in  a  highly  putrescent  state. 
The  process  of  dialysis  (p.  97)  will  allow  of  the  separation  of  strychnine, 
when  combined  with  acids  and  in  a  state  of  solution,  from  blood,  mucus, 
and  other  viscid  organic  matters  found  in  the  stomach.  The  liquid  con- 
tainin^'  the  salt  of  strychnine  may  be  tested  by  evaporating  a  few  drops 
and  applying  the  color-test.  If  thus  found  to  be  present,  it  may  be  neu- 
tralized by  ammonia  or  potash,  and  shaken  with  ether  or  chloroform  in 
order  to  obtain  pure  strychnine.  In  all  cases  the  physiological  test  should 
be  used  to  supplement  the  chemical  tests  for  strychnine.  ,  A  frog  may  be 
employed  for  this  purpose.  Whatever  process  may  be  adopted,  the  analyst 
should  bear  in  mind  that  it  is  better  to  operate  on  a  small  cjuautity  of 
strychnine  in  a  pure  state  than  on  a  large  quantity  in  an  impure  condition. 
Strychnine  does  not  appear  to  undergo  any  change  in  the  dead  body  from 
the  process  of  putrefaction,  but  it  may  disappear  from  the  stomach  like 
opium  or  morphine,  and  owing  to  similar  causes  (see  p.  184).  In  the 
case  of  Reg.  v.  Pearson  (Diirham  Sum.  Ass.,  1875),  where  death  w^as 
clearly  traced  to  strychnine,  only  l-16th  part  of  a  grain  was  found  in  the 
body  by  Scattergood.  Hid  the  man  survived  a  few  hours  longer,  proba- 
bly none  would  have  been  found.  Cameron  found  that  in  the  case  of  a 
man  who  died  from  strychnine  administered  by  his  step-mother,  not  a 
trace  of  the  poison  could  be  detected  through  the  entire  viscera.  [The 
following  papers  by  Prof.  John  J.  Reese  will  be  of  interest  and  value 
upon  this  subject:  "  On  the  Infiaence  of  Morphia  in  disguising  the  Color- 
test  of  Strychnia,"  also  "On  the  Comparative  Bitterness  of  Strychnia," 
and  "On  the  Physiological  or  Frog-test  for  Strychnia,"  in  the  Am. 
Journal  of  Med.  Sciences,  Oct.  18G1.]  This  question  is  now  in  a  great 
measure  set  at  rest.  A  person  may  die  from  poison,  although  none  may 
be  detected  in  the  body.  Among  other  cases  that  of  Chantrelle  may  be 
quoted  as  an  illustration  (see  p.  184).  The  editor  of  this  work  believes 
that  much  smaller  quantities  of  strychnine  may  be  detected  when  mixed 
with  organic  matters  than  the  author  (Dr.  Taylor)  admitted  ;  and  that, 
with  improved  methods  of  analysis,  which  cannot  here  be  given  in  detail, 
strychnine  can  hardly  fail  to  be  detected  in  the  body  in  any  case  of  poison- 
ing by  this  alkaloid  proving  fatal  within  a  couple  of  hours.  As  a  rule,  it 
may  be  readily  detected  in  the  urine  during  the  course  of  a  case  of 
strychnine-poisoning ;  and  also  when  the  alkaloid  is  only  being  given  in 
ordinary  medicinal  doses.  That  strychnine  is  absorbed  into  the  blood 
unchanged  is  incontestably  proved  by  the  experiments  of  Yulpian,  who 
killed  a  dog  by  transfusing  into  its  veins  the  blood  of  another  strychnized 
animal. 

Brucixe. 

Bi'ucine,  or  Brucia,  is  an  alkaloid  associated  with  strychnine  in  the 
seeds  of  the  nux  vomica,  but  it  is  more  'abundantly  contained  in  the  bark 
of  the  tree.  It  is  not  so  powerful  a  poison  as  strychnine,  but  the  symp- 
toms produced  by  the  commercial  article  are  very  similar.  It  is  con- 
sidered to  have  from  one-twelfth  to  one-fortieth,  or,  according  to  others, 
one-sixth  of  the  strength  of  strychnine.  Brunton  finds  that  brucine  acts 
very  like  strychnine,  producing  death  by  convulsions  when  injected  into 
the  tissues  or  the  blood.  When  taken  into  the  stomach,  it  often  does 
not   produce  convulsions,  owing   to   its  rapid  elimination   by  the  urine. 


000 


POISONING    WITH    HEJILOCK. 


(Jour,  of  Chem.  Soc,  1885,  p.  143.)  When  pure,  death  may  he  produced 
in  animals  without  convulsions.  It  is  not  ati'ected  by  the  color-tests 
employed  for  the  detection  of  strj'^chnine,  and  it  acquires  an  intensely  red 
color  on  the  addition  of  nitric  acid.  The  red  color  turns  to  a  beautiful 
violet  on  the  careful  addition  of  a  solution  of  stannous  chloride.  It  is 
much  more  soluble  in  water  than  strychnine,  and  has  a  similar  bitter 
taste.  Its  aqueous  solution  is  strongly  alkaline,  and,  by  spontaneous 
evaporation,  it  yields  groups  of  slender  prismatic  crystals  arranged  in  a 
fanlike  shape.  Unlike  strychnine,  it  cannot  be  cr3'stallized  from  a  solution 
in  benzene,  and  only  imperiectly  from  a  solutfon  in  alcohol.  Hydro- 
chloric and  iodic  acids  produce  in  it  no  change,  either  in  the  cold  or 
when  heated.  Sulphuric  acid  gives  to  it  a  pink-red  color  without  car- 
bonizing it.  The  sulphate  of  brucine  cr3^stallizes  in  well-defined  prisms 
truncated  at  the  ends.  They  are  larger  and  longer  than  the  prisms  of  strych- 
nine (see  Fig.  32).  From  a  case  of  poisoning  with  this  alkaloid  which 
occurred  to  Edwards,  it  is  necessary  to  give  a  caution  to  medical  men 
respecting  the  possible  criminal  use  of  brucine.  The  symptoms  which  it 
causes  may  so  closely  resemble  those  of  poisoning  with  strychnine,  that, 
in  the  event  of  death,  the  latter  poison  only  may  be  sought  for  and  not 

found  ;  the  real  poison,  brucine,  may  be  over- 
looked. The  tetanic  symptoms  are  more 
slowly  produced  by  brucine,  and  the  poison  is 
not  so  rapidly  fatal  as  strychnine;  but  these 
conditions  may  be  altered  by  the  larger  quan- 
tity given 

When,  in  any  suspected  case,  the  color-tests 

for  strychnine   fail  to  show  the  presence  of 

I   ^^    f\    <^  ^   ^\         I     this  alkaloid,  nitric  acid  should  be  added  to 

\^      W        /^      ^     /      the  crystalline   residue    obtained   (as   in   the 

process  for  strychnine)  from  ether  or  chloro- 
form-ether. The  intense  reddening  produced 
by  this  test,  with  the  other  characters  above 
mentioned,  will  indicate  the  presence  of 
brucine.  Sulphomolybdic  acid  (p.  183)  also 
yields  a  striking  distinction  between  the  two 
alkaloids.  While  it  slowly  gives  a  pale  blue  with  strychnine,  it  rapidly 
gives  a  deep  brick-red  color,  passing  to  brown-red,  with  brucine  or  its  salts. 


Fig.  32. 


Crystals  of  Sulphate  of  Brucine, 
magnified  124  diameters. 


CHAPTEE    XXII. 


CONTUM     OR     HEMLOCK. — CONINE. WATER     HEMLOCK.  —  (ENANTHE     CROCATA. JETHUSA 

CYNAPIUM. fool's    PARSLEY. WATER-PARSXIP. LOBELIA. FOXGLOVE. DIGITALIX. 

ACOHITE. — ACONITINE. LABtJRNDJI. 


Common  or  Spotted  Hemlock  (Conium  maculatum).     Conine. 

Symptoms  and  Appearances. — The  effects  produced  by  hemlock  have 
not  been  uniform  :  in  some  instances  there  have  been  stupor,  coma,  and 
slight  convulsions;  while  in  other  cases  the  action  of  the  ]ioison  has  been 
chiefly  manifested  on  the  spinal  marrow — i.e.  it  has  produced  paralysis. 
The  poisonous  effects  usually  appear  early  and  advance  somewhat  rapidly. 


HEMLOCK    SYMPTOMS ANALYSIS. 


223 


A  peculiar  muscular  debility  sets  in;  the  lower  limbs  become  weak  and 
eventually  paralyzed  ;  the  paralysis  advances  upwards,  eventually  reach- 
ing' the  respiratory  muscles.  There  is  difficulty  of  breathing,  anxiety  iu 
the  region  of  the  heart,  and,  towards  the  close  of  life,  convulsions,  con- 
sciousness having  been  previously  intact.  The  pupils  are  dilated,  though 
not  to  the  same  extent  as  when  atropine  or  a  solanaceoua  plant  has  been 
taken.  When  the  respiratioa  becomes  affected,  there  is  marked  blueness 
of  the  surface  of  the  body.  A  man  ate  a  larg-e  quantity  of  hemlock 
plant,  by  mistake  for  parsley.  In  from  fifteen  to  twenty  minutes  there 
was  loss  of  power  in  the  lower  extremities ;  but  he  apparently  suffered 
no  pain.  In  walking,  he  staggered  as  if  he  was  drunk ;  at  length  his 
limbs  refused  to  support  him,  and  he  fell.  On  being  raised,  his  legs 
dragged  after  him,  and,  when  his  arms  were  lifted,  they  fell  like  inert 
masses  and  remained  immovable.  There  was  perfect  paralysis  of  the 
upper  and  lower  extremities  within  two  hours  after  he  had  taken  the 
poison.  There  was  loss  of  power  of  swallowing,  and  a  partial  paralysis 
of  sensation,  but  no  convulsions — only  slight  occasional  motions  of  the 
left  leg ;  the  pupils  were  fixed.  Three  hours  after  eating  the  hemlock  the 
respiratory  movements  had  ceased.  Death  took  place  in  three  hours  and 
a  quarter ;  it  was  evidently  caused  by  gradual  asphyxia  from  paralysis 
of  the  muscles  of  respiration  ;  but  the  intellect  was  perfectly  clear  until 
shortly  before  death.  On  inspection,  there  w^as  slight  serous  effusion 
beneath  the  arachnoid  membrane.  The  substance  of  the  brain  was  soft; 
on  section  there  were  numerous  bloody  points,  but  the  organ  was  other- 
wise healthy.  The  lungs  were  gorged  with  dark  fluid  blood  ;  the  heart 
was  soft  and  flabby.  The  stomach  contained  a  green-colored  pulpy  mass 
resembling  parsley.  The  mucous  coat  was  much  congested,  especially  at 
its  greater  end.  Here  there  were  numerous  extravasations  of  dark  blood 
below  the  membrane,  over  a  space  of  about  the  size  of  the  hand.  The 
intestines  w^ere  healthy,  except  that  they  here  and  there  presented  patches 
of  congestion  in  the  mucous  coat.  The  blood  throughout  the  body  was 
fluid  and  of  a  dark  color. 

In  a  case  w^hich  was  the  subject  of  a  trial  for  murder  (Reg.  v.  Bowyer, 
Ipswich  Sum.  Ass.,  1848),  a  child  died  in  one  hour  after  swallowing  part 
of  a  teacupful  of  a  decoction  of  hemlock,  alleged  to 
have  been  administered  by  the  mother.  The  child 
sipped  the  decoction  until  it  lost  the  power  of 
holding  the  cup ;  it  became  insensible  and  para- 
lyzed, and  died  in  the  chair  in  a  sitting  posture. 
There  were  no  morbid  appearances,  and  no  hem- 
lock leaves  were  found  in  the  body,  these  having 
subsided  in  the  cup  and  been  left  in  the  dregs.  The 
child  had  been  poisoned  by  the  upper  stratum  of 
clear  liquid.  The  mother  was  accjuitted  for  want 
of  proof,  the  death  of  the  child  having  taken  place 
in  secrec3^ 

Analysis. — Hemlock  is  known  from  most  other 
plants  which  resemble  it  by  its  large,  round, 
smooth  stem,  with  dark  purple  spots.  The  leaves 
are  of  a  dark-green  color,  smooth  and  shining. 
Every  portion  of  the  plant  has  a  peculiar  and  dis- 
agreeable smell  when  bruised,  resembling  cat's 
urine,  or,  according  to  some,  the  odor  of  mice.  It  is  strongly  brought 
out  when  the  stem,  leaves,  or  seeds  are  rubbed  with  a  solution  of  caustic 
potash.     An  illustration  of  the  seeds  of  hemlock  is  annexeed.     (Fig-  33.) 


Fis.  33. 


^^>^ 


a,  Seed  of  Hemloeck,  natural 

size. 
6,  The    same,  magnified    30 

diameters, 
c,  Group  of  seeds. 


224  WATER-HEMLOCK,    OR    COWBANE. 

They  are  peculiar  in  their  form,  and  are  easily  disting-uished  from  the 
seeds  of  other  umbelliferous  plants.  There  are  three  common  umbellifer- 
ous plants,  indigenous  in  this  country,  that  may  be  mistaken  for  hemlock. 
Conium  maculatum,  the  true  hemlock,  has  a  round,  smooth  stem  blotched 
with  purple,  its  lower  leaves  are  smooth  and  lustrous,  it  has  a  general 
involucre  of  from  three  to  seven  leaflets,  and  a  partial  one  of  three  leaflets  ; 
the  fruit  has  wavy,  notched  ridges.  All  parts  of  the  plant  when  bruised 
have  a  special  mousey  odor.  jElhuna  cynapium,  fool's  parsley,  is  distin- 
guished by  its  one-sided  partial  involucre  of  three  leaflets,  and  the  absence 
of  a  general  involucre  ;  the  stem  is  hairy  and  striated  ;  and  the  ridges  on 
the  fruit  are  neither  undulated  nor  notched.  Anthriscus  vulgaris,  com- 
mon-beaked parsley,  has  slightly  hairy  leaves,  no  general  involucre,  and  a 
bristly  fruit.  Anthriscus  sylvestris,  cow  parsley,  has  a  striated  blotched 
stem,  which  is  downy  below,  a  partial  involucre  of  five  or  more  leaflets, 
and  a  smooth  fruit.  A  person  may  be  poisoned  by  a  decoction  of  leaves 
of  hemlock,  and  no  leaves  be  found  in  the  stomach  or  bowels  (case  of 
Bowyer,  p.  223).  In  this  case  the  stomach  had  been  emptied,  and  the 
contents  lost,  before  it  was  sent  for  analysis.  No  trace  of  conia  was 
found. 

Conine. — The  poisonous  alkaloid  of  hemlock  is  known  under  the  names 
of  Conine,  conia,  coniine,  conicine,  and  coniclna.  It  resembles  nicotine 
and  ammonia  in  its  volatility,  alkaline  reaction,  and  in  some  of  its  chemical 
properties.  It  is  a  liquid  of  oily  consistency,  of  a  pale  yellow  color, 
powerfully  alkaline,  and  has,  when  its  vapor  is  diluted,  a  smell  resembling 
that  of  mice,  and  an  acrid,  bitter  taste.  It  gives  a  volatile  greasy  stain  to 
paper,  and  burns  with  a  yellow  flame  and  thick  smoke.  [Prof.  Wormley 
says  that  when  strong  sulphuric  acid  is  brought  into  contact  with  pure 
canine,  the  mixture  assumes  a  pale  red  color,  which  increases  in  intensity, 
and,  after  a  time,  becomes  nearly  blood-red.  The  action  of  nitric  and  sul- 
phuric acids  is  nearly  similar,  especially  that  of  the  former.  Micro-Chem- 
istry of  Poisons,  p.  449.]  In  reference  to  its  presence  in  organic  mixtures, 
it  may  be  detected  by  its  peculiar  odor,  or  by  distilling  the  liquid  with  a 
solution  of  potash  and  examining  the  distillate.  It  may  also  be  separated, 
by  the  process  of  Stas. 

The  reactions  produced  by  tests  on  small  quantities  should  be  dis- 
trusted, unless  there  is  strong  evidence  of  the  action  of  the  poison  on  the 
body  from  the  symptoms. 

Water-hemlock,  or  Cowbane  (Cicuta  virosa). 

Symptoms  and  Appearances. — The  symptoms  produced  by  the  roots  of 
this  plant  are  giddiness,  dimness  of  sight,  headache,  and  difficulty  of 
breathing.  There  is  burning  pain  in  the  stomach,  with  vomiting,  and 
these  symptoms  are  accompanied  by  heat  and  dryness  of  the  throat. 
Convulsions  have  been  observed  to  precede  death.  In  the  cases  of  three 
children  who  died  in  convulsions  from  this  poison,  Metzdorfi"  found  an 
injected  state  of  the  mucous  membrane  of  the  stomach,  with  redness  of  the 
air-passages,  as  well  as  of  the  cardia  and  pylorus ;  the  vessels  of  the  brain 
and  the  sinuses  were  filled  with  dark  liquid  blood.   (Wibmer,  Cicuta,  119.) 

The  roots  of  the  five-leaved  water-hemlock  (Enanthe  phellandrium 
( Fh ellandrium  aquaticum)  have  been  eaten  in  mistake  for  parsnips,  and 
produced  symptoms  of  poisoning. 


poisonrng  with   cexanthe.  225 

Hemlock  Water-dropwort  (CEnanthe  crocata). 

This  umbelliferous  plant,  known  also  as  five-finger  root,  or  dead  tongue, 
grows  on  the  banks  of  rivers,  streams,  and  ditches.  It  is  one  of  the  most 
poisonous  of  the  order,  and  is  considered  to  be  one  of  the  most  virulent  of 
English  vegetable  poisons.     It  has  often  been  mistaken  for  celery. 

Symptoms  and  Appeai-airces. — In  1857,  two  cases  of  poisoning  with 
this  plant  occurred  at  West  Bolden,  in  Durham.  Two  laborers  ate  some 
of  the  roots  of  the  oenanthe.  They  were  found  soon  afterwards  lying 
insensible  and  speechless,  with  livid  faces,  swollen  and  protruded  tongues, 
and  there  were  convulsive  movements  of  the  jaws,  with  frothy  mucus  and 
blood  about  their  mouths  ;  the  eyes  full  and  projecting,  the  pupils  dilated, 
the  breathing  stertorous  and  labored,  with  occasional  general  convulsions. 
The  men  both  died  in  an  hour  and  a  half  from  the  time  at  which  thev  were . 
first  discovered.  On  ins^pection,  it  was  found  that  there  had  been  bleeding 
from  the  ears;  the  abdomen  was  livid  and  swollen.  The  stomach  con- 
tained a  gruel-like  liquid  with  some  of  the  partly  digested  roots;  on  re- 
moving this  liquid  the  lining  membrane  was  found  congested  and  softened. 
The  lungs  were  engorged  with  dark  liquid  blood,  and  the  blood  contained 
in  the  heart  was  in  a  similar  state.  Boyle,  in  whose  practice  these  cases 
occurred,  forwarded  to  the  author  a  portion  of  the  roots,  and  there  was  no 
doubt  that  they  were  the  roots  of  the  oenanthe  crocata.  Drinkwater  gives 
an  account  of  three  cases  of  poisoning  by  this  plant,  in  1875,  two  of  which 
proved  fatal.  It  seems  that  three  boys  ate  the  roots  and  stems  of  the 
plant,  which  they  supposed  to  be  wild  carrots.  They  had  a  sweet,  nuttv 
taste.  One  boy  complained  of  feeling  cold,  and  was  attacked  with  severe 
vomiting  and  purging.  After  this  he  recovered,  and  was  able  to  give 
evidence  at  the  inquest  on  his  two  companions.  A  second  boy  was  found 
dead  in  the  road  about  fifty  yards  from  the  brook  where  the  oenanthe  grew. 
He  had  vomited,  struggled,  and  been  violently  convulsed.  His  face  was 
black,  and  froth  had  escaped  from  his  mouth.  The  third  boy  was  found 
in  a  similar  condition — dead,  with  froth  about  his  mouth.  The  post-mortem 
e.Kaminatiou  revealed  congestion  of  the  brain  with  black  fluid  blood,  en- 
gorgement of  the  lungs  and  heart  with  the  same,  and  congestion  of  the 
mucous  membrane  of  the  stomach.  This  organ  contained  the  masticated 
root  of  the  oenanthe,  with  some  of  the  green  leaves.  (For  other  cases,  see 
Med.  Gaz.,  vol.  34,  p.  288.)  This  plant  is  equally  fatal  to  animals.  Cam- 
eron states  that  forty-three  oxen,  turned  into  a  pasture  in  which  the  oenanthe 
grew,  were  killed  by  eating  the  plant.  Foaming  at  the  mouth,  shivering, 
difficult  breathing,  tetanic  spasms,  with  pleurothotonos,  or  spasmodic  bend- 
ing of  the  bodv  to  one  side,  were  among  the  svmptoms.  (Lancet,  1873,  i. 
p.  918.) 

It  is  not  often  that  attempts  are  made  to  destroy  persons  by  the  admin- 
istration of  these  vegetable  poisons  ;  but  a  case  occurred  in  France  in  which 
a  woman  attempted  to  poison  her  husband  by  mixing  slices  of  the  root  of 
this  plant  with  his  soup.  His  suspicions  were  excited  by  the  acrid  taste 
of  the  soup.  The  woman  was  tried  for  the  crime,  and  Toulmouche  deposed 
at  the  trial  that  the  plant  from  which  the  root  had  been  taken  was  the 
oenanthe  crocata — that  it  was  a  powerful  poison,  and  mii-ht  cause  death  in 
two  or  three  hours.  The  prisoner  was  convicted.  (Gaz.  Med.,  Jan.  3, 
1846,  18;  also  Jour,  de  Chim.  Med.,  1854,  533.) 

Analysis. — The  oenanthe  crocata  can  be  identified  only  by  its  botanical 

characters.     The  leaves  are  of  a  dark-green  color,  with  a  reddish-colored 

border.     They  have  no  unpleasant  odor  when  rubbed.     The  seeds,  of  which 

an  illustration  is  annexed  (Fig.  34),  are  peculiar.    The  plant  bears  a  greater 

15 


226 


SYMPTOMS    PRODUCED    BY    FOOL'S    PARSLEY. 


resemblance  to  celery  than  mo»t  of  the  other  umbelliferte.  Its  stem  is  chan- 
nelled, round,  smooth,  and  branched,  of  a  yellowish-red  color,  and  growing 
to  the  height  of  two  or  three  feet.  The  root,  consisting  of  a  series  of  ob- 
long tubercules,  with  long  slender  fibres,  is  of  a  yellowish-white  color,  and 

Fig.  34. 


Seeds  of  CEnanthe  Crocata.    a,  Natural  size ;  h,  magnified  30  diameters,    c,  One-half 
of  a  Seed  magnified,    rf,  One-half  natural  size,    e,  Cjroup  of  t^eeds. 

not  unpleasant  to  the  taste.  It  is  the  mo.st  active  part  of  the  plant.  The 
leaves  yield  much  tannic  acid  to  water,  but  the  decoction  appears  to  con- 
tain no  alkaloidal  base,  since  the  chloride  of  potassium  and  mercury  pro- 
duces no  precipitate  in  it.  The  roots  and  stems  of  this  plant  are  more 
frequently  eaten  than  the  leaves  or  seeds. 


P'ool's  Parlsley  (^EiHrsA  cynapil'm). 

Fool's  Parsley,  or  Lesser  Hemlock,  is  very  common  in  gardens  and 
hedgerows.  The  leaves  so  closely  resemble  those  of  parsley  that  they 
have  often  been  gathered  by  mistake. 

Symfdoms  and  Appearances. — In  May,  1845,  a  girl,  aet.  five  years,  in 
good  health,  ate  the  bulbs  of  the  sethusa  by  mistake  for  young  turnips. 
She  was  suddenly  seized  with  pain  in  the  abdomen,  followed  by  a  feeling 
of  sickness ;  but  she  did  not  vomit.  She  complained  of  feeling  very  ill. 
On  trying  to  eat,  she  could  not  swallow.  She  was  incapable  of  answering 
questions,  and  her  countenance  bore  a  wild  expression.  The  lower  jaw 
became  fi.^ed,  so  as  to  prevent  anvthing  being 
•'^^o-  '^o-  introduced  into  the  mouth.     She  then  became 

insensible,  and  died  in  an  hour  from  the  com- 
mencement of  the  .symptoms:  so  far  as  could  be 
ascertained,  there  were  no  convulsions.  A  second 
child,  set.  three  years,  shortly  after  eating  the 
same  substance,  was  attacked  with  pain  in  the 
stomach,  sickness,  vomiting,  and  profuse  per.spi- 
ration.  She  soon  recovered,  with  the  exception 
of  suffering  severe  griping  pains  without  purg- 
ing;  but  the.^e  disappeared  on  the  following  day. 
A  third  child,  of  the  same  age,  suffered  from 
similar  symptoms.  Recovery  in  the  two  last 
cases  was  probably  due  to  the  plant  having  been 
eaten  on  a  full  .stomach,  and  to  the  effect  of  early 
and  copious  vomiting.  (Med.  Times,  Aug.  23, 
184.5,  p.  408.) 

This  plant  is  known  from  garden  parsley  by 
the  smell  of  its  leaves  when  rubbed,  which  is  peculiar,  disagreeable,  and 
very  different  from  that  possessed  by  the  leaves  of  parsley.     The  leaves 


Seeds  of  Fool's  Parsley. 
a,  Xatural  size. 
h.  Magnified  30  diameters, 
c,  Group  of  Seeds. 


WATER-PARSNIP LOBELIA.  227 

of  fool's  parsley  are  finer,  more  acute,  and  of  a  darker  green  color.  The 
seeds  are  also  peculiar.  They  are  rei)resented  in  the  annexed  illustration 
(Fig-.  35).  Its  flower-stem,  which  is  striated  or  slightly  grooved,  is  easily 
known  from  all  other  umbelliferous  plants  by  the  beard,  or  three  long 
pendulous  leaves  of  the  involucrum  under  the  flower.  The  flowers  are 
white,  whilst  those  of  the  garden  parsley  are  of  a  pale  yellow  color.  Jno. 
Harley  denies  the  existence  of  poisonous  properties  in  this  plant.  (See 
On  Poisons,  3d  edit.,  p.  745.) 

Water-parsnip. 

This  plant  (Stum  latifolium  and  S.  angnstifolium  or  S.  nodiflora)  is 
not  unlike  the  watercress,  for  which  it  has  been  mistaken.  Two  girls, 
aged  five  and  three  years  respectively,  died  in  1882  from  eating  the  leaves. 
After  these  were  eaten,  the  younger  child  became  suddenly  ill  and  died  ; 
while  the  other  succumbed  two  days  later.  (Brit.  Med.  Jour.,  1882,  ii. 
p.  26.) 

Indian  Tobacco  (Lobelia  inflata). 

The  powdered  leaves  of  Indian  tobacco  contain  an  alkaloid,  lobeline, 
capable  of  producing  poisonous  effects  on  the  brain  and  spinal  marrow, 
attended  with  irritation  of  the  stomach  and  bowels.     When  administered 
in  doses  of  from  ten  to  twenty  grains  lobelia  operates  as  an  emetic  ;  but 
in  larger  quantity  it  may  act  deleteriously.     In  one  case  a  man  lost  his 
life  by  swallowing  one  drachm  of  the  powdered  leaves^  prescribed  by  a 
quack.     This  person  was  seen  by  a  medical  practitioner  soon  after  taking 
the  poison  :  he  was  evidently  suffering  great  pain,  but  he  was  quite  uncon- 
scious— the  pulse  was  small,  and  the  pupils  were  strongly  contracted  and 
insensible  to  light.     He  had  vomited  the  greater  part  of  the  poison,  suf- 
fered from  spasmodic  twitchings  of  the  face,  sank  into  a  state  of  complete 
insensibility,  and  died  in  about  thirty-six  hours.     On  inspection,  some 
fluid  was  found  in  the  stomach,  but  none  of  the  powder.     The  gastric 
mucous  membrane  was  intensely  inflaiiied,   and  the  vessels  of  the  brain 
were  greatly  congested.     (Pharm.  Times,   1847,  p.   182.)     The  seeds  of 
lobelia  are  equally  poisonous.     In  the  Med.  Times  and  Gaz.,  1853,  ii.  p. 
568,  two  cases  are  reported  in  which  the  seeds  proved  fatal.     In  one,  the 
mucous  membrane  of  the  stomach  was  highly  inflamed.     Another  case  is 
referred  to  in  the  same  journal  (1853,  i.  p.  270).     There  have  been  many 
inquests  and  trials  for  manslaughter  in  this  country  as  the  result  of  the 
improper  administration  of  the  leaves  of  the  Lobelia  ivflata  by  ignorant 
quacks  (CofSnites)  calling  themselves  medical  botanists,  and  dealers  in 
vegetable  medicines.     The  medical  evidence  given  on   these  trials  has 
proved  that  in   large  doses  lobelia  is  a  most  noxious  drug.     (See  Med. 
Gaz.,  vol.  44,  pp.  383  and  433;  vol.  46,  p.  384;  Lancet,  1853,  i.  p.  237; 
Pharm.  Jour.,  Aug.  1851,  p.  87  ;  and  for  some  remarks  on  the  action  of 
the  poison,  see  a  paper  by  Curtis  and  Pearson,  Med.  Gaz.,  1850,  vol.  46, 
p.  285.)     Those  w^ho  profit  by  the  sale  of  this  drug  among  the  ignorant 
poor  maintain  the  doctrine  that  it  cannot  kill,  and  never  has  been  known 
to  destroy  life.     In  1856,  one  of  these  quacks  was  convicted  on  a  charge 
of  manslaughter  for  killing  a  w^oman  with  overdoses  of  lobelia.     Severe 
pain,  followed  by  loss  of  consciousness  and  congestion  of  the  brain,  w^as 
the  chief  symptom  preceding  death.     The  admission  that  in  proper  doses 
it  was  a  useful  remedy  in  spasmodic  asthma  was  of  no  avail  on  this  occa- 
sion.    The  man  was  sentenced  to  three  months'  imprisonment.     (Reg.  v. 
Boyden,   or  Jackson,  Lincoln  Sum.   Ass.,  1856.)     A  man  named  Riley 


228  POISONING    WITH    FOXGLOVE. 

Drake  was  convicted  in  the  United  States  of  having  caused  the  death  of 
a  woman  by  administering  lobelia  in  improper  doses.  (Wharton  &  Stille's 
Med.  Jur.,  p.  522.)  In  1882,  a  man  sufl'ering  from  heart-disease,  and  who 
was  an  enormous  eater,  took  as  an  emetic  a  medicine  containing  lobelia 
prepared  from  CoflSn's  prescriptions.  At  the  post-mortem  examination, 
made  twelve  hours  after  death,  an  aperture  about  the  size  of  a  goose-quill 
was  found  in  the  lesser  curvature  of  the  stomach,  and  about  two  pints  of 
liquid  having  a  milky  appearance  in  the  peritoneal  cavity.  The  stomach 
itself  contained  lobelia  seeds  and  cayenne  pepper.  The  dictum  of  the  so- 
called  Coffinites  is  that  "heat  is  life;  and  the  want  of  heat,  disease  and 
death."  In  accordance  with  their  principles,  their  drugs  are  lobelia  and 
cayenne.  (Brit.  Med.  Jour.,  1882,  2,  p.  24.)  In  1884  (Reg.  v  Wallis, 
C.  C.  C,  Jan.  1884),  an  herbalist  was  acquitted  when  tried  for  the  man- 
slaughter of  an  invalid  woman  named  Sainsbury.  The  deceased,  who  was 
suffering  from  chronic  lung-disease,  took  some  of  the  prisoner's  medicine, 
the  essential  ingredient  of  which  was  lobelia.  She  died  in  a  few  minutes. 
At  this  trial  many  herbalists,  and  two  medical  men,  swore  that  lobelia  was 
not  a  poison.  The  editor  believes  that,  when  full  doses  are  given,  the 
safety  of  the  patient  is  usually  insured  by  the  copious  vomiting  that 
ensues.  When  vomiting  does  not  supervene,  death  may  ensue.  The 
woman  Sainsbury  died  quickly  without  having  vomited. 

Lobelia  is  seen  in  the  form  of  a  greenish-colored  powder  (fragments  of 
leaves).     This  powder  acquires  a  reddish-brown  color  with  strong  nitric 
acid,  and  is  blackened  by  concentrated  sulphuric  acid.     Iodine  water  has 
no  effect  upon  the  infusion.     Ferrous  sulphate  and 
ferric  chloride  produce  with  it  a  dark-green  color 
— the  ferric  chloride  very  rapidly.     The  leaves  and 
seeds  contain  an  acrid  substance  called  Lohelacrin. 
It  acts  as  a  powerful  emetic  in  doses  of  from  one- 
half  to  one  grain.     The  leaves  of  lobelia  are  gene- 
rally seen  in  fragments  which  do  not  readily  admit 
of  identification  by  the  microscope.     The  seexh  are 
very  small,  of  a  lengthened  oval  shape  (Fig.  36), 
^  „     ^=*     „  reticulated  on  the  surface  with  projecting  hairs  or 

"  "^   "^  °    "  fibres,  and  of  a  light-brown  color.     The  discovery 

Seeds  of  Lobelia,  of  them  among  the  fragments  of  leaves  would  fur- 

«,  Natural  size  Y\\sh  a  Sufficient  proof  of  the  presence  of  lobelia, 

6,  Magnified /O  diameters.  ^  ,,_,     i  .^^    ,,.      ^      ^r>/^^     -i  t 

In  one  case  (Keg.  v.  Wallis,  p.  220),  the  editor 
succeeded,  by  a  modification  of  Stas's  process  (see  Strychnine,  p.  221, 
ante),  in  extracting  a  quantity  of  the  alkaloid,  lobeline,  from  the  stomach 
of  the  deceased  woman.      Lobeline  is  similar  to  nicotine  in  its  properties. 

Foxglove  (Digitalis  purpurea).     Digitalin. 

Purple  foxglove  is  a  well-known  hedge-plant  growing  abundantly  in 
England.  All  parts  of  the  plant — the  seeds,  leaves,  and  root — are 
poisonous,  owing  to  the  presence  of  the  poisonous  principle  digitaliv. 
The  leaves,  whether  in  the  form  of  powder,  infusion,  extract,  or  tincture, 
exert  an  action  on  the  brain  and  spinal  marrow,  as  well  as  on  the  stomach 
and  bowels.     They  retain  their  noxious  properties  when  dried. 

Symptoms  artd  IJJfects. — Cases  of  poisoning  with  foxglove  are  not  very 
common.  A  boy  who  took,  by  the  advice  of  a  quack,  six  ounces  of  a 
strong  decociion  of  the  leaves,  suffered  from  vomiting,  purging,  and  severe 
pain  in  the  abdomen.  After  some  time  he  became  lethargic,  and  slept  for 
several  hours;  in  the  ni^ht  he  was  seized  with  convulsions.     The  pupils 


POISONING    WITH    FOXGLOVE.  .  229 

were  dilated  and  insensible  to  light;  the  pulse  was  slow,  small,  and  irreg- 
ular ;  coma  followed,  and  the  boy  died  twenty-two  hours  after  taking  the 
poison.  On  inspection,  the  membranes  of  the  brain  were  found  much 
injected,  and  the  mucous  membrane  of  the  stomach  was  partially  inflamed. 
The  prisoner  was  acquitted  of  the  charge,  because  he  had  only  given  his 
fatal  advice  on  the  application  of  the  friends  of  the  deceased.  (Ed.  Med. 
and  Surg.  Jour.,  57,  p.  223.)  A  young  man  swallowed  a  strong  decoctio7i 
of  foxglove  by  mistake  for  purgative  medicine.  He  was  soon  seized  with 
vomiting,  pain  in  the  abdomen,  and  purging.  In  the  afternoon  he  fell 
asleep.  At  midnight  he  awoke,  was  attacked  with  violent  sickness,  colic, 
and  convulsions  ;  the  pupils  were  dilated  and  insensible  to  light,  the  pulse 
slow  and  irregular.  He  died  twenty-two  hours  after  taking  the  poison. 
(Wibmer.)  A  few  grains  of  the  powdered  leaves  have  been  known  to 
produce  giddiness,  languor,  dimness  of  sight,  and  other  nervous  symp- 
toms. A  drachm  has,  however,  been  taken  without  causing  death  ;  but  in 
this  instance  it  produced  violent  vomiting.  A  common  effect  of  this 
poison  is  to  produce  great  depression  of  the  heart's  action.  "  Blue-vision" 
is  said  to  be  a  not  uncommon  occurrence  in  poisoning  by  digitalis  ;  i.  e. 
the  patient  sees  all  objects  as  it  were  of  a  blue  color.  Tardieu  has  also 
described  a  blue  condition  of  the  sclerotic  coat  of  the  eye  as  characteristic 
of  poisoning  by  digitalis  and  digitalin. 

When  foxglove  has  been  taken  in  substance,  i.  e.  in  the  form  of  seeds  or 
leaves,  or  any  portion  of  these  has  been  swallowed  in  a  decoction  or  infu- 
sion, fragments  may  be  found  in  the  stomach  and 
bowels.     In   reference    to    the    infusion,  decoction, 
tincture,  or  extract,  except  there   be   sufficient  to 
allow  of  the  separation   of   digitalin,  there   is  no 
chemical  process  known  by  which  the  poison  may 
be   recognized.      If    any  fragments   of    leaves    or 
seeds  are  found  in  the  contents  of  the  stomach  or 
in  food,  they  may  be  identified  by  the  aid  of  the 
microscope.      The  illustration  (Fig.  37)  represents       ''""v/i^i"'"" 
the  seeds  of  foxglove ;  they  are  of  a  reddish-brown 
color,  very  small,  oblong,  and  somewhat  angular  in  Seeds  of  Foxglove. 

shape.     They  have  peculiar  markings.     By  the  aid      6,' Magnmed  so  diameters. 
of  the  microscope,  they  may  be  easily  distinguished 

from  the  seeds  of  hyoscyamus,  datura,  belladonna,  and  most  other  poison- 
ous plants. 

Digitalin  is  an  active  substance  obtained  from  digitalis.  The  French 
and  German  articles  are  not  identical ;  and  both  are  amorphous  mixtures 
of  several  chemical  substances.  German  digitalin  is  chiefly  used  in  this 
country.  The  physiological  actions  of  digitalin  (so  called)  have  been 
investigated  by  Homolle  (Jour,  de  Pharm.,  Jan.  1845),  by  Bouchardat 
(Ann.  de  Therap..  18fi4,  p.  155),  by  Fagge  and  Stephenson  (Guy's  Hosp. 
Rep.,  1866,  p.  37),  and  others.  Commercial  digitalin  operates  as  a  poison 
on  man  and  animals  in  very  small  doses.  One-sixteenth  of  a  grain,  which 
is  considered  to  be  equal  to  eight  grains  of  the  well-prepared  powder  of 
the  dried  leaves,  is  sufficient  to  cause  symptoms  of  poisoning.  Doses  of 
from  1-1 1th  to  l-32d  part  of  a  grain  have  lowered  the  pulse  and  caused 
nausea,  vomiting,  griping,  purging,  and  an  increased  secretion  of  urine. 
(Pereira,  Mat.  Med,,  vol.  2,  p.  528.)  Doses  of  from  one-quarter  to  one-half 
of  a  grain  would  probably  prove  fatal.  Digitalin  has  acquired  some 
notoriety  by  reason  of  the  trial  of  Dr.  De  la  Pommerais,  at  Paris,  in  May 
1864,  for  the  murder  of  a  woman  named  Pauw.  (See  On  Poisons,  3d 
edit.,  p.  801 ;  Ann.  d'Hyg.,  1864,  t.  2,  p.  105.)     Xativelle  has  obtained  a 


230  .  POISONING    WITH    MONK'S-HOOD. 

crystallized  digifalin  from  the  foxglove.  This  was  found  bj  Goerz  to  be 
phj'siologically  inactive.  It  is  associated  in  commercial  digitalia  with 
digitalein,  which  possesses  all  the  physiological  activity  of  digitalis. 

The  bark,  seeds,  berries,  and  leaves  of  the  Mezereon,  Privet,  Holly,  and 
Guelder  rose  have  in  a  few  cases  given  rise  to  symptoms  of  poisoning. 
These  poisons  alfect  the  brain  and  the  alimentary  canal,  producing  vomit- 
ing and  purging,  followed  by  insensibility  and  convulsions.  Accidents 
from  these  plants  are  not  frequent,  and  when  they  occur  there  is  usually 
sufficient  botanical  evidence  of  the  nature  of  the  poison  taken. 

MONK'S-HOOD    (ACONITUM   NAPELLLS).       ACONITINE. 

This  well-known  garden  plant  is  in  some  parts  of  the  country  called 
Wolffs-bane,  and  in  Ireland  Blue-rocket.  The  roots,  seeds,  and  leaves 
are  highly  poisonous,  owing  to  the  presence  of  the  alkaloid  aconitive ; 
the  root  is  especially  noxious,  and  when  the  leaves  have  fallen  off  it 
appears  to  possess  its  greatest  virulence.  These  parts  of  the  plant,  when 
masticated,  produce  a  peculiarly  cool,  numbing  sensation,  affecting  the 
lips,  tongue,  and  interior  of  the  mouth  generally.  At  first  the  root 
appears  to  be  tasteless,  as  the  effects  are  only  strongly  manifested  after  a 
^Qw  minutes.  After  tasting  only  a  small  portion  of  the  dried  root,  this 
disagreeable  sensation  remains  on  the  tongue  and  lips  for  several  hours. 
In  larger  quantity  the  taste  has  been  described  as  burning,  and  it  is  fol- 
lowed by  a  hot,  acrid  sensation  in  the  throat,  and  salivation. 

The  roots  of  Aconitum  ferox,  the  Indian  bikh  or  bisch,  and  those  of 
Japanese  aconite  from  A.  Fischeri,  are  also  articles  of  commerce,  and  are 
as  poisonous  as  the  ordinary  A.  vapellus.  The  official  tincture,  Fleminrfs 
tincture,  the  extract,  the  alcoholic  extract  (not  official),  and  the  liniment, 
may  all  be  productive  of  fatal  results. 

Symptoms  and  Appearances. — In  from  three  to  five  minutes  after 
chewing  the  root  of  aconite,  or  after  contact  of  any  of  its  preparations 
with  the  tongue,  a  hot,  burning,  astringent  sensation  is  experienced  on 
the  tongue,  extending  to  the  fauces  and  to  the  lips,  especially  the  lower 
one.  The  sensation  soon  becomes  very  severe,  and  is  accompanied  by  a 
certain  amount  of  salivation  and  a  sensation  of  swelling  in  the  fauces,  and 
there  may  be  difficulty  in  swallowing.  The  sensation  is  described  by 
some  as  one  of  numbness,  and  there  is  a  decided  loss  of  sensation  locally. 
Later  the  feeling  is  one  as  if  the  tongue  had  been  seared  with  a  hot  iron. 
Vomiting  generally  sets  in  in  an  hour  or  two  at  the  latest ;  and  is  usually 
severe  and  spasmodic.  The  patient  feels  cold,  especially  in  the  extremi- 
ties, and  the  skin  is  cold,  clammy,  and  perspiring.  There  may  be  a  feel- 
ing of  numbness  extending  over  the  whole  body,  or  a  sensation  of  impend- 
ing paralysis.  Poisoning  by  the  root  of  aconite  is  by  no  means  unfre- 
quent.  In  the  sprinii-  or  autumn,  the  root  is  liable  to  be  mistaken  for  that 
of  horse-radish.  It  has  been  thus  accidentally  eaten  on  several  occasions, 
and  has  caused  death.  A  mi.stake  of  this  kind  led  to  fatal  results  in  three 
hours  in  a  case  which  occurred  at  Lambeth;  and  another  set  of  cases 
occurred  at  Dingwall,  in  1850.  Here  three  persons  were  poisoned  by 
reason  of  their  having  had  sauce  made  with  the  root  of  aconite,  .=erved  at 
dinner  with  roast  beef  in  place  of  horse-radish  sauce.  They  were  healthy 
adults,  and  all  died  within  three  hours  and  a  half.  These  mistakes  show 
deplorable  ignorance,  but  there  is  always  the  ri.<k  of  their  occurrence  when 
horse-radish  and  aconite  are  groAvn  near  to  each  other  in  a  garden,  at  that 
season  of  the  year  when  the  leaves  have  fallen. 


POISONINa    WITH    ACONITE.  231 

A  trial  for  murder  by  poisoning  with  the  root  of  this  plant  took  place 
at  the  Monaghan  Lent  Assizes  in  1841  (Reg.  v.  McKonkey),  in  which 
Geoghegan  conducted  the  medico-legal  investigation.  The  medical  evi- 
dence was  beset  with  difficulties,  for  no  trace  of  the  poison  could  be  dis- 
covered in  the  body  ;  and  it  was  only  by  a  close  analysis  of  symptoms  and 
appearances  that  the  charge  was  brought  home  to  the  prisoner.  The 
deceased  had  eaten  for  his  dinner  some  greens  dressed  for  him  by  the 
prisoner,  and  complained  of  their  having  a  sharp  taste;  and  this  was 
perceived  also  by  another  person  present  who  tasted  them.  It  was  ascer- 
tained that  soon  after  the  meal  the  deceased  had  vomited  a  greenish 
matter,  and  suffered  from  purging,  restlessness,  incoherence,  lockjaw,  and 
clenching  of  the  hands.  He  died  in  about  three  hours  after  having  eaten 
the  greens,  but  was  not  seen  by  a  medical  man  while  living.  The  chief 
appearance  met  with  was  in  the  stomach,  where  the  mucous  membrane 
Avas  of  a  light,  reddish-brown  color.  Traces^  of  vegetable  matter  were 
found  in  the  intestines;  but  no  poison  could  be  detected,  either  by  botani- 
cal characteristics  or  chemically.  The  symptoms  suffered  by  a  friend  of 
the  deceased,  who  had  accidentally  tasted  the  greens,  were  very  charac- 
teristic of  poisoning  by  aconite.  In  tivo  minutes  he  felt  a  burning  heat  in 
the  mouth,  throat,  gullet,  and  stomach  ;  then  a  sensation  of  swelling  in 
the  face,  with  a  general  sensation  of  numbness  and  creeping  of  the  skin. 
Restlessness,  dimness  of  sight,  and  stupor  almost  amounting  to  insensi- 
bility, followed ;  and  in  about  an  hour  after  the  meal  he  was  found 
speechless,  frothing  at  the  nose  and  mouth,  the  hands  and  jaws  clenched, 
appearing  occasionally  as  if  dead,  and  then  again  reviving.  There  was 
vomiting,  purging,  tenderness  at  the  pit  of  the  stomach,  cramps,  tingling 
of  the  flesh,  and  a  burning  taste  in  the  mouth  followed.  This  man  did 
not  entirely  recover  until  after  the  lapse  of  five  weeks.  The  prisoner  was 
convicted  of  murder,  and  confessed  before  her  execution  that  the  powdered 
root  of  aconite  had  been  mixed  with  pepper  and  sprinkled  over  the  greens. 
(Dub.  Med.  Jour.,  vol.  19,  p.  403.) 

The  tincture  of  the  root  is  a  powerful  poison.  In  1853,  a  woman  took 
by  mistake  seventy  minims  of  Fleminrfs  tincture  of  the  root  mixed  with 
one  grain  of  acetate  of  morphine.  In  a  few  minutes  she  became  very 
thirsty,  complained  of  a  burning  sensation  and  pain  in  her  stomach,  to 
relieve  which  she  swallowed  a  quantity  of  cold  water.  In  fifteen  minutes 
there  was  violent  vomiting,  which  continued  for  two  hours.  She  lost  the 
power  of  standing  and  was  very  restless.  The  pain  in  the  stomach 
increased,  and  there  were  convulsive  movements  of  the  muscles.  She  was 
conscious  until  shortly  before  her  death,  which  took  place  in  about  four 
hours  after  she  had  taken  the  poison.  There  were  no  general  convulsions : 
the  pain  in  the  stomach  was  well  marked  throughout.  On  inspection,  the 
membranes  of  the  brain  were  congested,  but  the  brain  itself  was  firm  and 
healthy.  The  lungs  were  healthy,  the  heart  flaccid,  the  womb  congested. 
The  stomach  contained  some  mucus,  and  the  lining  membrane  at  the 
larger  curvature  was  reddened  in  patches,  but  otherwise  natural.  The 
mucous  membrane  of  the  duodenum  was  in  a  high  state  of  inflammation, 
partially  abraded,  softened,  and  broken  down.  Some  spots  were  of  a  very 
dark  color,  passing  into  gangrene.  In  1852,  an  Excise  officer  lost  his  life 
by  merely  tasting  Fleming's  tincture  of  aconite,  under  the  supposition  that 
it  was  flavored  spirit.  He  was  able  to  walk  from  the  custom  house  over 
London  Bridge ;  but  he  died  in  about  four  hours  after  tasting  the  poison. 

The  case  of  the  man  Hunt,  who,  in  Nov.  18(^3,  destroyed  his  wife  and 
children  by  prussic  acid,  and  himself  by  aconite,  presents  some  features 
of  interest  in  reference  to  the  symptoms  and  appearances  produced  by 


282  roisoNiNG  with  aconite — fatal  dose. 

the  tincture.  The  quantity  taken  by  him  was  not  determined  ;  but  the 
man  was  soon  afterwards  seized  with  violent  spasmodic  retching-;  the  face 
was  pale,  the  skin  cold  and  clammy,  the  pulse  small  and  hardly  percept- 
ible, and  the  action  of  the  heart  feeble.  The  pupils  were  much  dilated, 
and  the  eyes  brilliant  and  sparkling  ;  the  breathing  was  quiet  and  regular, 
except  during  the  spasms.  He  complained  of  pain  in  his  heart.  In 
attempting  to  walk  he  staggered,  and  had  no  power  to  raise  his  arms. 
He  was  perfectly  conscious,  called  for  writing  materials,  and  wrote  a  few 
lines.  He  then  became  suddenly  worse,  and  a  quarter  of  an  hour  before 
his  death  lost  all  power  and  sensation  in  his  limbs,  the  sharpest  pinches 
producing  no  impression.  The  pulse  was  imperceptible.  There  were  no 
convulsions,  but  complete  relaxation  of  the  limbs  at  death  from  syncope 
three-quarters  of  an  hour  after  he  had  taken  the  poison.  On  inspection, 
forty-two  hours  after  death,  there  was  great  rigidity  of  the  muscles.  The 
substance  of  the  brain  wasJirm  and  healthy  ;  the  vessels  on  the  surface 
were  filled  with  blood.  The  heart  was  healthy;  the  right  side  was  greatly 
distended  with  dark  fluid  blood  ;  the  left  side  contracted  and  quite  empty. 
The  lungs  were  healthy.  In  the  abdomen  the  viscera  were  healthy,  with 
the  exception  of  the  stomach  and  duodenum.  There  Avas  great  capillary 
congestion  at  the  larger  end  of  the  stomach,  the  mucous  membrane  having 
a  bright  red  color.  There  were  marks  of  irritation,  with  softening  and 
separation  of  the  mucous  lining,  the  whole  of  the  membrane  being  in  a 
highly  corrugated  condition.  Traces  of  an  alkaloid  were  found  in  the 
contents  of  the  stomach.  The  deceased  had  provided  himself  with  an 
ounce  of  the  tincture  of  aconite,  and  had  swallowed  the  greater  part  of 
this  mixed  with  water. 

In  ]884  the  editor  met  with  two  fatal  cases  of  poisoning  by  mixtures 
of  aconite  and  belladonna  liniments.  The  symptonis  differed  in  no  way 
from  those  of  aconite-poisoning,  except  that  the  pupils  w^ere  markedly 
dilated.  In  one  of  these  cases  he  obtained  aconitine  and  atropine  from  the 
stomach  of  the  deceased  woman,  as  was  proved,  not  only  by  the  chemical, 
but  also  by  the  physiological  properties  of  the  alkaloids.  A  similar  case 
has  been  recently  reported.     (Brit.  Med.  Jour.,  1885,  i.  p.  327.) 

Fatal  Dose. — Of  the  root  f'O  grains  have  proved  fatal,  but  it  is  probable 
that  this  is  much  in  excess  of  the  minimum  fatal  dose.  Of  the  pharmaco- 
posial  tincture  two  or  three  drachms  might  probably  be  fatal.  Fleming''s 
tincture  is  six  times  as  strong,  and  twenty-five  minims  have  killed  an 
adult.  Four  grains  of  alcoholic  extract  have  proved  fatal.  Of  the  official 
(non-alcoholic)  extract  two  grains  have  proved  fatal.  It  is  very  uncer- 
tain in  its  action  ;  but  is  much  less  active  than  the  alcoholic  extract.  The 
liniment  is  stronger  than  even  Fleming's  tincture,  and  eight  times  the 
strength  of  the  pharmacopoeial  tincture  ;  twenty  minims  would  probably 
be  a  fatal  dose. 

Analysis. — The  botanical  characters  of  the  leaves  and  root,  when  any 
portions  can  be  obtained,  will  enable  a  medical  witness  to  identif}^  this 
vegetable  poison.  The  root  has  been  frequently  and  fatally  mistaken  for 
horse-radish,  but  there  are  these  striking  diflerences :  1.  Aconite  root  is 
very  short,  conical,  and  tapers  rapidly  to  a  point  (Fig.  38,  p.  233).  2.  It 
is  externally  of  an  earthy-brown  color,  internally  white,  and  of  an  earthy 
smell,  and  the  cut  surface  is  rapidly  reddened  by  exposure  to  air.  It  has 
numerous  long,  thin  fibres  proceeding  from  it.  3.  It  has  at  first  a  bitter 
taste,  but  after  a  quarter  of  an  hour  or  twenty  minutes  it  produces  a  dis- 
agreeable sense  of  tingling  and  numbness  on  the  lips  and  tongue,  4. 
Horse-radish  root  is  long,  cylindrical,  or  nearly  so,  and  of  the  same  thick- 
ness for  man}'  inches  (Fig,  39,  p.  233).     It  is  externally  yellowish-white, 


poIso^MNG  "WITH  aconitine. 


233 


and  has  o.  punii^ent  odor  when  scraped.     5    The  taste  of  horse-radish  is 
sometimes  bitter,  but  it  produces  an  immediate  hot  or  pungent  sensation. 


Fig.  38. 


Fig.  39. 


Root  of  Aconite. 


Root  of  Horse-radish. 


Fig.  40. 


The  leaves  of  monk's-hood  are  of  a  dark  green  color  and  of  a  peculiar 
shape.  When  masticated  they  slowly  produce  on  the  lips  and  tongue  the 
persistent  sense  of  tingling  and  numbness,  with 
the  sense  of  coolness,  observed  in  the  root. 
They  are  less  powerful  than  the  roots  and  seeds. 
The  seeds  are  dark-colored  and  differ  in  appear- 
ance from  those  of  other  poisonous  plants 
(Fig.  40). 

AcoNiTiNE — The  chief  alkaloid  of  A.  napel- 
Itdi  is  acomtine,  aconitia,  or  oconitina  ;  and  is, 
perhaps,  the  most  formidable  known  poison, 
the  fatal  dose  being  probably  one-twentieth  of 
a  grain.  A.  ferox  contains  a  closely  allied 
alkaloid  known  as  pHeudaconUiiiP. ;  and  Japan- 
ese aconite  roots  yield  a  third  alkaloid  jopa- 
conitine.  The  editor  has  found  that  all  these 
alkaloids  are    toxic,    producing   similar  effects 

when  administered  to  animals,  and  that  they  are  of  almost  equal  physi- 
ological activities.  Commercial  samples  of  aconitine  are  of  varying  de- 
grees of  activity  and  purity;  most  of  the  German  or  "  exotic  "  varieties 


a,  Seed  of  Aconite,  natural  size. 
6,  The  same  luagnitied  30  diame- 
ters. 


23-t  POISONING    WITH    ACONITINE. 

being  comparatively  Inert.  Pseudaconitine  and  japacom'tine  are  not  arti- 
cles of  commerce.  The  statement  ot  some  authors  that  the  special  prepar- 
ation known  as  Morson's  is  pseudaconitine,  prepared  from  the  roots  of  the 
Indian  plant,  is  incorrect.  The  inertness  of  the  exotic  preparations  is  due 
to  admixture  with  other  and  inert  alkaloids,  partly  existent  in  the  plant, 
and  partly  the  products  of  decomposition  during-  the  manufacture.  In- 
deed, the  active  alkaloids  aconitine,  psaudaconitine,  and  japaconitine 
readily  undergo  a  kind  of  saponification  and  split  up  into  an  acid  and  a 
comparatively  inert  basic  body.  Thus  aconitine  in  ammoniacai  mixture 
speedily  splits  up  into  another  base,  aconine,  and  benzoic  acid. 

In  1880,  three  cases  of  poisoning  with  crystallized  nitrate  of  aconitine 
occurred  in  Holland  (Schmidt's  Jahresb.,  Bd.  189,  p.  122;  Berl.  Klin. 
Wochenschr.,  1880,  p.  337)  ;  and  one  of  them  proved  fatal.  The  first  was 
the  case  of  a  weakly  man,  sixty-one  years  of  age,  suffering  from  chronic 
bronchitis  and  a  febrile  attack.  For  this  there  Avas  prescribed  a  solution 
of  nitrate  of  aconitine.  The  patient  took  five  drops  containing  0.006  of  a 
grain  of  the  nitrate,  at  7  P.  M.  This  produced  an  astringent  and  burning 
taste  in  the  mouth  extending  to  the  stomach.  At  9  P.  M.  the  dose  was 
increased  to  twentv  drops  (=0.025  of  a  grain)  ;  and  this  dose  was  re- 
peated at  8  A.  M.,  11  A.  M.,  4  P.  M.,  9  P.  M.  ;  next  day,  at  10  P.  M.,  a  final 
dose  of  ten  drops  (=0.012  grain)  was  taken.  In  all  one-seventh  of  a  grain 
of  the  nitrate  was  taken  in  seven  doses.  After  every  dose  the  patient  was 
seriously  indisposed,  so  that  eventually  his  life  was  in  jeopardy.  The 
symptoms  were  a  feeling  of  coldness,  cold,  clammy  perspiration,  severe 
vomiting,  difficult  respiration,  great  lassitude,  and  the  patient  felt  as  if  he 
were  about  to  become  paralyzed.  There  were  intermittent  deafness  and 
blindness,  and  spasmodic  twitchings  of  the  whole  body,  but  more  especi- 
ally of  the  muscles  of  the  face.  At  one  time  he  felt  that  he  was  dying, 
aud  stated  that  he  had  been  poisoned.  The  respiration  became  stertorous 
and  quickened  ;  then  slow  and  gasping.  There  was  no  loss  of  conscious- 
ness. It  is  not  stated  that  there  was  any  loss  of  sensation  or  any  actual 
paralysis. 

In  the  second  case,  a  man,  set.  68,  took  an  undetermined  dose  of  the 
same  medicine.  When  seen  he  had  cold,  clammy  perspiration,  a  weak, 
irregular,  dicrotic  pulse,  and  was  conscious.  The  respirations  were  short, 
labored,  irregular,  and  superficial.  The  pupils  were  contracted  and  re- 
sponded feebly  to  light.  There  was  no  difficulty  in  swallowing.  There 
was  great  ]:)recordial  anxiety,  and  fades  hipj^od'atica.  Suddenly,  the 
pulse  entirely  ceased,  though  the  cardiac  beats  could  still  be  feebly  heai'd  ; 
and  a  deathly  pallor  supervened.  The  patient  rolled  from  side  to  side  of 
the  bed.  The  pupils  were  now  dilated.  Tonic  convulsions  of  the  facial 
muscles  set  in,  with  trismus  ;  then,  three  hours  after  the  dose,  clonic  con- 
vulsions, and  the  patient  lost  consciousness.  In  five  or  six  minutes  mus- 
cular relaxation  ensued,  but  the  convulsions  returned  in  a  quarter  of  an 
hour.  An  hour  later  death  appeared  imminent  Vomiting  now  set  in, 
the  pulsG  improved,  and  in  twenty-one  hours  the  man  was  convalescent. 

The  third  case  terminated  fatally.  Dr.  Mayer,  who  had  prescribed  for 
the  above  patients,  himself  took  from  fifty  to  sixty  drops  of  the  solution 
of  nitrate  of  aconitine  prescribed  for  the  first  patient.  This  corresponds 
to  l-13th  to  l-21st  of  a  grain  of  the  nitrate.  It  may  be  assumed  that  the 
do.se  was  probal)ly  l-16th  of  a  grain.  The  symptoms  commenced  in  an 
hour  and  a  half;  but  they  were  not  accurately  noted  till  8  P  M.,  four 
hours  after  the  alkaloid  had  been  taken.  He  was  then  found  with  a  small, 
weak,  irregular,  but  not  slowed  pulse,  cold  skin,  and  contracted  pupils. 
He  had  an  astringent  and  burning  pain  in  the  mouth,  extending  to  the 


POISONING    WITH    ACONITINE.  235 

stomach,  and  difficulty  in  swallowing'.  The  tong-ue  was  swollen.  There 
was  great  precordial  anxiety.  He  complained  of  burning  pain,  weakness, 
and  heaviness  of  the  limbs — especially  the  lower,  which  felt  cold.  Sud- 
denly, vision  was  lost,  and  the  pupils  became  dilated.  Soon,  however, 
they  again  contracted,  and  vision  was  restored.  Vomiting  was  procured 
by  tickling  the  fauces.  At  4.40  P.  M.  severe  convulsions  set  in,  with 
stertorous  respiration,  singing  in  each  ear  alternately,  and  deafness. 
Ether  was  employed  hypodermically,  and  its  use  was  followed  by  re- 
newed vomiting  and  convulsions.  The  pulse  nevertheless  improved,  and 
ether  was  again  injected.  In  a  few  minutes  there  was  a  renewal  of  severe 
vomiting  and  convulsions,  and  the  patient  became  unconscious  ;  the  pulse 
failed,  and  death  ensued  at  9  P.  M.,  without  return  of  consciousness,  five 
hours  after  the  administration  of  the  fatal  dose.  On  post-mortem  exam- 
ination, the  viscera  were  unusually  charged  with  blood,  and  there  was  con-, 
siderable  hyperaemia  of  the  stomach  and  small  intestines,  so  that  the  colon 
and  rectum  appeared  pale  and  bloodless  by  contrast.  The  intestines  con- 
tained feces,  there  having  been  no  stool  passed  during  the  illness ;  and  the 
bladder  contained  two  ounces  and  a  half  of  urine. 

In  these  cases  it  was  intended  to  give  Friedlander's  nitrate  of  aconitine 
— a  weak  German  preparation.  The  dispenser  used  instead  a  crystallized 
preparation  procured  from  Petit,  in  Paris.  Plugge,  to  whom  the  analvsis 
was  referred,  found  that  Petit's  preparation  was  eight  times  more  poison- 
ous to  animals  than  Merck's,  and  110  times  stronger  than  Friedlander's 
nitrate.     He  failed  to  detect  aconitine  in  a  benzene  extract  of  the  viscera. 

Alarming  results  have  also  been  known  to  result  from  the  administra- 
tion of  pills,  each  containing  l-250th  of  a  grain  of  aconitine,  four  times  a 
day.  The  symptoms  were  developed  on  the  second  day.  (Lancet,  1880, 
ii.  p.  46.) 

In  1882  a  medical  practitioner  named  Lamson  was  tried,  convicted,  and 
executed  for  the  murder  of  his  brother-in-law,  Percy  Malcolm  John. 
(Reg.  V.  Lamson,  C.  C.  C,  March,  1882.)  This  is  the  only  known  case 
of  the  homicidal  use  of  aconitine;  and  the  only  recorded  case  of  fatal  poi- 
soning by  English  (Morson's)  aconitine.  On  Dec.  3,  1881,  Lamson  visited 
his  brother-in-law,  set.  19,  who  was  at  a  school  in  Wimbledon.  John, 
though  a  cripple,  and  paralyzed  below  the  pelvic  region,  was  in  good 
health  at  that  time.  In  the  presence  of  the  master  Lamson  gave  to  John 
a  gelatine  capsule,  which  he  pretended  to  fill  with  sugar,  but  into  which 
he  had  no  doubt  introduced  a  fatal  dose  of  aconitine — perhaps  the  whole 
of  two  grains,  which  he  had  purchased  a  few  days  previously.  This  was 
done  under  the  pretence  of  showing  the  youth  how  to  use  the  capsules  for 
taking  nauseous  medicines.  Lamson  then  made  a  hasty  departure. 
Twenty  minutes  or  half  an  hour  after  swallowing  the  capsule  the  victim 
was  seized  with  pain  in  the  stomach,  which  he  at  first  called  heartburn, 
and  which  he  compared  to  pain  which  he  had  experienced  on  a  former 
occasion,  when  Lamson  had  given  him  what  professed  to  be  a  quinine 
pill  or  powder.  In  a  box  belonging  to  John  there  was  found,  after  his 
death,  a  packet  of  quinine  powders,  some  of  which  were  mixed  with  aconi- 
tine, w^iilst  others  were  free  from  that  poison  ;  and  also  pills  containing 
quinine  and  aconitine.  There  is  no  doubt  that  attempts  had  been  made 
on  John's  life  on  two  previous  occasions,  by  the  administration  of  these 
articles  furnished  to  his  brother-in-law  by  Lamson.  The  boy  was  taken 
upstairs,  and  he  vomited  and  was  in  great  pain.  He  said  his  skin  felt  all 
drawn  up,  and  that  his  throat  burned.  When  seen  by  Berry,  one  hour 
and  forty  minutes  after  the  administration  of  the  poison,  he  was  lying  on 
the  bed,  with  great  pain  in  the  stomach.     He  complained  of  the  skin  of  his 


236  POISONING    WITH    ACONITINE. 

face  being-  drawn,  of  a  sense  of  consti'iction  m  the  throat,  and  of  being 
unable  to  swallow.  He  retched  violently,  and  vomited  a  small  quantity 
of  dark-brown  fluid.  Half  an  hour  later  he  was  also  seen  by  Little,  and 
two  hours  and  three-quarters  after  the  poison  Avas  SAvallowed  a  quarter  of 
a  grain  of  morphine  was  injected  beneath  the  skin.  This  somewhat  eased 
the  patient's  agony  ;  but  the  sjanptoms  returned  with  increased  severity. 
At  one  time  he  was  with  difficulty  kept  lying  down  by  the  united  force  of 
two  men.  An  hour  later  the  morphine  injection  was  repeated — one-sixth 
of  a  grain  being'  used.  Twenty  minutes  later  he  died,  having  been  con- 
scious almost  to  the  last.  Death  occurred  four  hours  and  five  minutes 
after  the  administration  of  the  capsule,  and  not  quite  four  hours  after  the 
commencement  of  sj'mptoms.  At  the  post-mortem  examination,  made  by 
Bond,  the  only  unusual  appearances  were — redness  and  inflammation  of 
the  cardiac  end  of  the  stomach,  which  had  a  blistered  appearance  ;  great 
congestion  of  the  first  portion  of  the  small  intestine  (duodenum),  and 
patches  of  congestion  in  other  portions  of  the  intestine  in  a  less  degree. 
The  brain  w^as  hyperaemic.  The  membranes  of  the  spinal  cord  were  con- 
gested. The  lungs  were  much  congested,  more  especially  toward  the  pos- 
terior parts.  The  heart  was  vei-y  flaccid,  as  if  sodden  and  stained  with 
blood  pigment.  From  a  portion  of  the  first  ejected  vomit,  from  the  urine 
drawn  off  from  the  bladder  after  death,  and  from  the  stomach,  stomach 
contents,  liver,  spleen,  and  one  kidney  taken  together,  the  editor  and 
Dupre  extracted  aconitine  by  a  modification  of  Stas's  process.  The  exist- 
ence of  this  was  proved  by  its  general  reactions  as  an  alkaloid,  by  the 
peculiar  sensation  which  it  excited  upon  the  tongue,  and  by  comparison 
of  its  fatal  eftects  upon  mice  with  those  produced  by  IVI Orson's  aconitine. 
The  l-2000th  part  of  a  grain  of  English  aconitine  may  be  recognized  by 
the  taste-test,  and  the  same  quantity  will  kill  a  mouse  within  a  few  min- 
utes.    (Guy's  Hosp.  Rep.,  1883,  p.'SOY.) 

A  solitary  case  of  poisoning  with  German  aconitine  (Merck's)  is  very 
crudely  recorded.  An  analytical  chemist  took  eight  grains  of  aconitine 
after  dinner,  with  suicidal  intent.  Half  an  hour  later  the  first  violent 
symptoms  appeared.  A  burning  sensation  in  the  mouth  and  throat  first 
made  itself  felt,  and  this  became  more  intense  every  minute  ;  intense  pains 
in  the  stomach  ensued  after  thirty  minutes,  and  these  became  so  violent  in 
a  few  seconds  that  the  patient  writhed,  shrieking  in  the  most  dreadful 
convulsions,  and  trying  to  strike  the  wall  with  his  bead.  He  w-as  held 
with  difficulty,  and  milk  and  oil  were  given.  Yery  soon  he  became  in- 
capable of  swallowing,  was  seized  with  spasmodic  cough,  and  wanted  to 
vomit.  In  spite  of  emetics  he  could  not  vomit,  however,  until  an  hour 
after  taking  the  poison,  and  then,  with  great  exertion,  a  dark  greenish 
fluid  was  ejected  ;  but  this  afforded  no  relief  to  the  pain  in  the  stomach, 
and  the  burning  sensation  in  the  throat,  which  rendered  swallowing  diffi- 
cult. The  application  of  the  stomach-pump  afforded  no  relief.  Exhaustion 
ensued  after  violent  convulsions,  and  the  symptoms  reappeared  with  re- 
newed force.  At  the  beginning  of  the  third  hour  the  pains  and  convul- 
sions attained  such  violence  that  death  was  expected  every  instant.  In 
the  fourth  hour,  after  repeated  injections  of  morphine,  the  patient  seemed 
somewhat  better.  Previous  to  this  he  indicated  that  his  skin  was  greatly 
irritated.  This  irritation  of  the  skin,  as  of  ants  crawling,  continued  ap- 
parently the  whole  time,  and  whenever  the  intensity  of  the  pains  some- 
what remitted  he  scratched  the  skin  of  the  face  and  breast  in  a  conval- 
sive  manner  till  these  were  sore.  His  eyes  glared  wildly,  sometimes  rest- 
ing with  a  fixed  stare  on  one  point.  The  convulsions  were  repeated  at 
almost  regular  intervals,  and  the  inclination  to  vomit  continued,  although 


POISONING    WITH    LABURNUM.  '  237 

vomiting  did  not  continue  after  the  second  hour.  At  intervals  of  about 
forty  minutes,  the  patient  seemed  to  lose  consciousness,  but  only  for  a  few 
minutes;  and  then  the  convulsions  and  the  other  symptoms  reappeared 
with  undiminished  violence.  Three  hours  after  the  onset  of  the  symptoms 
he  became  incapable  of  intelligible  utterance,  but  indicated  that  he  felt 
g-iddiness,  and  soon  after  he  appeared  to  lose  sight.  He  threw  himself 
wildly  about  on  the  couch,  screamed,  and  uttered  fearful  groans.  Ex- 
haustion and  apparent  coma  ensued,  and  then  renewed  attacks  of  the  most 
violent  description.  Then  difficulty  of  breathing  set  in,  and  he  appeared 
to  suffocate.  At  intervals  he  was  conscious,  indicated  that  he  felt  pain  in 
the  head  and  stomach,  and  was  very  thirsty.  The  pulse  and  body  tem- 
perature fell  considerably,  and  before  death,  which  occurred  at  the  end  of 
twelve  hours,  exhaustion  and  unconsciousness  set  in,  with  cold  perspira- 
tions and  deathlike  pallor.  Though  death  from  asphyxia  was  all  along 
expected,  this  occurred  from  syncope.  The  post-mortem  appearances 
showed  nothing  unusual.  The  pupils  were  dilated,  the  interior  of  the 
mouth  was  pale,  the  brain  and  lungs  were  congested,  the  valves  of  the 
heart  were  very  flaccid,  the  liver  and  kidneys  were  congested.  There  was 
inflammation  of  the  stomach,  and  its  mucous  membrane  was  congested 
(sic).  The  alkaloid  was  found  by  chemical  analysis  in  the  contents  of  the 
stomach  ;  but,  very  remarkably,  none  was  found  in  the  urine  of  the  de- 
ceased.    (Med.  Press,  May  24,  18^2,  p.  439.) 

Analysis. — Aconitine  may  be  extracted  from  organic  liquids  by  means  of 
Stas's  process  for  the  separation  of  the  alkaloids.  In  this  way,  and  by 
applying  the  test  of  taste  and  that  of  physiological  action  on  animals  (mice) 
to  the  substance  thus  extracted,  a  very  minute  trace  of  aconitine  may  be  de- 
tected. No  other  alkaloid  produces  the  same  sensation  upon  the  tongue 
as  the  alkaloid,  or  mixture  of  alkaloids,  known  as  aconitine.  It  yields 
the  general  reaction  of  the  alkaloids,  and  a  color-test  with  sulphuric  acid 
has  been  described.  This  color-reaction  is,  however,  valueless,  as  it  does 
not  succeed  with  pure  aconitine,  and  is  due  to  the  presence  of  impurity. 
Aconitine  readily  decomposes  when  in  alkaline  solution  ;  and  hence  it 
speedily  disappears  from  liquids  which  remain  alkaline,  and  can  no  longer 
be  detected.  The  editor  finds  that  its  presence  can  longer  be  detected  in 
viscera  where  it  was  known  to  exist,  should  these  become  alkaline  from 
putrefactive  decomposition,  and  so  remain  for  some  time. 

Laburnum  (Cytisus  laburnum). 

Symptoms  and  Effects. — The  hark  and  seed  of  the  common  Laburnum 
contain  an  active  alkaloid,  called  Cytisine.  A  case  of  poisoning  by  the 
bark  was  the  subject  of  a  trial  at  Inverness.  (Edin.  Med.  and  Surg.  Jour., 
Oct.  1843.)  A  youth,  with  the  intention  of  merely  producing  vomiting 
in  one  of  his  fellow-servants,  a  young  woman,  put  some  dry  laburnum 
bark  into  the  broth  which  was  being  prepared  for  their  dinner.  The  cook, 
who  remarked  "  a  strong  peculiar  taste"  in  the  broth,  soon  became  very 
ill,  and  in  five  minutes  was  attacked  with  violent  vomiting.  The  account 
of  the  symptoms  is  imperfect,  for  the  cause  of  them  was  not  even  sus- 
pected until  six  months  afterwards.  The  vomiting  continued  thirty-f^ix 
hours,  was  accompanied  by  shivering,  pain  in  the  abdomen,  especially  in 
the  stomach,  great  feebleness,  and  severe  purging.  These  symptoms  con- 
tinued, more  or  less,  for  a  period  of  eight  months;  and  the  woman  fell  off 
in  flesh  and  strength.  At  this  time  she  was  seen  by  a  physician,  who  had 
been  called  on  to  investigate  the  case.  She  was  then  suffering  from 
gastro-intestinal  irritation,  vomiting  after  food,  pain  in  the  abdomen  in- 


238  POISONING    WITH    LABURNUM  —  ANALYSIS. 

creased  by  pressure,  tenesmus,  and  bloody  evacuations,  with  other  serious 
symptoms.  The  medical  opinion  was  that  she  was  in  a  highl}^  dangerous 
state.  The  woman  eventually  recovered.  There  was  no  doubt,  from  the 
investigation  made  by  Ross  and  Christison,  that  her  protracted  illness 
was  really  due  to  the  noxious  effect  of  laburnum  bark.  A  girl,  get.  18, 
idly  and  unthinkingly  put  a  small  portion  of  a  laburnum  branch  into  her 
mouth,  carrying  it  for  some  hours,  and  chewing  it.  It  was  described  as 
of  the  thickness  of  the  little  finger  and  two  or  three  inches  long.  There 
were  some  yellow  flowers  with  it,  but  she  was  not  aware  that  she  had 
swallowed  any.  In  about  half  an  hour  she  felt  unwell,  but  she  was  not 
seen  by  a  medical  man  until  the  day  following.  The  symptoms  were  then 
great  pain  in  the  stomach,  nausea  and  retching,  but  no  vomiting ;  pulse 
100,  tongue  M'hlte,  great  thirst,  anxiety  and  pallor  of  countenance,  dilated 
pupils,  sense  of  fainting  even  while  lying  down,  and  great  exhaustion. 
There  was  no  purging.  Under  treatment  these  symptoms  disappeared,  and 
the  girl  recovered  in  about  a  fortnight.     (Lancet,  18V0,  ii.  p.  182.) 

In  reference  to  poisoning  with  the  seeds  of  laburnum,  there  are  many 
instances  recorded. 

In  1882,  two  fatal  cases  of  poisoning  occurred  with  some  undetermined 
portions  of  the  laburnum  tree.  (Brit.  Med.  Jour.,  1882,  i.  p.  199.)  The 
victims  were  two  children,  aged  respectively  three  and  eight  years.  The 
elder  child  was  seized  with  vomiting  and  diarrhoea,  headache,  and  prostra- 
tion. In  six  hours  the  vomiting  and  diarrhoea  ceased.  She  then  made 
noises  in  breathing,  and  continued  in  much  the  same  state  till  her  death, 
fourteen  hours  after  she  was  attacked.  Next  day  the  younger  child 
became  tired  and  sleepy,  vomited,  and  complained  of  headache.  She 
vomited  freely  and  passed  two  motions.  Five  hours  and  a  half  after  the 
commencement  of  the  symptoms  she  was  convulsed,  and  the  convulsions 
continued  till  her  death,  eight  hours  from  the  commencement  of  the  attack. 
On  post-mortem  examination,  some  signs  of  irritation  of  the  stomach  and 
intestines  were  observed  in  each  case.  The  contents  of  the  stomachs  of 
both  children  were  examined  by  the  eye  and  by  the  microscope,  but  no 
fragments  of  the  structures  of  the  laburnum  were  discovered.  Good  evi- 
dence was,  however,  obtained  by  Faii'le\^  in  both  cases  of  the  presence 
of  cytisine,  the  poisonous  alkaloid  present  in  the  flowers,  seeds,  bark, 
leaves,  and  all  parts  of  the  common  laburnum  tree.  A  small  portion 
of  an  alcoholic  extract  made  from  the  stomach  and  contents  of  the  elder 
child  was  administered  to  a  mouse,  which  died  in  the  course  of  a  few 
hours. 

The  ^oicers  of  this  plant  are  highly  noxious.  A  child,  between  three 
and  four  years  of  age,  ate  twelve  laburnum  flowers,  and  in  about  fifteen 
minutes  jt  complained  of  sickness  and  severe  pain  in  the  stomach.  The 
child  vomited  a  quantity  of  mucus  mixed  with  the  yellow  petals  of  the 
laburnum.  An  emetic  was  given  ;  this  cleared  the  stomach,  and  the 
child  recovered.  There  was  no  purging.  (Guy's  Hosp.  Rep.  ,1850,  p. 
219.)  In  one  case  a  great  diminution  of  the  temperature  of  the  body 
was  noticed.     The  child  recovered.     (Brit.  Med.  Jour.,  1883,  i.  p.  1117.) 

Analysis. — The  poisonous  principle  of  the  laburnum  is  Cytisine,  an 
alkaloid  having  a  bitter  taste.  It  is  difficult  of  separation,  and  at  present 
has  no  well-defined  chemical  properties,  except  its  insolubility  in  chloro- 
form, and  that  it  sublimes  completely,  whereby  it  may  be  identified. 
Hence,  when  administered  in  powder,  infusion,  or  decoction,  there  are  no 
chemical  processes  known  by  which  the  poison  may  be  certainly  detected. 
(Pharm.  Jour.,  3d  ser.,  xx.  p.  1017.) 


WOU.\DS  —  MEDICO-LEGAL    DEFINITION.  239 


WOUNDS  AND  PERSONAL  INJURIES. 


CHAPTER   XXIII. 

DEFINITION'     OP     A     WOUND. DANGER     TO     LIFE. GRIEVOUS     BODILY    HARM.— EXAMINATION 

OF    WOUNDS. DESCRIPTION    OF    WOUNDS. CHARACTERS     OF    WOUNDS     INFLICTED    ON     THE 

LIVING    AND    DEAD    BODY. ECCHYMOSIS     IN    THE    LIVING    AND      DEAD. — EFFECTS     OF     VIO- 
LENCE   ON    THE    DEAD    BODY. — ECCHYMOSIS    NOT    ALWAYS    A    RESULT    OF    VIOLENCE. 

Definition. — In  a  medico-legal  sense,  a  wound  implies  a  breach  of  con- 
tinuity in  tiie  structures  of  the  body,  whether  external  or  internal,  sud- 
denly occasioned  by  mechanical  violence.  Tlie  definition  therefore  includes 
injuries  to  the  skin  or  mucous  membrane  of  the  outlets  of  the  body,  dis- 
locations and  fractures  whether  simple  or  compound,  as  well  as  ruptures 
of  the  viscera.  In  a  medical  point  of  view,  a  wound  is  commonly  re- 
stricted to  those  external  injuries  in  which  the  skin  is  implicated,  and 
fractures  are  excluded ;  but  in  legal  medicine  the  term  has  a  much  wider 
signification. 

[Crreat  care  should  be  exercised  by  the  medical  jurist  in  discriminating 
between  actual  danger  to  life  and  incidental  liabilities,  where  the  question 
arises  as  to  the  right  of  the  accused  to  be  released  on  bail,  which  is  the 
defendant's  right  in  cases  of  trifling  wounds.  In  such  cases  the  actual 
and  imminent  da'hger  and  not  the  remote  or  consequential  should  be 
considered.] 

Danyer-  to  Life. — When  a  wound  has  been  criminally  inflicted  on  a 
person  by  the  wilful  act  of  another,  one  of  the  first  questions  which  pre- 
sents itself  for  consideration  is  how  far  the  injury  is  dangerous  to  life. 
In  order  to  justify  the  detention  of  the  accused,  a  magistrate  may  require 
a  medical  opinion  or  a  written  statement  from  the  surgeon  in  attendance. 
The  meaning  of  the  words  "  dangerous  to  life''  is  left  entirely  to  the  pro- 
fessional knowledge  of  a  witness.  It  is  not  sufficient  on  these  occasions 
that  he  should  make  a  naked  declaration  of  the  wound  being  dangerous  to 
life;  he  must,  if  called  upon,  state  to  the  court  satisfactory  reasons  for  his 
opinion  ;  and  these  reasons  are  rigorously  inquired  into  by  counsel  for  the 
defence.  As  a  general  principle,  it  would  not  be  proper  to  consider  those 
wounds  dangerous  to  life  in  which  the  danger  is  not  imminent.  A  wound 
of  a  great  bloodvessel,  or  any  of  the  viscera,  or  a  compound  fracture  with 
depression  of  the  bones  of  the  head,  must  in  all  instances  be  regarded  as  a 
l)odily  injury  dangerous  to  life  ;  because  in  such  cases  the  danger  is 
imminent.  Unless  timely  assistance  be  rendered,  these  injuries  will  most 
probably  prove  fatal ;  and,  indeed,  they  often  destroy  life  in  spite  of  the 
best  surgical  treatment.  When,  however,  the  danger  is  remote — as  in  a 
puncture  or  laceration  of  the  hand  or  foot,  which  may  be  followed  by 
tetanus — or  in  a  laceration  of  the  scalp,  which  may  be  followed  by  ery- 
sipelas— or  in  penetrating  wounds  of  the  orbit,  which  may  be  attended 
by  fatal  inflammation  of  the  brain  or  its  membranes — the  case  is  some- 


240  DANGER    TO    LIFE. 

what  different.  Such  injuries  as  these  are  not  directly  dangerous  to  life — 
they  are  only  liable  to  be  attended  with  danger  in  certain  cases  and  under 
certain  circumstances;  hence  the  medical  opinion  must  be  qualified.  The 
law,  on  these  occasions,  appears  to  contemplate  the  direct,  and  not  the 
future  or  mere  possible  occurrence  of  danfrer  ;  if  the  last  view  were  adopted, 
it  is  clear  that  the  most  trivial  laceration  and  puncture  might  be  pro- 
nounced dangerous  to  life,  since  tetanus  or  erysipelas,  proving  fatal,  has 
been  an  occasional  consequence  of  very  slight  injuries.  A  difference  of 
opinion  will  often  exist  among  medical  witnesses  whether  a  particular 
wound  is  or  is  not  dangerous  to  life.  Unanimity  can  only  be  expected 
when  the  judgment  and  experience  of  the  witnesses  are  equal.  The  rules 
for  forming  an  opinion  in  these  cases  will,  perhaps,  be  best  deduced  from 
the  results  of  the  observations  of  good  surgical  authorities  in  relation  to 
injuries  of  different  parts  of  the  body. 

Wounds  causing  grievous  bodily  harm. — A  wound  may  not  be  danger- 
ous to  life,  but  it  may  have  produced  grievous  bodily  harm.  This  ques- 
tion is  sometimes  put,  although  the  usual  practice  is  to  leave  it  to  be 
drawn  by  the  jury  as  an  inference  from  a  professional  description  of  the 
injury.  The  words  have  a  vague  signiiication  ;  but  it  would,  perhaps,  be 
difficult  to  substitute  for  them  others  less  open  to  criticism.  They  evi- 
dently refer  to  a  minor  description  of  offence,  and  are  applied  commonly 
to  those  injuries  which,  while  they  do  not  actually  place  life  in  danger, 
may  be  attended  with  considerable  personal  inconvenience  ;  or  be  in  some 
way  detrimental  to  the  health  of  the  wounded  person.  Pollock,  C.  B., 
stated  on  one  occasion  that  "grievous  bodily  harm"  would  reasonably  apply 
to  such  an  injury  as  would  render  medical  treatment  necessary.  It  is 
always  a  question  for  a  jury  whether  the  intent  of  the  prisoner,  in  inflict- 
ing a  wound,  was  or  was  not  to  produce  grievous  bodily  harm.  In  some 
cases  the  nature  of  the  situation  of  the  wound,  as  well  as  the  kind  of 
weapon  used,  will  at  once  explain  the  intent :  so  far  the  medical  witness 
may  assist  the  court  by  giving  a  plain  description  of  the  injury,  as  well 
as  of  the  consequences  with  which  it  is  usually  attended.  It  may  happen 
either  that  the  wound  itself  is  not  of  a  serious  nature,  and  yet  the  inten- 
tion of  a  prisoner  may  have  been  to  do  grievous  bodily  harm  to  the 
wounded  person  ;  or  the  injury  may  be  really  serious,  and  yet  the  prisoner 
may  not  have  intended  to  do  grievous  bodily  harm.  On  a  trial  for  man- 
slaughter (C.  C.  C,  April,  1873),  Cleasby,  B.,  made  the  following  legal 
distinction  between  a  simple  wounding  and  wounding  with  intent  to  do 
grievous  bodilv  harm  :  There  was,  he  said,  no  proof  as  to  the  instrument, 
if  anv,  with  which  the  wound  was  inflicted.  The  injuries  were  certainly 
serious,  and  it  would  be  for  the  jury  to  say  whether  they  were  done  with 
the  intention  to  inflict  grievous  bodily  harm.  The  intention,  as  it  hap- 
pened in  this  case,  could  only  be  inferred  from  the  injury  which  really  was 
done.     Possibly  the  prisoner  inflicted  more  harm  than   he  really  intended. 

Let  us  suppose  that  the  wounded  person  is  found  dead,  and  an  exami- 
nation of  the  body  is  required  to  be  made.  The  most  difficult  part  of  the 
duty  of  a  medical  jurist  now  begins.  Among  the  numerous  questions 
which  here  present  themselves,  the  first  which  demands  examination  is 
whether  the  wound  was  inflicted  on  the  body  before  or  after  death. 

E.%amination  of  Wounds. — In  examining  a  wound  on  a  dead  body,  its 
situation,  extent,  length,  breadth,  depth,  and  direction  should  be  observed  ; 
whether  there  is  about  it  effused  blood,  either  liquid  or  coagulatecl;  and 
whether  there  is  ecchymosis,  i.  e.,  a  livid  discoloration  of  the  skin  from 
the  effused  blood.  It  "should  also  be  ascertained  whether  the  surrounding 
parts  are  swollen,  whether  adhesive  matter  or  pus  is  effused,  whether  the 


EXAMINATION    AND    DESCRIPTION    OF    WOUNDS.  241 

edg'es  of  the  wound  ure  g'angrenous,  or  any  foreig-n  substances  are  present 
in  it.  Care  must  be  taken  that  putrefaction  is  not  mistaken  for  a  gan- 
grenous condition  of  the  wound.  The  wound  may  be  examined  by  gently 
introducing  into  it  a  probe  or  a  bougie,  and  carrying  on  the  dissection 
around  this  instrument,  avoiding  as  much  as  possible  any  interference 
with  the  external  appearances.  The  preservation  of  the  external  form 
will  allow  of  a  comparison  being  made  at  any  future  time  between  the 
edges  of  a  wound  and  a  weapon  found  on  a  suspected  person.  Of  all 
these  points  notes  should  be  taken,  either  on  the  spot  or  immediately 
afterwards.  In  the  dissection,  every  muscle,  vessel,  nerve,  or  organ 
involved  in  the  injury  should  be  traced  and  described.  This  will  enable 
a  witness  to  answer  many  collateral  questions  that  may  unexpectedly 
arise  during  the  inquiry.  Another  point  should  be  especially  attended  to. 
A  medical  man  has  frequently  contented  himself  with  connning  his  dis-  . 
section  to  the  injured  part,  thinking  that,  on  the  trial  of  the  accused,  the 
questions  of  counsel  would  be  limited  to  the  situation  and  extent  of  the 
wound  only  ;  but  this  is  a  serious  mistake.  If  the  cause  of  death  be  at  all 
obscure,  on  no  account  should  the  inspection  be  abandoned  until  all  the 
important  organs  and  cavities  of  the  body  have  been  closely  examined ; 
since  it  may  be  affirmed  that  a  natural  cause  of  death  might  have  existed 
in  that  organ  or  cavity  which  the  medical  witness  had  neglected  to  ex- 
amine. It  rests  with  the  practitioner  to  disprove  the  probability  thus 
urged  by  counsel.  In  the  medical  reports  on  the  examination  of  the 
bodies  of  wounded  persons,  care  should  be  taken  to  avoid  the  introduction 
of  any  remarks  in  the  form  of  inferences  from  the  facts  of  the  case  {ante, 
p.  27).  The  facts  should  be  simply  recorded,  and  the  inferences  or  com- 
ments reserved  for  evidence  at  the  inquest  or  trial,  or,  if  required,  the 
inferences  should  be  stated  separately  after  the  facts.  In  making  an 
inspection  of  the  wounded  body,  the  stomach  should  not  be  overlooked. 
Death  may  have  been  apparently  caused  by  violence,  and  yet  really  be 
due  to  poison,  of  which  a  portion  may  be  found  in  the  stomach  or  bowels. 

De)>cription  of  Wounds. — It  is  impossible  to  impress  too  strongly  on 
the  mind  of  a  medical  witness  that,  in  describing  the  wounds  which  he 
has  found  on  the  examination  of  a  body,  he  should  employ  plain  and 
simple  language,  and  avoid  as  much  as  possible  the  use  of  technical  or 
professional  terms.  The  desire  of  a  good  witness  should  be  to  make  him- 
self understood ;  but  this  cannot  be  accomplished  if  he  clothes  his  ideas  in 
language  which  is  incomprehensible  to  educated  men  of  the  legal  profes- 
sion, and  d  fortiori  to  the  class  of  men  who  constitute  common  juries. 
There  are  few  assizes  which  do  not  afford  many  illustrations  of  the  injury 
done  to  scientific  evidence,  and  the  clear  understanding  of  a  case,  by  the 
technical  language  in  which  it  is  given.  A  medical  witness  should,  for 
his  own  credit  and  for  that  of  the  profession  to  which  he  belongs,  employ 
])lain  and  simple  language  in  describing  a  wound,  as  well  as  in  giving  his 
(nidence  generally  (see  p.  50). 

Characters  of  a  Wound  inflicted  during  Life. — If  we  find  about  a 
wound  marks  of  gangrene,  the  effusion  of  adhesive  or  purulent  matter,  or 
if  the  edges  are  swollen  and  enlarged,  and  cicatrization  has  commenced,  it 
is  not  only  certain  that  the  injury  must  have  been  inflicted  before  death, 
but  that  the  person  must  have  lived  some  time  after  it  was  inflicted. 
Marks  of  this  description  will  not,  however,  be  commonly  found  when 
death  has  taken  place  within  ten  or  tw'elve  hours  from  the  infliction  of  the 
injury.  A  wound  which  proves  fatal  within  this  period  of  time  will  pre- 
sent throughout  much  the  same  characters.  Thus,  supposing  it  to  have 
been  clean-cut,  or  incised,  there  w^ill  be  traces  of  more  or  less  bleeding, 
16 


242  "WOUNDS    ON    THE    LIVING. 

the  blood  having  chiefly  an  arterial  character,  and  it  will  be  found  coagu- 
lated where  it  has  fallen  on  surrounding  bodies.  The  edges  of  the  wound 
are  everted,  and  the  musculnr  and  cellular  tissues  around  are  deeply  I'ed- 
dened  by  effused  blood.  Coagula,  or  clots,  are  found  adhering  to  the 
w^ound,  provided  it  has  not  been  interfered  wnth.  The  principal  charac- 
ters of  a  wound  inflicted  during  life  are,  then,  the  following:  1.  Eversion 
of  the  edges,  owing  to  vital  elasticity  of  the  skin.  2.  Abundant  hemor- 
rhage or  bleeding,  often  of  an  arterial  character,  wnth  general  diffusion  of 
blood  in  the  surrounding  parts.  3.  The  presence  of  clots.  The  w^ound 
may  not  have  involved  any  vessel,  and  there  may  be  no  appearance  of 
bleeding ;  still  the  edges  will  be  everted,  and  the  muscles  and  skin  re- 
tracted. By  an  observation  of  this  kind  made  on  the  body  of  a  newborn 
child  (case  of  Elphick,  March,  1848),  Prince  w^as  enabled  to  state  that  the 
child  was  living  when  the  wound  was  inflicted,  an  opinion  afterwards  con- 
firmed by  the  confession  of  the  mother 

Characters  of  a  Wouvd  made  after  Death. — If  the  wound  on  a  dead 
body  be  not  made  until  twelve  or  fourteen  hours  have  elapsed  from  the 
time  of  death,  it  cannot  be  easily  mistaken  for  one  produced  during  life. 
Either  no  blood  is  effused,  or  this  is  of  a  venous  character,  i.  e.  it  may 
have  proceeded  from  some  divided  vein.  The  blood  is  commonly  liquid, 
and  does  not  readily  coagulate  as  it  falls  on  surrounding  bodies,  like  that 
poured  out  of  a  wound  in  the  living.  The  edges  are  soft,  yielding,  and 
destitute  of  elasticity ;  they  are  therefore  in  close  approximation.  The 
cellular  and  muscular  tissues  around  are  either  not  infiltrated  wnth  blood, 
or  only  to  a  very  partial  extent.  There  are  no  coagula,  or  clots,  within 
the  W'Ound.  In  experinienting  upon  amputated  limbs  the  author  found 
these  characters  possessed  by  a  wound  produced  two  or  three  hours  after 
death,  although  they  are  best  seen  when  the  w^ound  is  not  made  until  after 
the  body  has  lost  all  its  heat.  In  wounds  on  the  dead  body,  divided  arte- 
ries have  no  marks  of  bleeding  about  them,  while  in  the  living  body  the 
fatal  bleeding  commonly  proceeds  from  these  vessels.  Hence,  in  a  wound 
on  the  living,  it  will  be  found  that  the  surrounding  vessels  are  empty. 
The  absence  of  spirting  of  arterial  blood  may  be  of  importance  in  deter- 
mining whether  one  of  tw'o  or  more  fatal  wounds  was  first  inflicted. 
(Reg.  V.  Lee,  Exeter  Ass.,  Feb.  1885.)  The  chief  characters  of  a  wound 
after  death  are,  therefore:  1  Absence  of  copious  bleeding.  2.  If  there 
is  bleeding,  it  is  exclusively  venous.  3.  The  edges  of  the  wound  are 
close,  not  everted.  4.  There  is  no  diffusion  of  blood  in  the  cellular  tissue. 
5.  There  is  an  absence  of  coagula.  But  it  may  happen  that  a  wound  has 
been  inflicted  soon  after  the  breath  has  left  the  body,  and  while  it  was  yet 
w^arm.  The  distinction  between  a  wound  then  made  and  one  made  during 
life  is  not  so  well  marked  as  in  wounds  inflicted  at  a  later  period  after 
death. 

In  any  case  in  which  it  is  doubtful  whether  a  wound  was  inflicted  on  a 
living  or  dead  body,  we  should  be  cautious  in  giving  an  opinion  ;  since  it 
must  be  remembered  there  are  no  decisive  characters  by  which  wounds  of 
the  kind  referred  to  can  be  distinguished,  and  a  medical  witness  is  as 
likely  to  be  wrong  as  right  in  selecting  either  hypothesis.  It  is  a  consid- 
erable step  in  evidence  when  we  are  able  to  assert  that  a  particular  wound, 
found  on  a  dead  body,  must  have  been  inflicted  either  during  life  or  imme- 
diately after  death ;  for  it  can  scarcely  be  supposed  that,  in  a  case  calling 
for  criminal  investigation,  any  one  but  a  murderer  would  think  of  inflict- 
ing upon  a  body  immediately  after  death  a  w^ound  which  would  assuredly 
have  produced  fatal  effects  had  the  same  person  received  it  while  living. 
So  soon  as  such  an  opinion  can  be  safely  expressed  by  a  witness,  circum- 


ECCIIYMOSrS    FROM    VIOLENCE.  2i3 

stantial  evidence  will  often  make  up  for  that   which  may    be,    medical] v 
speal<lnu-,  a  matter  of  uncertainty. 

Wuiinch  or  Injuries  unattended  with  Hemorrhage. — The  copious  effu- 
sion of  blood  has  been  set  down  as  a  well-marked  character  of  a  severe 
wound  received  during- life ;  but  this  observation  applies  chiefly  to  cuts 
and  stabs.  Lacerated  and  contused  wounds  of  a  severe  kind  are  not 
usually  accompanied  with  much  bleeding-,  even  when  a  large  bloodvessel 
is  implicated.  It  is  well  known  that  a  whole  member  has  been  torn  from 
a  living  body,  and  that  little  blood  has  been  lost;  but  in  such  cases  coag- 
ula,  or  clots  of  blood,  are  commonly  found  adhering  to  the  separated  parts 
— a  character  which  indicates  that  the  wound  was  infiicted  either  during 
life  or  soon  after  death,  while  the  blood  was  warm  and  fluid.  When  a 
lacerated  or  contused  wound  involves  a  highly  vascular  part,  although  no 
large  bloodvessel  may  be  implicated,  it  is  liable  to  cause  death  by  loss  of 
blood. 

Ecchymosis  from  Violeyice. — Contusions  and  contused  wounds  are  com- 
monly accompanied  by  a  discoloration  of  the  surrounding  skin,  to  which 
the  term  ecchymosis  {sxxv(^,  to  pour  out)  is  applied.  This  consists  essen- 
tially in  the  extravasation  or  effusion  of  blood  generally  from  small  rup- 
tured vessels  into  the  surrounding  cellular  tissue  beneath  the  skin.  An 
ecchymosis  is  commonly  superficial,  affecting  only  the  layers  of  the  skin, 
and  showing  itself  externally,  either  immediately  or  in  the  course  of  a 
short  time,  in  the  form  of  a  deep  blue  or  livid  red  patch;  but  the  effusion 
may  be  so  deeply  seated  as  not  to  produce  any  external  discoloration  of 
the  skin. 

Violence  inflicted  on  a  living  body  may  not  show  itself  under  the  form 
of  ecchymosis  until  after  death.  A  man  received  several  kicks  on  the 
lower  part  of  his  abdomen,  which  caused  a  rupture  of  the  bladder,  and 
death  by  peritonitis  in  about  thirty-five  hours;  but  there  was  no  ecchy- 
mosis in  the  seat  of  the  blows,  i.  e.  in  the  pubic  and  lumbar  regions, 
until  after  death.  Hinze  met  with  a  case  of  suicidal  hanging  in  which  it 
was  observed  that  ecchymosis  appeared  in  the  course  of  the  cord  only 
after  death.  This  is  not  uncommon.  (See  Hanging,  post.)  It  has  been 
remarked  by  Devergie  that  ecchymoses  are  often  concealed  on  the  bodies 
of  the  drowned,  when  first  removed  from  water,  owing  to  the  sodden  state 
of  the  skin  ;  and  they  may  become  apparent  only  after  the  body  has  been 
exposed  for  some  days,  when  the  water  has  evaporated. 

A  medical  jurist  must  guard  against  the  error  of  supposing  that,  when 
a  blow  has  been  inflicted  on  a  living  person,  it  is  necessary  that  the  indi- 
vidual who  is  maltreated  should  survive  for  a  long  period  in  order  that 
ecchymosis  may  be  produced.  Among  numerous  instances  proving  the 
contrary,  the  case  of  the  Duchesse  de  Praslin  (1847)  may  be  mentioned. 
This  lady,  who  was  assassinated  by  her  husband,  was  attacked  while  asleep 
in  bed.  The  number  of  wounds  on  her  person  (thirty)  showed  that  there 
had  been  a  mortal  struggle,  which,  however,  could  not  have  lasted  more 
than  half  an  hour.  Yet,  on  inspection,  there  were  the  marks  of  numer- 
ous ecchymoses  which  had  resulted  from  the  violent  use  of  a  bruising  in- 
strument. (Ann.  d'Hyg.,  1847,  t.  2,  p.  377.)  Casper  considered  that 
ecchymosis  required  a  certain  time  for  its  production,  and  that,  if  a  person 
died  speedily  from  the  effects  of  violence,  no  ecchymosis  would  be  found 
on  the  body,  although  the  violence  might  have  been  of  a  bruising  nature. 
The  case  of  the  Duchesse  de  Praslin  shows  that  this  is  not  correct,  and 
Casper  himself  has  admitted  that  ecchymosis  may  be  produced  as  the. 
result  of  violence  applied  to  a  recently  dead  body  (see  Strangulation, 
post) — a  result  which  is  in  accordance  with  other  facts  mentioned  above  ; 


244  ECCIIYMOSIS    IN    THE    DEAD    BODY. 

but  if  ecchymosis  can  be  produced  by  violence  to  the  recently  dead,  it  is 
clear  that  a  continuance  of  active  life  is  not  necessary  for  its  production. 
The  followinjj:  case  shows  how  these  facts  may  be  misapplied.  A  3'oun<:i' 
man  was  seen  to  strike  one  of  his  companions.  The  person  struck  died 
suddenly.  On  a  post-mortem  examination  the  mark  of  a  bruise  Avas  seen 
over  the  sixth  and  seventh  ribs  on  the  right  side.  About  a  fortnight 
before  this  blow  Avas  struck  the  deceased  had  met  with  an  accident — a 
heavy  box  fell  on  his  right  side,  knocked  him  senseless,  and  nearly  killed 
him.  The  question  at  issue  was,  whether  the  ecchymosed  mark  on  the 
.side  was  owing  to  the  blow  struck  shortly  before  the  man  died,  or  to  the 
fall  of  the  box  upon  his  body  a  fortnight  previously.  It  was  suggested, 
on  the  authority  of  Casper,  that,  as  the  man  died  soon  after  the  blow  was 
struck,  the  ecchymosis  could  not  have  arisen  from  the  blow,  but  that  it 
was  most  probably  due  to  the  fall  of  the  box  a  fortnight  before.  (Lancet, 
1870,  vol.  2,  p.  35.)  Such  a  case  dues  not  present  much  difficulty.  If 
the  ecchymosed  mark  was  blue  or  livid  and  without  any  marginal  colors, 
it  was  probably  the  result  of  the  blow  struck  just  before  death.  If  the 
blood  is  fluid  at  the  time  of  violence,  and  the  small  capillary  vessels  are 
torn  through — sudden  death  following — a  blow  may  cause  the  effusion  of 
blood  and  the  production  of  a  mark  on  the  skin.  The  warm  liquid  blood 
thus  effused  will  find  its  Avay  into  the  cellular  tissue  and  produce  the 
usual  external  appearance.  If  in  the  case  quoted  the  ecchymosis  had  been 
produced  a  fortnight  before,  it  would  have  shown  some  changes  of  color 
at  the  margin,  as  described  in  the  next  paragraph.  When  the  injury  is 
deep-seated,  ecchymosis  may  appear  at  a  distance  from  the  site  of  the  in- 
jury. This  is  well  .seen  in  blows  about  the  hips;  and  a  blow  on  the  calf 
of  the  leg  may  manifest  itself  by  ecchymosis  around  and  below  the 
knee. 

The  changes  which  take  place  in  the  color  of  an  ecchymosed  spot  are 
worthy  of  attention,  since  they  may  serve  to  aid  the  witness  in  giving  an 
opinion  on  the  probable  time  at  which  a  contusion  has  been  inflicted. 
After  a  time — commonly  in  eighteen  or  twenty-four  hours — the  blue  or 
livid  margin  of  the  spot  is  observed  to  become  lighter  ;  it  acquires  a  violet 
tint,  and  before  its  final  disappearance  it  passes  successively  through 
shades  of  a  green,  yellow,  and  lemon  color.  During  this  time  the  spot 
is  much  increased  in  extent,  but  the  central  portion  of  the  ecchymosis. 
that  part  which  received  the  violence,  is  always  darker  than  the  circum- 
ference. 

Contusions  on  the  Dead. — Christison  found  that  blows  inflicted  on  a 
dead  body  within  two  hours  after  death  gave  rise  to  appearances  on  the 
skin  .similar  to  those  Avhich  resulted  from  blows  inflicted  on  a  person 
shortly  before  death  The  livid  discoloration  thus  produced  generally 
aro.se  from  an  effusion  of  the  thinnest  possible  layer  of  the  fluid  part  of 
the  blood  on  the  outer  surface  of  the  true  skin,  but  sometimes  also  from 
an  effusion  of  blood  into  a  perceptible  stratum  of  the  true  skin  itself.  He 
likewi.se  found  that  dark  fluid  blood  might  even  be  effused  into  the  cellular 
tissue  in  the  seat  of  the  discolorations,  so  as  to  blacken  or  redden  the 
membranous  partitions  of  the  cells  containing  the  fat ;  but  this  last  effusion 
was  never  extensive.  From  this,  then,  it  follows  that,  by  trusting  ib 
external  appearances  only,  contu.sions  made  soon  after  death  may  be  easily 
confounded  with  those  which  have  been  produced  by  violence  shortly 
before  death.  If  a  contusion  has  been  caused  some  hours  before  death; 
there  will  be  swelling  of  the  part,  and  probably  also  changes  of  color  in 
the  ecchymosed  patch,  in  either  of  which  ca.ses  there  will  be  no  difficulty 
in  forming  an  opinion.     Although  ecchymosis,  or  an  appearance  similar 


EFFECT    OF    BLOWS    ON    THE    DEAD.  245 

to  it,  may  be  produced  on  a  body  after  death,  the  changes  in  color  are 
then  met  with  only  under  peculiar  circumstances,  as  where  the  person  is 
laboring  under  general  dropsy,  and  the  serum  effused  beneath  the  skin 
may  lead  to  the  diffusion  of  the  blood.  The  most  satisfactory  mark  of 
distinction  between  the  effects  of  blows  on  the  living  and  dead  body,  in 
the  opinion  of  Clu'istison,  is  the  following:  In  a  contusion  inflicted  during 
life,  the  ecchymoscd  portion  of  cutis  (true  skin)  is  generally  dark  and 
much  discolored  from  the  infiltration  of  blood  throughout  its  whole  thick- 
ness ;  the  skin  at  the  same  time  is  increased  in  firmness  and  tenacity. 
This  is  not,  however,  a  uniform  consequence  of  a  contusion  during  life  ; 
for  a  blow  may  cause  effusion  of  blood  beneath  the  skin  without  affecting 
the  cutis  in  the  manner  stated.  The  state  of  the  skin  here  described 
cannot  be  produced  by  a  contusion  on  acdead  body  ;  although  it  is  still  an 
open  question  whether  it  might  not  be  produced  if  the  contusion  were 
inflicted  a  few  minutes  after  death.  As  it  is,  the  value  of  this  sign  is 
somewhat  limited:  it  is  not  always  produced  on  the  living, — it  might  be 
possibly  produced  on  the  recently  dead ;  so  that  when  it  does  not  exist 
we  must  look  for  other  differential  marks,  and  when  it  does  exist  we 
ought  to  satisfy  ourselves  that  the  contusion  was  not  inflicted  recently 
after  death. 

The  period  at  which  such  injuries  cease  to  resemble  each  other  has  not 
been  fixed  with  any  degree  of  precision;  but,. as  in  the  case  of  incised 
wounds,  it  w^ould  seem  that  there  is  little  danger  of  confounding  them, 
when  a  contusion  has  not  been  inflicted  on  a  dead  body  until  after  the 
disappearance  of  animal  heat  and  the  commencement  of  rigor  mortis. 

The  practical  inference  from  these  observations  is  that  discolorations  of 
the  skin,  caused  by  blows  inflicted  soon  after  death  may  be  sometimes 
mistaken  for  marks  of  violence  on  the  living  body.  An  instance  has  been 
communicated  to  the  author  in  which,  for  the  sake  of  experiment,  blows 
with  a  stick  were  inflicted  on  the  recently  dead  body  of  a  woman,  while 
still  warm.  The  body  v/as  afterwards  accidentally  seen  by  non-profes- 
sional persons,  who  were  not  aware  of  the  performance  of  these  experi- 
ments ;  and  so  strong  was  the  impression  from  the  appearances  that  the 
deceased  had  been  maltreated  during  life,  that  a  judicial  inquiry  was 
actually  instituted,  when  the  circumstances  were  satisfactorily  explained. 
The  fact,  therefore,  that  severe  blows  after  death  resemble  slight  blows 
during  life,  is  of  some  importance;  there  is  ecchyraosis  in  each  case,  and 
no  certain  method  of  distinguishing  the  one  from  the  other. 

Is  ecchymosis  a  necessa7'y  result  of  violence'? — This  medico-legal  ques- 
tion has  often  created  great  difficulty.  It  has  been  repeatedly  asserted  in 
courts  of  law  that  no  severe  blow  could  have  been  inflicted  on  the  body 
of  a  person  found  dead,  in  consequence  of  the  absence  of  ecchymosis  or 
other  indication  of  violence  on  the  part  struck ;  but  this  assertion  is 
entirely  opposed  to  well-ascertained  facts.  However  true  the  statement 
may  be  that  severe  contusions  are  commonly  followed  by  ecchymosis,  it 
is  open  to  numerous  exceptions;  and  unless  these  are  known  to  a  practi- 
tioner, his  evidence  may  mislead  the  court.  The  presence  of  ecchymosis 
is  commonly  presumptive  evidence  of  the  infliction  of  violence,  but  its 
absence  does  not  necessarily  negative  this  presumption. 

[Cadaveric  ecchymoses  (lividities)  almost  invariably  show  themselves 
during  the  eight  or  ten  hours  after  death  while  the  body  is  warm  and  the 
blood  liquid,  varying  in  extent  according  to  the  amount  of  blood  in  the 
body.  These  changes  are  not  due  to  violence  before  or  after  death,  but  to 
causes  about  which  different  views  have  been  advanced  by  Caspar,  Pe- 
vergie,  Ogston,  Sir  James  Paget,  Meymott  Tidy,  and  others.  The  ablest 
scieutific  inquiry  into  their  phenomena  and  causes  is  that  given  by  Mey- 


246  ECCIIYMOSIS    NOT    ALWAYS    PRODUCED    BY    BLOWS. 

mott  Tidy,  vol.  1,  Phila.  Ed.,  1882,  p.  "75  et.  seq.  The  important  fact  is  that 
they  constanlly  occur  in  dead  bodies  after  death,  and  that  they  so  closely 
resemble  the  ecchymosis  produced  by  bruises  upon  the  living  body  and 
also  after  death,  as  frequently  to  be  mistaken  the  one  for  the  other.] 

[After  putrefaction  has  set  in,  and  when  the  tissues  have  become  soft 
and  the  blood  easily  difi'used,  the  difficulty  of  distinguishing  the  one  from 
the  other  increases. 

The  table  and  illustrations  given  by  Tidy,  *78-81,  well  define  the  distin- 
guishing characteristics  of  each,  and  illustrate  how  the  skilled  observer 
can  discriminate  between  them.  Vid.,  also  "  Extravasation  of  Blood,"  by 
J.  Mitchell  Bruce,  in  Quain's  Dictionary  of  Medicine.] 

It  was  long  since  reniarked  by  Portal  that  the  spleen  had  been  found 
ruptured  from  blows  or  i'alls,  without  any  ecchymosis  or  abrasion  of  the 
skin  ajjpearing  in  the  region  struck.  This  has  been  also  observed  in 
respect  to  ruptures  of  the  stomach,  intestines,  and  urinary  bladder,  from 
violence  directly  applied  to  the  abdomen.  Portal  supposed  that  the 
mechanical  impulse  was  simply  transferred  through  the  supple  parietes  (or 
walls)  of  the  abdomen  to  the  viscera  behind,  as  in  the  striking  of  a  bladder 
filled  with  water.  Whether  this  be  the  true  explanation  or  not,  it  is  quite 
certain  that  the  small  vessels  of  the  skin  often  escape  rupture  from  a 
sudden  blow,  so  that  their  contents  are  not  effused.  A  case  is  reported 
by  Henke,  in  w^hich  a  labpring  man  died  some  hours  after  fighting  with 
another,  and  on  an  inspection  of  the  body  the  peritoneum  was  found  ex- 
tensively inflamed,  owing  to  an  escape  of  the  contents  of  the  small  intes- 
tines, which  had  been  ruptured  to  a  considerable  extent.  There  was, 
however,  no  ecchymosis  or  mark  on  the  skin  externall}^,  and  the  medical 
inspectors  were  inclined  to  affirm,  contrary  in  this  case  to  direct  evidence, 
that  no  blow  could  have  been  struck  ;  but  others  of  greater  experience 
were  appealed  to,  who  at  once  admitted  that  the  laceration  of  the  intes- 
tines might  have  been  caused  by  a  blow,  even  although  there  was  no 
appearance  of  violence  externally.  Watson  states  that  a  girl,  aged  nine, 
received  a  smart  blow  upon  the  abdomen  from  a  stone.  She  immediately 
complained  of  great  pain  ;  collapse  ensued,  and  she  died  in  twent3^-one 
hours.  On  inspection  there  was  no  mark  of  injury  externally,  but  the 
ileum  (small  intestines)  was  found  ruptured,  its  contents  extravasated,  and 
the  peritoneum  extensiveh^  inflamed.  (On  Homicide,  p.  187.)  William- 
son met  with  a  case  in  which  a  man  received  a  kick  on  the  abdomen  from 
a  horse:  he  died  in  thirty  hours  from  peritonitis.  The  ileum  was  found 
to  have  been  lorn  completely  across  in  its  lower  third.  There  was  not 
the  slightest  trace  of  ecchymosis  externally— a  fact  which  is  the  more 
remarkable  since  the  blow  was  here  struck  by  a  somewhat  angular  or 
pointed  body,  the  hoof  of  a  horse.  (Med.  Gaz.,  May,  1840.  See  also 
Guy's  Hos|).  Rep.,  1865,  p.  286.)  A  man  who  had  been  run  over  by  an 
omnibus  was  brought  into  hos))ital.  The  wheel  had  gone  over  his  chest 
and  abdomen,  but  on  admission  no  injury  was  discoverable.  On  the 
second  day  peritonitis  set  in,  from  which  he  rapidly  sank.  The  liver  and 
the  small  intestines  w^ere  found  ruptured.  (Guy's  Hosp.  Gaz.,  1873.) 
Man}^  other  cases  might  be  adduced  in  support  of  the  statement  that 
ecchymosis  is  not  a  necessary  or  constant  result  of  a  severe  blow  or  severe 
bruising  violence;  but  these  sufficiently  establish  the  fact.  This  medico- 
legal question  frequently  arises  in  cases  in  which  the  bladder  or  liver  is 
ruptured,  as,  owing  to  the  general  absence  of  marks  of  violence,  it  is  often 
alleiied  in  defence  that  no  blow  or  kick  could  have  been  inflicted  on  this 
part  of  the  abdomen.  It  is  unnecessary  to  say  that  this  view  is  not  in 
accordance  with  facts.  (See  Ptuptures  of  the  Heart,  Liver,  Spine,  and 
Intestines,  post.) 


EVIDENCE    OF    THE    USB    OF    A    WEAPON.  2-17 


CHAPTERXXIV. 

EVIDENCE  OF  THE  USE  OF  A  WEAPOX. CHARACTERS  OF  WOUNDS    CAUSED    BY    WEAPONS. IN- 
CISED,  PUNCTURED,   LACERATED,   AND  CONTUSED  WOUNDS. STABS  AND  CUTS. WHAT    ARE 

WEAPONS  ? EXAMINATION  OF  THE    DRESS. IMPUTED  OR  SELF-INFLICTED  WOUNDS. 

Evidence  of  the  Uae  of  a  Weapon. — It  is  not  necessaiy  to  prove  that 
a  weapon  has  been  used  for  the  production  of  a  wound,  for  the  words  of 
the  statute  are:  "Whoever  shall,  by  any  means  whatsoever,  wound  or 
cause  any  grievous  bodily  harm  to  a  person,"  etc.;  yet  evidence  of  the  use 
of  a  weapon  in  cases  of  assault  may  materially  aft'ect  the  amount  of  pun- 
ishment awarded  on  conviction.  When,  upon  the  clearest  evidence,  it  is 
certain  that  a  weapon  has  been  used,  it  is  not  unusual  for  prisoners  to  de- 
clare that  no  weapon  was  employed  by  them,  but  that  the  wound  had 
been  occasioned  by  accidental  circumstances.  A  witness  should  remem- 
ber that  he  is  seldom  in  a  position  to  swear  that  a  particular  weapon  pro- 
duced at  a  trial  must  have  been  used  by  the  prisoner;  he  is  only  justified 
in  saying  that  the  wound  was  caused  either  by  it  or  by  one  similar  to  it. 
(Reg.  V.  Goodale,  Norwich  Aut.  Ass.,  1885.)  Schworer  relates  the  fol- 
lowing case :  A  man  was  stabbed  by  another  in  the  face,  and  a  knife  with 
the  blade  entire  was  brought  forward  as  circumstantial  evidence  against 
him,  the  surgeon  having  stated  that  the  wound  had  been  caused  by  this 
knife.  The  wounded  person  recovered;  but  a  year  afterwards  an  abscess 
formed  in  his  face,  and  the  broken  point  of  the  real  weapon  was  discharged 
from  it.  The  wound  could  not,  therefore,  have  been  produced  by  the 
knife  which  was  brought  forward  as  evidence  against  the  prisoner  at  the 
trial.  (Lehre  von  dem  Kindermorde.)  Although  the  criminality  of  an 
act  is  not  affected  by  an  occurrence  of  this  kind,  it  is  advisable  that  such 
mistakes  should  be  avoided  by  the  use  of  proper  caution  on  the  part  of  a 
witness.  (On  this  question  see  the  case  of  Renaud,  by  Boys  de  Loury, 
Ann.  d'Hvg.,  1839,  t.  11,  p.  170.  As  to  what  is  a  weapon,  see  Henke, 
ZeitschPift  der  S.  A.,  1844,  voh  1,  p.  67.) 

Characters  of  Wounds  j^roduced  by  Weapons. — Let  us  now  suppose 
that  no  weapon  is  discovered,  and  that  the  opinion  of  a  witness  is  to  be 
founded  only  on  an  examination  of  a  wound.  It  is  right  for  him  to  know 
that,  on  all  criminal  trials,  considerable  importance  is  attached  by  the  law 
to  the  fact  of  a  wound  having  been  caused  by  the  use  of  a  weapon ;  since 
this  generally  implies  malice,  and  in  most  cases  a  greater  desire  to  injure 
the  party  assailed  than  the  mere  employment  of  manual  force.  Some 
wounds,  such  as  cuts  and  stabs,  at  once  indicate  that  they  must  have  been 
produced  by  weapons. 

1.  Incised  Wounds. — In  incised  wounds,  the  sharpness  of  the  instru- 
ment may  be  inferred  from  the  cleanness  and  regularity  with  which  the 
edges  are  cut;  in  stabs,  also,  the  form  and  depth  of  a  wound  will  often 
indicate  the  kind  of  weapon  employed.  Stabs  sometimes  have  the  char- 
acters of  incised  punctures,  one  or  both  extremities  of  the  wound  being 
cleanly  cut,  according  to  whether  the  weapon  is  single  or  double-edged. 
Dupuytren  has  remarked  that  such  stabs,  owing  to  the  elasticity  of  the 
skin,  are  apparently  smaller  than  the  weapon — a  point  to  be  remembered 
in  instituting  a  comparison  between  the  size  of  a  wound  and  the  instru- 


248  LACERATED    AND    CONTUSED    WOUNDS. 

ment.  A  lateral  motion  of  the  weapon  may,  however,  cause  a  considera- 
ble enlargement  of  the  wound.  (See  case  Ann.  d'Hyg.,  1847,  t.  1,  p.  400.) 
When  a  stab  has  traversed  the  body,  the  aperture  of  entrance  is  commonly 
larger  than  that  of  exit;  and  its  edges,  contrary  to  what  might  be  sup- 
posed, are  sometimes  everted,  owing  to  the  rapid  withdrawal  of  the  in- 
strument. That  facts  of  this  kind  should  be  available  as  evidence,  it  is 
necessary  that  the  body  should  be  seen  .soon  after  the  infliction  of  the 
wound,  and  before  there  has  been  any  interference  wilh  it. 

In  general,  wounds  made  by  glass  or  earthemuare  are  characterized  by 
their  great  irregularity  and  the  unevenness  of  their  edges.  In  Reg.  v. 
Ankers  (Warwick  Lent  Ass.,  1845),  a  clean  cut  as  from  a  penknife,  about 
two  inches  long  and  one  deep,  was  proved  to  have  existed  on  the  person 
of  the  wounded  man,  who  had  fallen  during  a  quarrel  with  the  prisoner. 
Some  broken  crockery  was  lying  near  the  spot,  and  it  w^as  alleged  in  the 
defence  that  a  fall  upon  this  had  caused  the  wound.  This  allegation  was 
quite  inconsistent  with  the  clean  and  even  appearance  of  the  edges  of  the 
Avound.  The  prisoner,  in  whose  possession  a  penknife  had  been  found, 
was  convicted. 

2.  Punctured  Wounch — It  is  necessary  to  notice  whether  the  edges  of 
a  punctured  wound  are  lacerated  and  irregular,  or  incised;  because  it  may 
be  alleged,  in  defence,  that  the  wound  was  produced  by  a  fall  on  some  sub- 
stance capable  of  causing  an  injury  somewhat  resembling  it.  In  a  case 
that  occurred  to  Watson,  a  deeply-penetrating  wound  on  the  genital 
organs  of  the  deceased,  which  had  evidently  caused  the  woman's  death, 
was  ascribed,  by  the  prisoners  charged  with  the  murder,  to  her  having 
fallenon  some  broken  glass;  but  it  was  proved  that  the  edges  of  the 
wound  were  bounded  everywhere  by  clean  incisions,  which  rendered  this 
defence  inconsistent,  if  not  impossible.  A  similar  defence  has  been  made 
on  other  occasions,  where  the  cases  came  to  trial.  In  general,  wounds 
made  by  glass  or  earthenware  are  characterized  by  their  great  irregularity 
and  the  unevenness  of  their  edges,  with  portions  of  the  substance  in  them. 
Cases  of  this  kind  show  that,  as  it  is  not  always  possible  to  know  when 
this  sort  of  defence  may  be  raised,  a  medical  witness  should  never  fail  to 
make  a  minute  examination  of  a  wound  which  is  suspected  to  have  been 
criminal!}^  inflicted.  These  medical  difficulties  are  now  for  the  most  part 
removed  by  the  24  &  25  Vict.,  c.  100.  This  must  not,  however,  lead  the 
witness  to  suppose  that  a  personal  injury  is  not  to  be  carefully  examined 
with  a  view  to  the  determination  of  this  question. 

3;  Lacerated  and  Contused  Wounds. — Lacerated  wounds  do  not  in 
general  present  greater  difficulty  with  regard  to  their  origin  than  those 
which  are  incised  or  punctured.  The  means  which  produced  the  lacera- 
tion are  commonly  well  indicated  by  the  appearance  of  the  wound.  These 
injuries  are  generally  the  result  of  accident;  they  are,  however,  frequently 
met  with  on  the  bodies  of  newborn  children,  in  which  case  they  may 
give  rise  to  a  charge  of  infanticide.  If  it  could  be  proved  that  they  had 
arisen  from  the  use  of  a  weapon,  and  that  the  weapon  fitted  the  wounds, 
these  facts  would,  of  course,  go  far  to  a  conviction  on  a  charge  of  murder. 
In  the  case  of  Montgomery  (Omagh  Sum.  Ass.,  18T3),  it  was  proved  that 
a  bill-hook,  found  buried  in  a  spot  to  which  the  prisoner  was  seen  to  go, 
fitted  the  injuries  produced  on  the  skull  of  the  deceased,  and  this  piece  of 
evidence  served  to  connect  the  prisoner  and  the  weapon  with  the  act  of 
murder,  which  took  place  in  a  dwelling-house.     (See  p.  269,  post.) 

Contused  wounds  and  severe  contusions  present  much  greater  difficulty 
to  a  medical  jurist.  It  is  not  often  in  his  power  to  say  whether  a  contused 
wound  has  resulted  from  the  use  of  a  weapon,  from  a  blow  of  the  fist,  or 


LACERATED    AND    CONTUSED    WOUNDS.  249 

2.  fall,  by  reason  of  the  deceased  having-  accidentally  fallen  against  some 
hard  surface.  The  question  is  frequently  put  to  medical  witnesses  on 
those  trials  for  manslaughter  which  arise  out  of  the  pugilistic  combats  of 
half-drunken  men.  One  of  the  combatants  is  generally  killed,  either  by  a 
blow  on  the  head,  by  a  fall,  or  by  both  kinds  of  violence  combined,  The 
skull  may  or  may  not  be  fractured;  and  the  person  may  die  of  concussion, 
inflammation  of  the  brain,  or  from  etfusion  of  blood.  The  general  defence 
is  that  the  deceased  struck  his  head  against  some  hard  substance  in  falling 
on  the  ground,  and  a  surgeon  is  asked  whether  the  particular  appearances 
might  not  be  explained  on  the  supposition  of  a  fall.  A  medical  witness 
is  rarely  in  a  position  to  swear  with  certainty  that  a  contused  wound  of 
the  head  must  have  been  produced  by  a  weapon  and  not  by  a  fall.  (Reg. 
xs.  Budd,  Kingston  Lent  Ass.,  18G8.)  Some  circumstances,  however,  may 
occasionally  enable  him  to  form  an  opinion  on  this  point.  If  there  are 
contused  wounds  on  several  parts  of  the  head,  with  copious  effusion  of 
blood  beneath  the  skin,  the  presumption  is  that  a  weapon  must  have  been 
used.  If  the  marks  of  violence  are  on  the  summit  of  the  head,  it  is  highly 
probable  that  they  have  been  caused' by  a  weapon,  since  this  is  not  com- 
monly a  part  which  can  receive  injury  from  a  fall.  So  again,  if  sand, 
gravel,  grass,  or  other  substances  be  found  in  a  contused  wound,  this  will 
render  it  highly  probable  that  the  injury  was  really  caused  by  a  fall. 

It  matters  not,  under  the  statute  on  wounding,  whether  the  wound  was 
produced  directly  by  a  weapon  employed  by  an  assailant,  or  indirectly  by 
any  act  of  violence  on  his  part.  A  man  may  fracture  the  skull  of  another, 
either  by  striking  him  with  a  brick,  or  by  striking  him  with  his  fist  and 
thus  causing  hini  to  fall  against  a  l)rick.  Acquittals  formerly  took  place 
upon  technicalities  of  this  kind  (Law  Times,  March  21,  1846,  p.  501); 
but  in  Reg.  v.  Dodd  (Shrewsbury  Sum.  Ass.,  ISoS),  Coleridge,  J.,  ex- 
pressed a  strong  opinion  against  the  distinction  thus  made.  The  prisoner, 
it  was  alleged,  threw  a  stone  at  the  deceased,  who  immediately  fell  on  a 
stone  floor.  The  deceased  was  able  to  go  about  for  several  days,  but  he 
died,  a  week  after  he  had  sustained  the  violence,  from  inflammation  of  the 
brain,  as  a  result  of  fracture  of  the  skull.  The  medical  witness  ascribed, 
the  fracture  to  a  blow  from  a  stone.  In  the  defence,  it  was  urged  that 
the  fracture  might  just  as  well  have  arisen  from  a  fall  on  a  stone  floor. 
Coleridge,  J.,  held,  if  the  prisoner  knocked  the  deceased  down,  that  it 
would  make  no  difference  whether  the  deceased  died  from  a  fall  on  a  stone 
floor  or  from  an  injury  produced  by  the  stone  which  was  thrown  at  him. 

A  doubt  may  arise  whether  a  weapon  has  or  has  not  been  used  in 
reference  to  lacerated  or  contused  wounds.  Contused  wounds  on  bony 
surfaces,  as  on  the  head  (e.  cj.,  the  wound  inflicted  bv  the  blow  of  a  cricket- 
ball),  sometimes  present  the  appearance  of  incised  wounds,  the  skin  being 
evenly  separated.  When  a  wound  is  recent,  a  careful  examination  will 
generally  enable  a  witness  to  form  a  correct  opinion,  but  if  some  time  has 
elapsed  before  a  wound  is  examined,  great  caution  will  be  required  in 
forming  a  judgment. 

In  1853,  Hancock  was  enabled  by  the  careful  examination  of  a  wound 
to  disprove  a  charge  of  maliciously  wounding  made  against  innocent  per- 
sons. A  little  girl  was  represented  to  have  received,  while  sitting  over 
an  iron  grating,  a  wound  in  the  pudendum,  by  some  persons  pushing 
a  toasting-fork,  or  other  pointed  instrument,  between  the  bars  of  the 
grating  from  below.  There  were  no  marks  of  punctures,  which  would 
have  been  found  had  this  statement  been  true,  but  a  slight  laceration  of 
the  parts,  such  as  might  have  been  produced  by  an  accidental  fall  on  the 
edge  of  the  iron  grating  while  the  girl  was  in  a  sitting  position.     There 


250  INJURIES    FROM    BLOWS    OR    FALLS. 

were  also  marks  of  bruises  on  the  thi^'-h,  such  as  mi.irht  have  occurred  from 
an  accident  of  this  kind.  The  mother  of  the  child  had  made  the  false 
charge  for  the  sake  of  exciting  public  compassion  and  extorting  money. 
A  surgical  examination  of  the  injury  clearly  established  that  it  had 
resulted  from  accident.  The  part  of  the  body  in  which  the  injury  existed 
in  this  case  is  not  usually  exposed  to  laceration  or  punctures  from  acci- 
dent ;  but  the  child,  for  a  necessary  purpose,  had  placed  herself  voluntarily 
in  this  position,  and  had,  on  her  own  admission,  slipped,  and  thus  probably 
injured  herself. 

A  surgeon  should  be  cautious  in  listening  to  the  statement  of  others 
that  a  weapon  has  been  used,  unless  the  wound  itself  bears  about  it  such 
characters  as  to  leave  the  fact  indisputable.  During  a  scuffle,  the  person 
assaulted  may  be  easily  deceived  as  to  the  way  in  which  an  accused 
person  inflicted  a  wound  upon  him;  and  a  bad  motive  may  sometimes 
exist  for  imputing  to  an  assailant  the  use  of  a  weapon  during  a  quarrel. 
In  such  cases  a  medical  witness  should  rather  trust  to  the  appearance  of 
the  Avound  for  proof  of  the  use  of  a  weapon,  than  to  any  account  given  by 
interested  parties. 

A  judge  suggested  to  the  author  that  some  means  of  discrimination 
between  the  effects  of  falls  and  blows  affecting  the  same  part  of  the  body 
would  greatly  aid  the  administration  of  justice.  There  is  no  doubt  that 
it  would,  but  as  no  two  cases  coming  under  this  class  of  injuries  are  pre- 
cisely alike,  either  in  the  part  wounded  or  the  amount  of  force  employed, 
it  is  scarcely  possible  to  introduce  general  rules  or  to  make  statistics  prac- 
tically available.  It  is  commonly  supposed  that  a  mere  fall  is  not  sufficient 
to  produce  the  same  degree  of  injury  that  may  be  caused  by  a  blunt 
weapon  applied  suddenly  to  the  head  by  human  force  ;  but  a  severe  frac- 
ture may  arise  from  a  simple  accident  of  this  kind,  and  present  nearly  all 
the  characters  of  homicidal  violence.  The  difficulties  at  criminal  trials 
will  be  found  to  proceed,  not  so  much  from  want  of  rules  to  assign  the 
violence  to  one  condition  or  the  other,  as  from  a  want  of  observation  when 
the  wounds  are  first  examined.  If  minute  attention  were  given  to  an  ex- 
amination of  these  injuries  soon  after  their  occurrence,  circumstances 
would  be  noticed  which  would  help  the  medical  witness  to  a  conclusion. 
The  defence  that  they  might  have  been  produced  by  a  fall  is  not  set  up 
until  a  subsequent  period,  and  the  surgeon  is  then  obliged  to  trust  to  his 
memory  for  the  main  points  of  distinction.  Such  improvised  opinions 
usually  fail  in  impressing  a  jury. 

When  it  is  a  question  which  of  two  weapons  produced  certain  bruised 
wounds  found  on  the  head,  the  difficulties  of  medical  evidence  are  in- 
creased. Under  these  circumstances,  the  presence  of  blood,  hair,  cotton, 
or  woollen  fibres  on  one  of  tlie  weapons  may  render  it  probable  that  this 
weapon  was  used.  (Reg.  v.  Lee,  Exeter  Ass.,  Feb.  1885.)  In  most  in- 
stances an  accurate  observation  of  the  form  of  a  contused  wound,  and  an 
early  comparison  of  it  with  the  alleged  weapon,  or  the  substance  said  to 
have  produced  it,  will  enable  a  witness  to  come  to  a  correct  conclusion  on 
the  subject.  The  situation,  depth,  and  shape  of  the  wound  may  be  such 
that  no  accidental  fall  could  reasonably  account  for  its  production.  In 
assaults  on  women,  it  is  not  unusual  to  find  that  the  complainant  herself 
endeavors  to  exculpate  the  assailant  by  ascribing  the  marks  of  violence, 
not  to  blows,  but  to  some  accidental  fall.  A  woman  deposed  before  a 
magistrate  that  certain  severe  injuries  which  she  had  sustained  had  been 
caused  by  her  falling  on  a  fender.  The  medical  man  who  examined  her 
found  on  the  top  of  the  head  three  distinct  wounds,  which  were  bleeding. 
Two  appeared  as  if  they  had  been  caused  by  a  blunt  instrument;  the 


STABS    AND    CUTS — WEAPONS.  251 

third,  on  the  back  of  the  head,  was  a  clean-cut  wound.  He  considered 
that  they  had  been  produced  by  a  chopper,  and  that  none  of  them  had 
been  caused  by  a  fall  or  a  series  of  falls.  The  prisoner,  on  this  evidence, 
was  committed  for  trial. 

If  the  fall  has  taken  place  from  a  great  height,  as  over  a  precipitous  or 
rugged  slope,  it  is  obvious  that  the  body  may  sustain  many  severe  in- 
juries to  various  parts  quite  sufficient  to  account  for  death.  Such  a  fall 
may  be  the  result  of  accident,  of  suicide,  or,  as  in  the  case  of  Madame  de 
Tourville,  in  July,  1816,  of  a  deliberate  design  to  destroy  life  by  pushing 
the  person  over  the  precipice.  The  injuries  would  be  similar  in  each  case. 
De  Tourville,  a  barrister,  was  charged  before  the  Austrian  Court  at 
Botzen  with  the  murder  of  his  wife  by  pushing  her  over  a  precipice  in 
the  Stelvio  Pass.  Her  lifeless  body  was  found  at  a  considerable  depth 
below.  The  chief  seat  of  injury  was  the  head,  which  had  been  crushed  by 
the  fall.  There  was  nothing  in  the  appearance  of  the  body  to  show  inten- 
tional violence.  The  guilt  of  the  prisoner  was  made  out  by  the  false  and 
inconsistent  statements  which  he  had  made  respecting  the  occurrence. 
There  were  marks  of  the  body  having  been  dragged  some  distance,  and 
part  of  the  dress,  in  a  bloody  state,  was  found  at  a  distance  from  the  spot 
where  the  body  was  lying,  and  there  were  marks  of  blood  on  the  prison- 
er's hands  and  dress.  After  a  lengthy  trial,  during  Avhich  the  spot  was 
visited  by  the  judge  and  jury,  He  Tourville  was  found  guilty  and  sen- 
tenced to  death.  This  sentence  was  subsequently  commuted  to  imprison- 
ment for  life. 

4.  Stabs  and  Cuts. — It  has  been  remarked  that  the  law  in  some  cases 
attaches  great  importance  to  the  clear  proof  of  the  use  of  a  weapon;  and 
a  medical  man  has  therefore  a  certain  responsibility  thrown  upon  him 
when,  in  the  absence  of  a  weapon  and  the  denial  of  its  use,  he  is  called 
upon  to  say  whether  one  has  or  has  not  been  used.  In  reference  to  cuts 
and  stabs,  there  can  in  general  be  no  difficulty,  for  these  injuries  carry 
with  them  distinct  evidence  of  their  mode  of  production.  Formerly  stab- 
bing and  cutting  were  treated  as  distinct  ironi  wounding,  and  very  nice 
legal  distinctions  were  draAvn  between  these  terms,  w^hich  had  the  effect 
of  procuring  acquittals  on  mere  legal  technicalities.  Under  the  consoli- 
dated Act,  the  words  "stab"  and  "cut"  are  properly  omitted,  and  the 
word  "wound"  only  has  been  retained.  Medical  men  w^ould  always 
agree  upon  a  stab  or  cut  being  a  wound,  but  they  might  reasonabl}^  differ 
upon  the  question  whether  in  a  given  case  a  wound  was  really  a  stab  or  a 
cut.  It  might  be  punctured,  lacerated,  or  contused,  and  not  fairly  come 
under  the  professional  description  either  of  a  cut  or  a  stab.  A  medical  wit- 
ness has  now  only  to  prove  that  the  personal  injury  falls  strictly  within 
the  meaning  of  the  term  loovnd  (p.  239) ;  he  is  not  called  upon  to  prove 
the  precise  variety  of  wounding  to  which  the  injury  should  be  assigned. 
At  the  same  time,  he  should  always  be  prepared  wnth  a  full  description  of 
the  characters  of  an  injury  in  case  questions  on  the  subject  should  be  put 
to  him. 

What  are  Weapons'? — The  consolidated  statute  has  removed  those  legal 
subtleties  which  raised  doubts  on  the  true  significance  of  the  term  iveapon. 
Thus  the  teeth,  the  uncovered  hands  or  feet,  were  formerly  held  by  the 
judges  not  to  be  weapons  ;  and  injuries  produced  by  them,  however  severe, 
were  not  treated  as  wounds  within  the  meaning  of  the  statute.  Persons 
were  tried  on  charges  of  biting  off  fingers  and  noses,  and  although  the  med- 
ical evidence  proved  that  wounds  of  a  severe  kind  had  been  inflicted,  and  that 
great  disfigurement  and  mischief  had  been  done  to  individuals,  yet  the  nature 
of  the  injur}^  produced  was  not  so  much  regarded  as  the  actual  method 


252  EXAMINATION    OP    THE    DRESS. 

by  which  it  was  accomplished.  The  pei-sons  charged  were  acquitted 
under  an  indictment  for  "  wounding,"  since  wounds,  in  a  legal  sense, 
could  be  produced  only  by  weapons,  while  the  teeth,  hands,  and  feet  were 
not  weapons  in  law. 

Examination  of  the  Dress. — ^This  is  sometimes  a  most  important  part 
of  the  duty  of  a  medical  man.  In  a  case  of  severe  wounding  of  whatever 
kind,  he  should  always  require  to  see  the  dress  of  the  wounded  person.  It 
may  throw  a  material  light  upon  the  mode  in  which  a  wound  has  been 
produced ;  it  may  remove  an  erroneous  suspicion  of  murder,  and  may 
sometimes  serve  to  indicate  that  a  wound  has  been  self-inflicted,  for  the 
concealment  of  other  crimes,  or  falsely  to  impute  its  infliction  to  other 
persons.  Marks  of  blood,  dirt,  grass,  or  other  substances  on  the  clothing 
may  also  throw  a  light  upon  the  mode  of  infliction.  So  again  the  use  of  a 
weapon,  in  reference  to  cuts  and  stabs,  may  be  inferred  from  the  dress 
presenting  corresponding  cuts  or  perforations.  Contused  wounds  by 
bludgeons  may,  however,  be  readily  produced  through  the  dress,  Avithout 
tearing  or  injuring  it.  Considerable  laceration  of  the  skin  and  muscles, 
and  even  severe  fractures,  may  be  caused  without  necessarily  penetrating 
the  dress,  supposing  this  to  be  at  all  of  an  elastic  or  yielding  nature.  In 
self-inflictQd  or  imputed  cuts  or  stabs,  there  is  often  a  want  of  correspon- 
dence between  the  perforations  of  the  dress  and  the  wounds  on  the  person  : 
this  is  one  of  the  characters  by  which  the  correctness  of  a  statement  may 
be  tested.  A  severe  wound  may  be  indirectly  produced  by  a  bruising- 
weapon,  and  medical  witnesses  have  been  often  questioned  on  this  point. 
Thus  the  prosecutor  may  at  the  time  have  worn  about  his  person  some 
article  of  dress  which  received  the  blow,  and  this  may  have  actually  caused 
the  wound.  Cases  of  this  kind  must  be  determined  by  the  circumstances 
which  accompany  them.  Hence  it  is  obvious  that  a  medical  practitioner 
should  always  make  a  minute  and  careful  examination  of  wounds  which 
are  likely  to  become  the  subject  of  criminal  charges,  as  well  as  of  the  dress 
and  clothing  worn  by  the  wounded  person  at  the  time  of  the  assault.  In 
performing  his  duties  as  a  surgeon,  he  is  bound,  so  far  as  he  consistently 
can,  to  notice  as  a  medical  jurist  the  characters  of  all  personal  injuries,  so 
as  to  be  able  to  give  an  opinion  on  the  mode  in  which  they  were  produced. 
A  careful  examination  of  the  dress  has  served  to  remove  doubts  respecting 
the  mode  in  which  contused  wounds  have  been  inflicted  on  the  body  of  a 
person  found  dead  ;  while,  on  the  other  hand,  a  neglect  to  examine  the 
dress  has  led  to  accidental  being  mistaken  for  homicidal  violence,  as  in  the 
following  case.  A  woman  was  found  dead  in  bed.  She  had  vomited 
slightly,  and  there  waa  on  the  floor  a  small  quantity  of  blood,  which  had 
flowed  from  the  nose.  She  had  been  seen  in  her  usual  health  on  the  pre- 
vious night.  There  were  found  two  indentations  about  the  middle  of  the 
right  parietal  bone,  and  there  was  a  large  clot  of  blood  in  this  situation 
beneath  the  skin.  On  removing  this  clot,  the  bone  was  found  fractured 
to  the  extent  of  four  inches.  Nearly  three  ounces  of  clotted  blood  were 
found  on  the  outer  membrane  of  the  brain  (dura  mater),  between  it  and 
the  skull.  All  the  other  viscera  were  healthy.  This  was  the  only  injury, 
and  quite  sufficient  to  account  for  death  ;  but  a  question  arose  respecting 
the  mode  in  which  this  fracture  was  caused.  It  was  in  evidence  that,  on 
the  evening  before  her  death,  the  deceased  had  been  knocked  down,  while 
she  was  walking  in  a  public  road,  by  a  man  accidentally  running  against 
her.  One  witness  stated  that  she  fell  heavil}'-  on  the  back  of  her  head,  on 
which  at  the  time  she  wore  a  bonnet.  She  appeared  stunned — was  raised 
up  by  the  man — some  brandy  was  given  to  her,  and  she  recovered  suffi- 
ciently to  w^alk  home  and  eat  her  supper  as  usual,  after  which  no  one  saw 


EXAMINATIO>'    OF    THE    DRESS.  253 

her  until  she  was  found  dead  in  bed  on  the  following  morning.  Some 
suspicion  arose  that  the  violence  done  to  the  head  was  too  great  to  be 
accounted  for  by  a  mere  fall,  and  it  was  a  question  whether,  with  such  an 
amount  of  injury,  the  deceased  could  have  walked  to  her  home,  at  the  dis- 
tance of  a  mile  and  a  half,  and  have  eaten  her  supper  before  going  to  bed. 
At  first  it  was  thought  that  this  was  a  case  of  murder,  and  a  man  who 
lodged  in  the  house  with  the  deceased  was  suspected.  His  room  was 
searched,  and  a  hammer  with  two  claws  was  found.  On  comparing  these 
claws  with  the  two  indentations  and  fracture,  the  medical  witness  thought 
that  this  weapon  w^ould  account  for  their  production.  The  deceased  and 
this  man  had  been  in  the  habit  of  quarrelling,  and  they  were  the  only 
persons  in  the  house  on  this  occasion.  The  lodger  said  that  he  let  the 
woman  in  about  9  P.M.  (the  fall  in  the  road  occurred  about  7.30  P.M.)  ; 
her  appearance  presented  nothing  unusual,  and  he  saw  no  more  of  her 
until  called  at  seven  the  next  morning,  when  she  was  found  dead  and  cold. 
It  was  only  at  the  adjourned  inquest  that  the  bonnet  worn  by  the  deceased 
at  the  time  of  the  fall  was  called  for  by  the  coroner.  Two  indentations 
were  then  found  upon  the  back  part  of  it,  corresponding  to  those  on  the 
skull  of  deceased.  The  indentations  on  the  bonnet  contained  dust  and 
dirt,  thereby  confirming  the  statements  of  the  witnesses,  and  rendering  it 
prol)able  that  the  fall  in  the  road  had  really  caused  the  fatal  injury  to  the 
head.  The  examination  of  the  dress  in  this  case  cleared  up  what  might 
have  been  otherwise  doubtful.  Jt  is  probable  that  the  large  internal 
effusion  of  blood  which  had  caused  death  did  not  take  place  until  the  de- 
ceased had  reached  home,  and  perhaps  as  a  result  of  the  exertion  made. 
She  must  have  died  very  soon  after  she  went  to  bed,  as  her  body  was 
found  cold  at  seven  o'clock  the  next  morning.  In  addition  to  the  caution 
which  this  case  conveys  respecting  medical  opinions  on  the  origin  of 
w^ounds,  it  shows  that  persons  may  walk  far,  and  die  at  a  great  distance 
from  the  spot  where  a  serious  injury  to  the  head  has  been  sustained. 

If  several  wounds  have  been  inflicted  through  the  dress,  an  examination 
of  this  may  sometimes  suffice  to  show  which  \vas  fii'st  received.  A  man, 
in  struggling  with  an  assailant,  received  three  stabs  with  a  knife — two  on 
the  left  elbow  and  a  third  in  the  back.  The  latter  was  at  about  the  level  of 
the  eighth  rib  ;  it  w^as  vertical  to  the  chest  and  had  clean  edges.  The 
lower  margin  was  obtuse — the  upper  acute  ;  hence  it  was  evident  that  the 
cutting  edge  of  the  weapon  had  Ijeen  directed  upwards.  It  had  traversed 
the  left  lung  and  the  heart,  and  had  caused  immediate  death.  It  ■was  ob- 
vious, on  examination,  that  this  mortal  wound  had  been  first  received,  and 
the  stabs  at  the  elbow  inflicted  subsequently.  These  two  stabs,  Avhich 
were  slight,  had  divided  the  cloth  coat  and  shirt,  and  had  only  grazed  the 
skin,  so  that  no  blood  had  been  effused.  But  the  edge  of  the  cuts  in  the 
cloth  coat  and  shirt  were  stained  with  blood ;  hence  it  was  evident  that 
they  must  have  been  produced  by  a  weapon  already  rendered  bloody  by  a 
previ.jus  wound.  The  fact  was  of  importance  in  the  case,  and  the  correct- 
ness of  the  medical  opinion  was  confirmed  by  the  evidence  at  the  judicial 
inquiry.     (Ann.  d'Hyg.,  1847,  p.  461.) 

Imputed  or  Self-infiicted  Wounds. — A  man  may  produce  upon  himself 
one  or  more  w^ounds  for  the  purpose  of  simulating  a  homicidal  assault, 
which  he  may  allege  to  have  been  committed  upon  him.  "With  the  motives 
for  the  self-infliction  of  wounds  a  medical  jurist  is  not  concerned — it  is  of 
the  fact  only  that  he  can  take  cognizance.  From  cases  that  have  occurred, 
it  appears  that  the  object  has  been  to  extort  money,  to  conceal  murder, 
robbery,  or  some  other  crime,  and  to  turn  away  a  suspicion  of  criminality 
from  the  wounded  person  himself;  but  it  is  not  always  easy  to  trace  a 


254  ■  SKLF-INFLICTED    WOUNDS. 

motive  for  the  self-infliction  of  injuries,  and  when  a  reasonable  motive  is 
not  at  once  forthcoming-,  persons  are  apt  to  be  misled  and  to  credit  the 
story.  Persons  who  have  been  convicted  of  thus  imputing  violence  to 
others  have  frequently  borne  good  characters  until  the  occurrence ;  and 
this  has  contributed  to  give  support  to  their  statements.  When  a  person, 
intending-  to  commit  suicide,  fails  in  the  attempt,  he  has  sometimes,  under 
a  sense  of  shame,  attributed  the  infliction  of  a  wound  in  his  throat  to 
another  ;  but  facts  of  this  kind  may  without  difficulty  be  cleared  up  by 
circumstantial  evidence.  Imputed  wounds — if  Ave  except  the  case  of  an 
actual  attempt  at  suicide,  in  which  the  injury  is  commonly  severe — are 
generally  of  a  superficial  character,  consisting  of  cuts  or  incisions  not  ex- 
tending below  the  true  skin  ;  deep  stabs  are  seldom  resorted  to  where  the 
purpose  is  not  suicide,  but  merely  to  conceal  other  crimes.  Further,  these 
wounds  are  in  front  of  the  person,  and  may  be  on  the  left  or  right  side, 
according  to  whether  the  person  is  right-  or  left-handed.  They  have  also 
been  generally  numerous  and  widely  scattered  5  sometimes  they  have  had 
a  complete  parallelism,  unlike  those  which  must  have  been  inflicted  by  an 
adversary  during  a  mortal  conflict  with  a  weapon.  The  hands  are  seldom 
woundecl,  although  in  the  resistance  to  real  homicidal  attempts  these  parts 
commonly  suffer  most  severely.  The  injuries  are  not  usually  situated 
over  those  parts  of  the  body  in  which  wounds  are  by  common  repute  con- 
sidered mortal,  and  there  is  in  general  an  entire  want  of  correspondence 
between  the  situation  of  the  wounds  on  the  person,  and  the  cuts  or  other 
marks  on  the  dress.     This  is  a  fact  which  requires  special  attention. 

In  comparing  cuts  on  the  dress  with  wounds  on  the  person,  there  are 
several  circumstances  to  be  attended  to.  What  articles  of  dress  were  worn 
at  the  time  of  the  assault?  In  a  case  of  actual  stabbing  by  another,  all 
ought  to  present  marks  of  perforation  corresponding  in  direction,  form, 
size,  sharpness  of  the  edges  of  the  weapon,  etc.  In  imputed  wounds,  the 
marks  on  several  layers  of  dress  may  not  correspond  with  each  other  in 
the  characters  above  mentioned.  It  is  difficult  for  a  man  simulating  such 
injuries  so  to  arrange  his  clothes  when  oft"  his  person  as  to  deceive  a  care- 
ful examiner.  There  will  be  some  inconsistency  or  want  of  adjustment. 
Apart  from  the  fact  that  several  stabs  or  cuts  cannot  exist  on  the  same 
part  of  the  clothes  without  one  or  more  being  stained  with  blood  from  the 
outside  or  inside,  an  impostor  may  either  do  too  much  or  too  little,  and 
thus  lead  to  his  detection.  In  a  case  which  excited  much  public  discus- 
sion in  London  many  years  since,  a  simple  circumstance  led  to  the  infer- 
ence that  certain  stabs  or  cuts  through  a  shirt  had  not  been  produced 
while  the  shirt  was  on,  but  while  it  was  off"  the  body.  There  were  two 
cuts  in  the  shirt  near  to  each  other,  precisely  similar  in  size,  form;  and 
direction  ;  in  fact,  the  knife  or  dagger  producing  them  must  have  gone 
through  a  fold  of  the  shirt,  so  accurate  was  the  correspondence.  Then, 
however,  it  followed  that  the  shirt  could  not  have  been  upon  the  body  of 
the  wounded  person,  as  he  alleged,  because  a  stab  through  the  shirt  M'hen 
worn  over  the  skin  must,  in  order  to  reach  the  body,  traverse  not  only  a 
fold  (producing  two  cuts),  but  a  single  layer  in  contact  with  the  skin,  and 
thus  produce  three  cuts,  or,  in  the  event  of  traversing  two  Mds,  five  cuts. 
In  simulating  the  wounds  by  cuts  on  the  shirt,  the  person  is  supposed  to 
have  forgotten  this,  and  have  merely  stabbed  a  fold  of  the  shirt  while 
lying  on  a  table,  or  in  some  situation  convenient  for  the  purpose.  This, 
a"mong  other  facts,  rendered  it  probable  that  the  slight  wounds  on  the 
chest  were  self-inflicted.  A  case  occurred  at  Nottingham,  in  1872,  which 
shows  how  persons  who  inflict  wounds,  and  at  the  same  time  cut  the  dress 
covering  the  wounded  part,  may  furnish  evidence  against  themselves.     A 


CHARACTERS    OF    IMPUTED    WOUNDS.  255 

youth  charged  a  man  with  unlawfully  wounding  him  on  the  highway. 
He  stated  that  the  man  had  stabbed  him  in  the  arm,  cutting  through  his 
shirt  and  coat-sleeve.  There  was  no  attempt  at  robbery,  and  no  motive 
for  such  an  act.  On  examining  the  coat  and  shirt-sleeve  it  was  found 
that  they  had  been  cut,  but  there  was  no  corresponding  cut  in  the  lining 
of  the  coat-sleeve.  The  prosecutor  could  give  no  explanation  of  this.  It 
was  clear  that  the  charge  was  false,  that  there  had  been  no  cutting  or 
stabbing  by  another,  but  that  the  wound  was  self-inflicted  when  the  coat 
was  not  worn.  The  3'outh  wished  to  leave  the  place  where  he  had  been 
sent  for  private  study,  and  he  had  adopted  this  plan  to  induce  his  friends 
to  remove  him. 

It  has  been  contended  that  no  rules  can  be  laid  down  for  the  detection 
of  such  cases:  each  must  be  decided  by  the  facts  which  accompany  it. 
The  facts  which  a  medical  man  must  endeavor  to  ascertain  are  the  follow- 
ing:  1.  The  relative  positions  of  the  assailant  and  the  assailed  person  at 
the  time  of  the  alleged  attack.  2.  The  situation,  direction,  and  depth  of 
the  wound  or  wounds.  3.  The  situation  or  direction  of  marks  of  blood  or 
wounds  on  the  person  or  dress  of  either,  or  of  both  the  assailant  and 
assailed.  4.  The  marks  of  blood,  and  the  quantity  etfused  at  the  spot 
where  the  mortal  struggle  is  alleged  to  have  taken  place.  The  importance 
of  these  inquiries  cannot  be  overestimated.  A  strong  suspicion  was 
raised  against  the  then  Duke  of  Cumberland,  in  1810,  in  reference  to  the 
death  of  Sellis,  when  a  skilful  examination  of  the  wounds  on  the  deceased 
would  have  shown  that  they  might  have  been  self-inflicted. 

It  is  worthy  of  remark  that  imputed  wounds  are  generally  cuts  or  stabs. 
They  are  seldom  of  the  contused  kind;  the  impostor  cannot,  in  reference 
to  contusions,  so  easily  calculate  upon  the  amount  of  mischief  which  is 
likely  to  ensue.  Bergeret,  however,  has  related  some  cases  in  Avhich 
females  laboring  under  hysterical  attacks  have  inflicted  upon  themselves 
severe  contusions,  and  have  charged  innocent  persons  Avith  attempts  to 
murder.  (Ann.  d'Hyg.,  ISGS,  t.  1,  p.  463.)  In  general  the  inconsistency 
of  the  story  is  so  palpable  as  to  betray  the  imposture  at  once ;  but  much 
prejudice  is  often  unjustly  excited  against  those  who  have  been  falsely 
accu.sed.  Slight  excoriations  or  bruises  may  be  magnified  into  marks  of 
murderous  violence;  and  if  a  medical  man  can  be  found  to  admit  in  an 
unqualified  form  that  a  severe  blow  may  be  inflicted  and  yet  leave  but 
slight  marks  on  the  skin,  the  charge  will  be  considered  proved  against 
the  unfortunate  accused. 

The  case  of  M.  Arinand,  a  merchant  of  Montpelier,  who  was  tried  at 
the  assizes  at  Aix,  in  March,  18R4,  for  an  alleged  murderous  assault  upon 
his  servant,  Maurice  Roux,  furnishes  a  good  illustration  of  the  readiness 
with  which  the  most  inconsistent  stories  are  accepted  by  the  public  when 
they  are  supported  by  pseudo-medical  evidence.  This  case  was  rather  one  * 
of  imputed  homicidal  strangulation  than  self  inflicted  wounding;  never- 
theless, a  foundation  was  laid  for  medical  opinions  by  the  presence,  as  it 
was  alleged,  of  a  slight  excoriation  of  the  skin  on  the  nape  of  the  neck. 
The  injury  was  so  slight  that  it  escaped  the  observation  of  some  medical 
men  who  examined  the  complainant,  and  there  could  be  no  doubt  from  the 
facts  that  it  had  been  produced,  either  accidentally  or  designedly,  by  the 
complainant  on  himself.  Several  medical  gentlemen,  taking  the  man's 
story  as  true,  asserted  without  any  qualification:  1.  That  a  blow  on  the 
nape  of  the  neck  might  produce  cerebral  concussion  and  syncope.  2.  That 
a  blow  to  produce  such  effects  need  not  be  violent.  3.  That  such  a  blow 
so  inflicted  would  not  always  leave  upon  the  skin  marks  of  contusion  or 
ecchymo.sis.     These  admissions  were  taken  by  the  court  to  support  the 


256  WOUNDS    INDICATIVE    OF    HOMICIDE. 

man's  story that  his  master  had  struck  a  severe  blow  on  the  back  of  his 

neck,  that  this  bloAv  h:id  produced  concussion  of  the  brain,  and  that  he  had 
been  rendered  insensible  for  many  hours.  (Ann.  d'Hyg.,  1864,  t.  i,  p. 
451.)  The  evidence  for  the  defence,  and  chiefly  that  given  by  Tardieu,  re- 
moved the  evil  effect  produced  by  such  loose  medical  statements  as  these, 
and  satisfied  the  jury  that  the  story  of  the  complainant  was  a  pure  fabri- 
cation. The  accused  was  justly  acquitted  of  the  charge.  Although  it 
has  been  elsewhere  stated  that  severe  blows  are  not  always  attended  with 
external  marks  of  violence  (p.  241),  it  by  no  means  follows  that  such 
blows  have  been  struck  in  all  cat^es  in  Avhich  the  skin  presents  a  slight 
abrasion.  This  would  be  converting  the  exception  into  the  rule,  and  every 
superficial  injury  might  be  thus  distorted  into  a  proof  of  the  infliction  of 
murderous  violence. 

Pistol-shot  wounds  are  sometimes  voluntarih'  inflicted  for  the  purpose 
of  imputing  murder  or  extorting  charity.  A  man  intending  to  commit 
suicicie  by  firearms,  and  failing  in  the  attempt,  may,  from  shame  and  a 
desire  to  conceal  his  act,  attribute  the  wound  to  the  hand  of  some  assas- 
sin. In  examining  such  imputed  wounds,  they  will  not  be  found  to  in- 
volve vital  parts,  except  in  cases  of  attempted  suicide;  and  they  will  pos- 
sess all  the  characters  of  near  wounds  produced  by  gunpowder,  wadding, 
or  a  bullet.  The  skin  around  will  be  more  or  less  lacerated  and  bruised  ; 
there  will  be  much  eechymosis,  and  the  hand  holding  the  weapon,  as  well 
as  the  dress  and  the  wounded  skin,  may  be  blackened  or  burnt  by  the  ex- 
ploded gunpowder.  A  pistol-shot  wound  from  an  assassin  may  be  pro- 
duced from  a  distance,  while  an  imputed  wound  which  is  inflicted  by  a 
person  on  himself  must  always  partake  of  the  characters  of  a  near  wound. 


CHAPTER  XXy. 

WOUNDS    INDICATIVE    OF    HOMICIDE,    SUICIDE,    OR    ACCIDENT. EVIDENCE    FROM     THE     SITUA- 
TION   OF    A    WOUND. EVIDENCE     FROM    ITS    NATURE    AND     EXTENT. EVIDENCE    FROM    THE 

DIRECTION    OF    A    WOUND. WOUNDS     INFLICTED     BY     THE    RIGHT     OR     LEFT     HAND. SEV- 
ERAL   WOUNDS. USE    OF    SEVERAL    WEAPONS. 

Wounds  indicative  of  Homicide,  Suicide,  or  Accident. — Supposing 
that  the  wound  which  is  found  on  a  dead  body  is  proved  to  have  been 
caused  before  death,  it  may  be  necessary  to  inquire  whether  it  was  the  re- 
sult of  suicide,  homicide^ or  accident.  It  might  at  first  sight  be  consid- 
ered that  the  determination  of  a  question  of  this  nature  was  wholly  out  of 
the  province  of  a  medical  jurist.  In  some  instances  it  may  be  so,  and  the 
settlement  of  it  is  then  properly  left  to  the  legal  authorities;  but,  in  a 
large  number  of  cases,  it  is  so  closely  dependent  for  its  elucidation  on  med- 
ical facts  and  opinions,  that  juries  could  never  arrive  at  a  satisfactory 
decision  without  medical  evidence.  Let  us  suppose,  then,  that  a  medical 
jurist  is  consulted  in  a  doubtful  case:  what  are  the  points  to  which  he 
should  direct  his  attention?  They  are,  with  regard  to  the  wound,  (1)  its 
situation,  (2)  its  nature  and  extent,  and  (3)  its  direction. 

1.  Evidence  from  the  Situation  of  a  Wound. — It  is  a  general  princi- 
ple, in  which  most  medical  jurists  agree,  that  wounds  inflicted  by  a  suicide 
are  usually  confined  to  the  fore  or  lateral  parts  of  the  body.  The  throat 
and  chest  are  commonly  selected  when  cutting  instruments  are  employed; 


.  WOUNDS  —  EVIDENCE    FROM    SITUATION.  257 

while  the  chest,  especially  in  the  region  of  the  heart,  the  mouth,  the  orbit, 
and  the  temples  are  the  spots  generally  chosen  for  the  perpetration  of  sui- 
cide by  firearms.  But  it  is  obvious  that  any  of  these  parts  may  be  also 
selected  by  a  murderer,  with  the  especial  design  of  simulating  a  suicidal 
attempt;  therefore,  the  mere  situation  of  a  wound  does  not  suflice  to  estab- 
lish the  fact  of  suicide.  Some  have  regarded  it  as  fully  established  in  legal 
medicine  that,  when  wounds  exist  at  the  back  of  the  body,  it  is  a  positive 
proof  that  they  have  not  been  self-inflicted.  This  situation  is  certainly 
unusual  in  cases  of  suicide;  but,  as  Orfila  observes,  it  is  not  the  situation 
so  much  as  the  direction  of  a  wound  which  here  furnishes  evidence  against 
the  presumption  of  suicide.  A  wound  traversing  the  body  from  behind 
to  before  in  a  direct  line  is  not  likely  to  have  resulted  from  a  suicidal  at- 
tempt; at  least,  it  must  be  obvious  that  it  would  require  more  preparation 
and  contrivance  on  the  part  of  a  self-murderer,  so  as  to  arrange  matters 
that  such  a  wound  should  be  produced,  than  we  can  believe  him  to  possess 
at  the  moment  of  attempting  his  life.  Besides,  his  object  is  to  destroy 
himself  as  quickly  and  as  surely  as  circumstances  will  permit;  he  is,  there- 
fore, not  likely  to  adopt  complicated  and  uncertain  means  for  carrying  this 
design  into  execution.  Nevertheless,  we  must  not  always  expect  to  find 
suicidal  wounds  in  what  an  anatomist  would  pronounce  to  be  the  most 
appropriate  situation  to  produce  instant  destruction.  An  incised  wound 
in  a  concealed  or  not  easily  accessible  part  is  presumptive  of  murder,  be- 
cause this  kind  of  injury  could  have  resulted  only  from  a  deliberate  use  of 
the  weapon.  Suicidal  wounds  are,  however,  sometimes  found  in  unusual 
situations.  Thus,  the  bloodvessels  of  the  arms  or  legs  may  be  the  seat  of 
injury.  Abdul  Aziz,  Sultan  of  Turkey,  was  found  dead  under  suspicious 
circumstances.  The  arms  presented  two  gashes  at  the  bend  of  each  elbow 
in  front.  The  direction  of  both  of  these  wounds  was  oblique,  from  above 
downwards  and  from  within  outwards,  and  their  edges  were  jagged.  That 
on  the  left  arm  penetrated  to  the  joint.  The  superficial  veins  and  the 
deep-seated  tissues  were  cut  through,  and  the  ulnar  artery  laid  open,  but 
not  entirely  divided.  The  wound  on  the  right  arm  was  superficial,  in- 
volving only  the  skin  and  the  veins.  The  bleeding  from  the  ulnar  artery 
and  veins  had  led  to  death.  The  dress  was  soaked  with  blood.  A  pair  of 
scissors  stained  with  blood  was  found  upon  the  sofa.  Although  the  situa- 
tion of  these  wounds  is  unusual,  there  is  nothing  in  them  inconsistent 
with  suicide.  The  body  was  examined  by  nineteen  physicians,  and  they 
agreed  in  signing  a  report  that  the  act  was  suicidal.  '  Unfortunately,  they 
assigned  as  one  of  their  reasons,  "that  the  direction  and  nature  of  the 
wounds,  as  well  as  the  instrument  which  might  have  effected  them  (the 
scissors),  lead  to  the  conclusion  of  suicide;"  whereas,  it  is  perfectly  clear 
from  the  description  that  such  wounds  as  these  might  have  been  easily 
produced  by  an  assassin,  and  that  their  situation,  nature,  and  direction 
were  very  unusual  in  cases  of  suicide.  In  reference  to  this  subject  it  has 
been  truly  remarked  that  there  is  no  wound  which  a  suicide  is  capable  of 
inflicting  upon  himself  which  may  not  be  produced  by  a  murderer;  but 
there  are  many  wounds  inflicted  by  a  murderer  which,  from  their  situa- 
tion and  other  circumstances,  a  suicide  would  be  incapable  of  producing 
on  his  own  person.  We  cannot  always  obtain  certainty  in  a  question  of 
this  kind — the  facts  will  often  allow  us  to  speak  only  with  different  de- 
grees of  probability.  See  the  case  of  Elizabeth  Gibbons,  convicted  of  the 
murder  of  her  husband.     (See  p.  2B1,  post.) 

The  situation  of  a  wound  sometimes  serves  to  show  whether  it  is  of  an 
accidental  nature  or  not — a  point  often  insisted  on  in  the  defence.     Acci- 
dental wounds  are  generally  found  on  those  parts  of  the  body  which  are 
17 


258  EVIDENCE    FROM    NATURE    AND    EXTENT. 

exposed.  Some  wounds,  however,  forbid  the  supposition  of  accident  even 
when  exposed ;  as  deeply-incised  wounds  of  the  throat  and  gunshot 
wounds  of  the  mouth  and  temple.  (For  the  report  of  a  case  in  which  an 
accidental  wound  on  the  head  by  an  axe  closely  simulated  a  homicidal 
wound,  see  Casper's  Wochenschrift,  May  24,  1845.) 

2.  Evidence  fro-nx  the  Nature  and  Extent  of  a  Wound. — Contused 
wounds  are  rarely  seen  in  cases  of  suicide,  because  in  producing  them 
there  is  not  that  certainty  of  speedily  destroying  life  to  which  a  self- 
murderer  commonly  looks.  There  are,  of  course,  exceptions  to  this 
remark  ;  as  where,  for  instance,  a  man  precipitates  himself  from  a  con- 
siderable height,  and  is  wounded  by  the  fall.  Circumstantial  evidence 
will,  however,  rarely  fail  to  clear  up  a  case  of  this  description.  Greater 
difficulty  may  exist  when  life  is  destroyed  by  a  contused  wound  volun- 
tarily inflicted.  When  persons  laboring  under  insanity  or  delirium  commit 
suicide,  they  often  inflict  upon  themselves  wounds  of  an  extraordinary 
kind,  such  as  would  at  first  view  lead  to  a  suspicion  that  they  had  been 
produced  by  the  hand  of  a  murderer;  and  therefore  the  rules  which  are 
here  laid  down  to  distinguished  homicidal  from  suicidal  wounds  must  be 
guardedly  applied  to  cases  of  this  kind.  In  1850,  a  case  occurred  at  Guy's 
Hospital,  in  which  a  patient  in  a  fit  of  delirium  tore  away  the  whole  of  the 
abdominal  muscles  from  the  lower  and  forepart  of  the  abdon^en.  Had 
the  body  of  this  person  been  found  dead  with  such  an  unusual  and  serious 
personal  injur}^,  it  is  not  improbable  that  it  would  have  been  pronounced 
homicidal  and  not  suicidal.  In  1876,  a  French  artisan  was  found  dead, 
with  a  severe  wound  in  his  throat.  He  had  weighted  a  large  knife  with 
heavy  stones,  and  had  placed  it  between  two  upright  planks,  on  the  prin- 
ciple of  the  guillotine.  He  had  so  placed  his  neck  that  when  the  knii'e 
fell  by  releasing  a  string  it  would  cause  a  fatal  wound.  In  the  following 
case,  but  for  the  facts  being  known,  an  accidental  wound  in  a  concealed 
part  of  the  body  might  have  been  pronounced  to  be  homicidal.  A  girl, 
tet.  15,  while  jumping  on  to  the  knee  of  her  uncle,  received  a  severe  wound 
under  the  following  circumstances.  He  was  holding  a  stick  between  his 
legs,  and  the  girl  did  not  observe  it.  In  the  act  of  jumping,  this  passed 
up  the  anus.  She  withdrew  the  stick,  and  though  she  complained  of  pain, 
she  amused  herself  as  usual.  On  the  following  night  acute  symptoms  set 
in,  and  she  died  in  forty-eight  hours  of  peritonitis.  A  rent  was  found  in 
the  forepart  of  the  rectum  which  had  penetrated  the  peritoneal  cavity. 
(Brit.  Med.  Jour.,  1874,  ii.  p.  403.)  The  body  of  a  man  was  found  in  a 
lane  near  Rhyl.  It  appeared  that  the  deceased  had  stretched  himself  on 
his  back  on  the  ground,  unbuttoned  and  turned  back  the  lower  part  of  his 
vest  on  the  left  side,  and  had  then  thrust  the  long,  thin  blade  of  a  pocket-knife 
into  the  heart,  between  the  fifth  and  sixth  ribs.  The  knife  was  found  on 
his  breast  close  to  the  wound.  The  body  was  warm  when  found.  He 
had  not  been  disturbed;  there  had  been  no  robbery  of  his  person,  his  hat 
remained  on  his  head  and  his  gloves  in  his  left  hand.  He  had  arrived  at 
Rhyl  that  afternoon.     Everything  indicated  great  deliberation. 

The  extent  of  a  wound,  by  which  we  are  to  understand  the  number  and 
importance  of  the  parts  injured,  must  in  these  cases  be  always  taken  into 
consideration.  It  has  been  somewhat  hastily  laid  down  as  a  rule  that  an 
extensive  wound  of  the  throat,  involving  all  the  vessels  and  soft  parts  of 
the  neck  to  the  spine,  could  not  be  self-inflicted.  Although,  in  general, 
suicidal  wounds  of  this  part  of  the  body  do  not  reach  far  back  or  involve 
the  vessels  of  more  than  one  side,  yet  we  find  occasionally  that  all  the 
soft  parts  are  thus  completely  divided.  These  are  cases  in  which,  perhaps, 
with  a  firm  hand,  there  is  a  most  determined  purpose  of  self-destruction. 


EVIDENCE    FROM    THE    DIRECTION    OF    A    WOUND.  259 

In  a  case  of  suicide,  observed  by  Marc,  the  Aveapon  had  divided  all  the 
muscles  of  the  neck,  the  windpipe  and  gullet — had  opened  the  jugular  veins 
and  both  carotid  arteries,  and  had  even  grazed  the  anterior  ligaments  of 
the  spine.  A  wound  so  extensive  as  this  is  rarely  seen  in  a  case  of  suicide, 
but  there  is  no  ground  for  the  assertion  that  such  extensive  wounds  in  the 
throat  are  incompatible  with  self-destruction.  (See  also  Ann.  d'Hyg., 
1872,  t.  1,  p.  419.) 

Incised  wounds  in  the  throat  are  generally  set  down  as  presumptive  of 
suicide,  but  murderers  sometimes  woiind  this  part  for  the  more  effectual 
concealment  of  crime.  Circumstances  connected  with  the  form  and  direc- 
tion of  a  wound  may  in  such  cases  lead  to  detection  ;  for,  unless  the  per- 
son attacked  be  asleep  or  intoxicated,  resistance  is  offered,  evidence  of 
Avhich  may  be  obtained  by  the  presence  of  great  irregularity  in  the  wound 
or  the  marks  of  other  wounds  on  the  hands  and  person  of  the  deceased. 
The  peculiar  form  of  a  wound  on  the  throat  has  sometimes  led  to  a  justi- 
fiable suspicion  of  homicide.  In  one  instance  a  man  was  found  dead  with 
his  throat  cut  in  the  manner  in  which  butchers  arc  accustomed  to  kill 
sheep.  This  led  the  medical  man  to  believe  that  the  wound  had  been  in- 
flicted by  a  butcher.  The  police,  guided  by  this  observation,  arrested  a 
butcher,  who  was  subsequently  tried  and  convicted  of  the  murder.  In 
some  instances,  however,  it  is  extremely  difficult  to  say  whether  the 
wound  is  homicidal  or  suicidal,  the  medical  facts  being  equally  explicable 
on  either  hypothesis.  (See  case  by  Marc,  Ann.  d'Hyg.,  1830,  t.  2,  p. 
408  ;  another  by  Devergie,  ibid.  414  ;  and  a  third  by  Olivier,  Ann.  d'Hyg., 
1836,  t.  1,  p.  394.)  Regularity  in  a  wound  of  the  throat  has  been  consid- 
ered to  be  presumptive  of  suicide.  This  was  the  publicly-expressed  opin- 
ion of  Sir  Everard  Home  in  the  well-knoAvn  case  of  Sellis.  The  deceased 
was  found  lying  on  a  bed,  with  his  throat  extensively  cut,  and  the  edges 
of  the  incision  were  regular  and  even.  This  condition  of  the  wound,  it 
was  inferred,  repudiated  the  idea  of  homicide;  but,  as  a  general  principle, 
this  appears  to  be  a  fallacious  criterion.  A  murderer,  by  surprising  his 
victim  from  behind,  by  having  others  at  hand  to  assist  him,  or  by  direct- 
ing his  attack  against  one  who  is  asleep  or  intoxicated,  or  who  from  age 
or  infirmity  is  incapable  of  offering  resistance,  may  easily  produce  a  regular 
and  clean  incision  on  the  throat. 

3.  Evidence  from  the  Direction  of  a  Wound. — The  direction  of  a 
w^ound  has  been  considered  by  some  to  afford  presumptive  evidence  suffi- 
ciently strong  to  guide  a  medical  jurist  in  his  inquiry.  It  has  been  re- 
marked that  in  most  suicidal  wounds  which  affect  the  throat,  the  direction 
of  the  cut  is  commonly  from  left  to  right,  either  transversely  or  passing 
obliquely  from  above  downwards ;  in  suicidal  stabs  or  punctured  wounds 
the  direction  is  commonly  from  right  to  left  and  from  above  downwards. 
In  left-handed  persons,  the  direction  would,  of  course,  be  precisely  the  re- 
verse. Suicidal  wounds  are,  however,  subject  to  such  variation  in  extent 
and  direction  that  it  is  scarcely  possible  to  generalize  with  respect  to  them. 
Nevertheless,  an  attention  to  these  points  may  sometimes  be  of  real 
assistance  to  the  inquirer,  especially  when  the  body  has  not  been  removed 
from  its  position.  It  is  recommended  that  the  instrument  with  which  the 
wound  has  been  inflicted  should  be  placed  in  either  hand  of  the  deceased 
and  the  arm  moved  towards  the  wounded  part,  so  that  it  may  be  clearly 
seen  whether  the  direction  of  the  wound  could  or  could  not  correspond  to 
it  in  any  position.  It  mijrht  happen  that  neither  arm  would  reach  the 
wounded  part,  so  as  to  inflict  a  wound  of  the  particular  direction  observed  : 
this  may  be  the  case  in  Avounds  situated  on  the  back.  It  is  obvious  that 
if  a  murderer  makes  an  incised  wound  in  the  front  of  the  throat  from 


260  WOUNDS — SUICIDE    OR    ACCIDENT? 

behind,  the  direction  may  be  the  same  as  that  commonly  observed  in  cases 
of  suicide.  (See  on  this  point  the  case  of  Reg.  v.  Dalmas,  C.  C  C,  May, 
1844.)  Again,  if  the  person  attacked  is  powerless,  the  wound  may  be 
deliberately  made,  so  as  to  simulate  a  suicidal  act;  indeed,  murderers 
seldom  attack  the  throat  except  with  the  design  of  simulating  an  act  of 
suicide.  A  homicidal  stab  may  also  take  the  same  direction  as  one  which 
is  suicidal,  but  this  wound  would  be  confined  to  those  cases  in  which  the 
assailant  was  placed  behind  or  aside.  If  in  front  of  the  person  whom  he 
attacks,  the  direction  would  probably  be  from  left  to  right ;  but  in  suicide, 
when  the  right  hand  is  commonly  used,  it  is  the  reverse.  Oblique  wounds, 
passing  from  above  downwards,  are  common  to  homicide  and  suicide,  but 
those  which  take  an  oblique  course  from  below  upwards  are  generally 
indicative  of  homicide,  for  it  is  extremely  rare  that  a  person  bent  on 
suicide,  unless  a  lunatic,  thus  uses  a  weapon.  Homicidal  incisions,  espe- 
cially in  the  throat,  are  often  prolonged  below  and  behind  the  skin  forming 
the  angles  of  a  wound,  deeply  into  the  soft  parts.  Those  which  are 
suicidal  rarely  possess  this  character;  they  terminate  gradually  in  a  sharp 
angle,  and  the  skin  itself  is  the  furthest  point  wounded  ;  the  weapon  is 
not  carried  either  behind,  below,  or  beneath  it.  Suicides  may  graze  the 
ligaments  in  front  of  the  spinal  column,  but  that  they  should  make  deep 
incisions  into  the  bones,  cut  off  hard  bony  processes,  and  divide  the  inter- 
vertebral substance  and  the  vertebral  arteries,  is  a  proposition  contrary  to 
all  experience  and  probability.  The  case  of  the  Earl  of  Essex,  who  was 
found  dead  in  the  Tower  in  1683,  bore  somewhat  on  these  points.  The 
deceased  was  discovered  wMth  his  throat  cut,  and  a  razor  lying  near  him. 
This  razor  was  found  to  be  much  notched,  while  the  throat  was  smoothly 
and  evenly  cut  from  one  side  to  the  other  and  to  the  vertebral  column. 
Some  considered  this  to  have  been  an  act  of  suicide,  others  of  murder. 
Those  medical  witnesses  who  supported  the  view  of  suicide  were  asked  to 
explain  how  it  was  that  such  an  even  wound  could  have  been  produced  by 
a  notched  razor.  They  attempted  to  account  for  this  by  asserting  that 
the  deceased  had  probably  drawn  the  razor  backwards  and  forwards  across 
the  neck-bone ;  forgetting  that  before  this  could  have  been  done  by  the 
deceased,  all  the  great  vessels  of  the  neck  must  have  been  divided.  Ex- 
ceptions to  these  characters  of  homicidal  and  suicidal  woi'inds  may  exist; 
but  in  a  dark  and  intricate  subject  of  this  nature  we  have  only  limited 
rules  to  guide  us.  The  instrument  with  which  a  wound  is  supposed  to 
have  been  inflicted  should  be  adapted  to  the  edges  of  the  incision,  its 
sharpness  compared  with  the  cleanness  and  evenness  of  the  cut,  and  its 
length  with  the  depth  of  the  incision  or  stab.  It  is  no  uncommon  occur- 
rence for  a  murderer  to  substitute  some  instrument,  belonging  to  the  de- 
ceased or  another  person,  for  that  which  he  has  actually  employed ;  and 
this  by  its  size,  shape,  bluntness.  or  other  peculiarities,  may  not  account 
for  the  appearances  presented  by  the  wound. 

It  is  not  often  that  any  diifficulty  is  experienced  in  distinguishing  a 
suicidal  from  an  accidental  wound.  When  a  wound  has  really  been 
suicidally  inflicted,  there  are  generally  to  be  found  about  it  clear  indica- 
tions of  design  ;  and  the  whole  of  the  circumstances  are  seldom  reconcil- 
able with  the  supposition  of  accident.  But  if  the  position  of  the  deceased 
with  respect  to  surrounding  objects  has  been  disturbed  ;  if  the  weapon  has 
l)een  removed,  and  the  body  carried  to  a  distance ;  then  it  will  not  always 
be  easy  to  distinguish  a  wound  accidentally  received  from  one  inflicted  by 
a  suicide  or  a  murderer.  The  evidence  of  those  who  find  the  body  can 
alone  clear  up  the  case ;  and  the  medical  witness  may  be  required  to  state 
how  far  this  evidence  is  consistent  with  the  situation,  extent,  and  direc- 


WOUNDS  —  SUICIDE    OR    HOMICIDE?  261. 

tion  of  the  wound  found  on  the  deceased.  In  the  case  of  the  Uxbridge 
murder  (Reg.  v.  Elizabeth  Gibbons,  C.  C.  C,  Dec.  1884),  the  situation 
and  direction  of  four  gunshot  wounds  on  the  deceased  man  were  all- 
important  considerations;  and  from  a  careful  consideration  of  these 
Bowlby  was  enabled  to  arrive  at  a  conclusion  adverse  to  suicide.  (Brit. 
Med.  jour.,  1885,  i.  p.  62.)  Circumstantial  evidence  is  commonly  suffi- 
cient to  show  whether  a  wound  has  been  accidentally  received  or  not; 
but  as  an  accidental  wound  may  sometimes  resemble  one  of  homicidal  or 
suicidal  origin,  so  it  follows  that  it  is  not  always  possible  for  a  medical 
jurist  to  decide  the  question  peremptorily  from  a  mere  inspection  of  the 
wound. 

It  would  not  be  difficult  to  produce  instances  in  which  murdei*ers  have 
alleged,  in  defence,  that  the  wounds  observed  on  the  bodies  of  their 
victims  were  of  accidental  origin,  and  the  allegations  have  been  clearly 
refuted  by  medical  evidence.  A  witness  must  be  prepared,  therefore,  in 
all  cases  in  which  death  has  taken  place  in  secrecy,  and  the  nature  of  the 
wound  is  such  as  to  render  its  origin  doubtful,  to  be  closely  examined  by 
counsel  for  a  prisoner  charged  with  felonious  homicide,  on  a  question 
whether  the  wound  might  not  have  been  accidental.  The  law  requires 
that  it  should  be  made  clear  to  a  jury,  before  such  a  charge  can  be  sus- 
tained, that  the  fatal  wound  could  7wt  have  had  an  accidental  or  suicidal 
origin.  The  subject  of  wounds  of  the  neck  has  been  examined  in  relation 
to  homicide,  suicide,  and  other  medico-legal  questions,  by  Giiterbock. 
(Vierteljahrsschr.  f.  Gerichtl.  Med.,  1873,  2,  p.  1.) 

Wounds  injiicfed  by  the  Bight  or  Left  Hand. — Some  remarks  have 
been  made  in  reference  to  the  direction  of  a  cut  or  stab  varying  according 
to  whether  the  right  or  the  left  hand  has  been  used  by  a  suicide.  Jt  is 
necessary  for  a  medical  jurist  to  be  aware  that  there  are  many  persons  who 
are  ambidextrous,  i.  e.  who  have  equal  facility  in  the  use  of  the  right  and 
the  left  hands.  This  may  not  be  generally  known  to  the  friends  of  the 
deceased  ;  and  such  persons  are  often  pronounced,  even  by  those  who  have 
associated  with  them,  to  have  been  right-handed.  A  want  of  attention 
to  this  point  is  said  to  have  been  one  of  the  circumstances  which  led  to  a 
suspicion  of  murder  in  the  case  of  Sellis.  (Wills's  Circ.  Evid.,  p.  97.) 
The  man  was  found  dead  on  his  bed  with  his  throat  cut ;  the  razor  was 
discovered  on  the  left  side  of  the  bed ;  whereas,  it  was  generally  supposed 
and  asserted  that  he  was  right-handed.  The  truth  was,  he  was  equalh^ 
expert  in  the  use  of  the  razor  with  his  left  and  right  hands ;  and  thus  the 
apparentlv  suspicious  circumstance  of  the  razor  being  found  on  his  left 
side  was  at  once  explained  away.  The  importance  of  making  due  allow- 
ance for  the  characters  presented  by  wounds  in  the  throat  is  also  illus- 
trated by  a  case  which  occurred  in  London  in  ISHS.  A  publican  and  his 
wife  had  been  frequently  in  the  habit  of  quarrelling.  One  night  the  wife 
gave  an  alarm,  and  the  man  was  found  dead  on  the  bed,  with  his  throat 
severely  cut.  On  examination,  the  fatal  wound  had  all  the  characters  of 
a  left-handed  cut,  while  the  deceased  was  generally  believed  to  be  right- 
handed  ;  and  there  was  bloody  Avater  in  a  wash-hand  basin  in  the  room. 
The  wife,  who  had  marks  of  bruises  upon  her,  said  that  she  had  left  her 
husband  in  the  bedroom  for  a  short  time,  and  on  her  return  found  him 
dead.  The  suspicious  facts  were  explained  at  the  inquest  by  a  daughter 
of  the  deceased  by  a  former  marriage.  She  stated  that  her  father  had 
been  brought  up  as  a  wood-carver,  a  trade  which  requires  a  man  to  use 
both  hands  equally  well ;  that  he  had  frequently  threatened  to  destroy 
himself;  and  that  the  blood  in  the  wash-hand  basin  was  owing  to  her 
having  washed  her  hands  after  she  had  touched  her  father's  head.     This 


2G2  SUICIDE    OR    HOMICIDE? SEVERAL    WEAPONS. 

satisfactorily  explained  the  medical  circumstance,  which  appeared  at  first 
to  point  to  an  act  of  homicide. 

The  Presence  of  Several  Wounds. — In  suicides,  except  in  cases  of  cut- 
throat, commonly  one  wound  only  is  seen,  namely,  that  \Yhich  has 
destroj^ed  life,  and  the  presence  of  several  wounds  on  the  body,  or  the 
marks  of  several  attempts  around  the  principal  wound,  have  been  consid- 
ered to  furnish  presumptive  evidence  of  murder.  But  any  inferences  of 
this  kind  must  be  cautiously  drawn,  since  not  only  may  a  murderer 
destroy  his  victim  by  one  wound,  but  a  suicide  may  inflict  many,  or  leave 
the  marks  of  several  attempts  before  he  succeeds  in  his  purpose.  Og-ston, 
Sr.,  has  pointed  out  (Lect.  on  Med.  Jurispr.,  p.  424)  that  in  suicidal  cut- 
throat the  principal  wound  is  often  associated  with  small  tentative  inci- 
sions, near  and  parallel  to  this  ;  but  that  in  homicidal  incised  wounds  of 
the  throat  the  tentative  cuts,  if  present,  do  not  preserve  the  same  parallel- 
ism— obviously  because  the  victim  docs  not  remain  passive  under  the 
attack  of  his  assailant ;  and  thus  the  relativfi  positions  of  the  assailant  and 
the  assailed  are  continually  changed.  Ogston,  Jr.,  describes  a  case  in 
which  a  man  was  supposed  to  have  committed  suicide  by  cutting  his 
throat  and  chest,  finishing  by  drowning  himself.  The  superficial  cuts  in 
this  case  might  easily  have  given  rise  to  a  suspicion  of  murder,  had  not 
moral  circumstances  led  the  examiner  to  conclude  that  the  case  was  one 
of  suicide.     (Edin.  Med.  and  Surg.  Jour.,  188,5,  i.  p.  689.) 

The  Use  of  Several  Weajjons. — In  general,  suicides  when  foiled  in  a 
first  attempt  continue  to  use  the  same  weapon  ;  but  sometimes,  after 
having  made  a  severe  wound  in  the  throat,  they  will  shoot  themselves,  or 
adopt  some  other  method  of  self-destruction.  These  cases  can  onl}^  appear 
complicated  to  those  who  are  unacquainted  with  the  facts  relative  to  self- 
murder.  Neither  the  presence  of  several  wounds  by  the  same  kind  of 
weapon,  nor  of  different  wounds  by  difi"erent  weapons,  can  be  considered 
of  itself  to  furnish  any  proof  of  the  act  having  been  homicidal.  In  one 
instance,  a  lunatic,  in  committing  suicide,  inflicted  thirty  wounds  upon  his 
head.  In  a  case  of  murder,  when  many  wounds  are  found  on  a  dead  body, 
it  may  happen  that  the  situation  or  direction  of  some  will  be  incompatible 
with  the  idea  of  a  suicidal  origin.  Thus  a  stab  or  cut  may  be  close  to  a 
contusion  or  contused  wound,  and,  although  a  fall  or  other  accident  might 
account  for  the  latter,  the  former  would  indicate  violence  separately  in- 
flicted. 

Two  or  3Iore  3Tortal  Wovnds. — When  we  find  several  wounds  on  the 
body  of. a  suicide,  it  generally  happens  that  only  one  bears  about  it  a 
mortal  character,  namely,  that  which  has  caused  death.  On  this  account 
it  has  been  asserted  by  some  medical  jurists  that,  when  two  mortal  wounds 
are  found  upon  the  body,  and  pai'ticularly  if  one  of  them  is  of  a  stunning 
or  stupefying  tendency  {i.  e.  affecting  the  head),  they  must  be  considered 
incompatible  with  suicide.  An  inference  of  this  kind  can  be  applied  to 
tho.se  cases  only  in  which  the  two  wounds,  existing  on  different  parts  of 
the  body,  were  likely  to  prove  immediately  fatal.  It  must,  however,  be 
borne  in  mind  that  all  suicides  do  not  immediately  perish  from  wounds 
which  are  commonly  termed  mortal;  on  the  contrary,  they  have  often  the 
power  to  perform  acts  of  volition  and  locomotion,  which  might  by  some 
be  deemed  wholly  incompatible  with  their  condition.  It  is  diflBcult  to  say 
Avhether  one  Avound  is  likely  to  destroy  life  so  rapidly  as  to  render  it  im- 
possible for  the  person  to  have  inflicted  another  upon  himself;  but  when 
there  are  several  distinct  incisions  on  the  throat,  each  involving  important 
bloodves.sels,  there  is  good  reason  to  infer  that  they  have  resulted  from  an 
act  of  murder. 


WOUNDS — EVIDENCE    FROM    CIRCUMSTANCES.  263 

Wounds  prod aced  simuUaneouslij  or  at  different  times. — When  several 
wounds  are  found  on  a  dead  body,  the  question  is  frequently  asked,  Which 
was  first  received  ?  If  one  is  what  is  commonly  termed  mortal,  and  the 
others  not,  it  is  probable  that  the  latter  were  first  inflicted.  This  remark 
applies  both  to  cases  of  homicide  and  suicide  ;  but  it  is  apparent  that  when, 
in  a  murderous  assault,  a  person  has  been  attacked  by  several  assailants  at 
once,  the  wounds  may  have  been  simultaneously  produced.  This  is,  how- 
ever, a  question  to  which  it  is  not  easy  to  give  a  specific  answer.  Each 
case  must  be  decided  from  the  special  circumstances  attending  it ;  and  in 
most  instances,  unless  some  direct  evidence  is  forthcoming,  a  medical 
opinion  can  be  little  more  than  conjectural.  It  is  a  question  almost  always 
put  in  a  court  of  law;  and  a  witness  should  at  least  prepare  himself  to 
meet  it  by  a  proper  examination  of  the  medical  circumstances  of  the  case. 


CHAPTER    XXVI. 

EVIDENCE     FROM     CIRCUMSTANCES. — THE     POSITION     OF     THE     BODY. — OF     THE     ■WEAPON'. — 

EVIDENCE      FROM     BLOOD,      HAIR,      AND     OTHER     SUBSTANCES     ON     WEAPONS. MARKS     OF 

BLOOD    ON    CLOTHING    AND    FURNITURE,    ON    THE    DECEASED,    AND    ON    THE   ASSAILANT. 

Evidence  from  Circumstances. — In  pursuing  the  examination  of  the 
question  respecting  the  homicidal  or  suicidal  origin  of  wounds,  the  atten- 
tion of  the  reader  may  be  called  to  the  force  of  evidence  which  is  sometimes 
derived  from  the  circumstances  under  which  the  body  of  a  person,  dead 
from  wounds,  is  discovered.  It  may  be  said  that  this  is  a  subject  wholly 
foreign  to  the  duties  of  a  medical  jurist,  but  we  cannot  agree  to  this  state- 
ment. There  are  few  in  the  profession  who,  when  summoned  to  aid 
justice,  by  their  science,  in  the  detection  of  crime,  do  not  seek  for  circum- 
stances by  which  to  support  the  medical  evidence  required  of  them.  A 
practitioner  would  certainly  be  wrong  to  base  his  professional  opinion  on 
these  circumstances,  but  it  is  scarcely  possible  for  him  to  avoid  drawing 
an  inference  from  them  as  they  fall  under  his  observation.  Care  must  be 
taken  that  this  inference  is  not  overstrained.  The  medical  evidence  may 
be  of  itself  weak  and  insufficient  to  support  a  charge  against  the  accused ; 
in  such  a  case,  if  any  suspicious  circumstances  have  come  to  his  knowl- 
edge, the  witness  may  be  often  unconsciously  induced  to  attach  greater 
importance  to  the  medical  facts  than  he  is  justified  in  doing.  In  short,  he 
may,  through  a  feeling  of  prejudice,  which  it  is  not  always  easy  to  avoid, 
give  an  undue  force  to  the  medical  evidence.  But  if  a  proper  degree  of 
caution  is  used  in  drawing  inferences,  and  the  circumstances  are  not 
allowed  to  create  a  prejudice  in  his  mind  against  the  accused,  a  medical 
man  is  bound  to  observe  and  record  them  ;  for,  being  commonly  the  first 
person  called  to  the  deceased,  many  facts  capable  of  throwing  an  im- 
portant light  on  the  cause  of  death  would  remain  unnoticed  or  unknown 
but  for  his  attention  to  them.  The  position  of  a  dead  body,  the  sudden- 
ness of  death,  the  discovery  of  a  deadly  poison,  the  distance  at  which  a  knife 
or  pistol  is  found,  the  position  of  the  instrument — whether  situated  to  the 
right  or  left  of  the  deceased — the  marks  of  blood  or  wounds  about  the  per- 
son, or  of  blood  on  the  clothes  or  furniture  of  the  apartment,  are  facts 
which  must  assist  materially  in  developing  the  real  nature  of  a  case,  and 


26-4  EVIDENCE  FROM  CIRCUMSTANCES. 

in  givinji^  force  to  a  medical  opinion.  Many  of  these  circumstances  can 
fall  under  the  notice  of  him  only  who  is  first  called  to  the  deceased;  and, 
indeed,  if  observed  by  another,  no  advantage  could  be  taken  of  them,  ex- 
cept from  the  interpretation  of  a  medical  man. 

At  the  same  time  a  person  may  have  died  suddenly  and  a  weapon  or 
poison  be  found  near  the  body,  and  yet  the  death  may  have  taken  place 
from  natural  causes.  Due  allowance  must  be  made  for  coincidences  of 
this  kind.  The  purchase  and  possession  of  a  deadly  poison  shortly  before 
a  sudden  death  may  create  suspicion,  but  an  analysis  may  show  that  there  is 
no  poison  in  the  body,  and,  further,  that  the  po^t-mortem  appearances  are 
consistent  with  natural  disease,  and,  unless  treated  as  exceptional  in  char- 
acter, they  are  not  consistent  with  death  from  poison.  A  woman  was 
found  dead  under  very  suspicious  circumstances.  Within  half  an  hour  of 
her  death  she  had  sent  a  boy  to  a  shop  to  purchase  a  packet  of  Battle's 
vermin-killer  (strychnine).  He  g-ave  it  to  her  and  left  the  house.  When 
he  returned  at  the  time  mentioned,  he  found  her  leaning  on  the  table, 
speechless  and  motionless.  She  was  then  dead.  There  was  no  rigidity 
and  no  evidence  of  convulsions.  Some  fluid  was  found  in  the  stomach, 
but  in  this  there  was  no  strychnine,  and  none  of  the  blue  coloring  matter 
which  had  been  sold  with  the  powder.  No  trace  of  the  poAvder  could  be 
found  on  the  premises,  and  no  cup,  glass,  or  vessel  in  Avhich  the  poison 
might  have  been  mi.xed,  could  be  seen.  (Med.  Times  and  Gaz.,  1865, 
i.  p.  34.)  The  absence  of  any  characteristic  symptoms,  and  the  non- 
detection  of  the  poison  and  its  coloring  ingredient  under  the  circum- 
stances, negatived  the  suspicion  of  poisoning.  The  purchase,  possession, 
and  the  non-discovery  of  the  purchased  packet  after  the  death  of  the 
woman,  were  circumstances  which  created  suspicion,  but  nothing  more. 
The  state  of  the  lungs  and  heart  was  sufficient  to  account  for  sudden 
death. 

Among  the  questions  which  present  themselves  on  these  occasions  are 
the  following:  Is  the  position  of  a  wounded  body  that  which  a  suicide 
could  have  assumed?  Is  the  distance  of  a  weapon  from  the  body  such  as 
to  render  it  improbable  that  it  could  have  been  placed  there  by  the  deceased? 
In  answering  either  of  these  questions,  it  is  necessary  to  take  into  con- 
sideration the  extent  of  the  wound,  and  the  time  at  which  it  probably 
proved  fatal.  Again,  it  may  be  inquired,  Has  the  deceased  bled  in  more 
places  than  one?  Are  the  streams  of  blood  all  connected?  Are  there 
any  marks  of  blood  on  his  person  or  clothes  which  he  could  not  well  have 
produced  himself?  Are  there  any  projecting  nails,  or  other  articles,  which 
might  account  for  wounds  on  the  body  as  the  result  of  accident?  These 
are  questions,  the  answers  to  which  may  materially  affect  the  case  :  hence, 
a  practitioner,  in  noticing  and  recording  the  circumstances  involved  in 
them,  ought  to  exercise  due  caution. 

The  rules  for  investigating  a  case  of  alleged  death  from  violence  have 
been  elsewhere  described  (p.  21,  ante).  Among  the  additional  circum- 
stances to  which  a  medical  witness  should  specially  direct  his  attention  on 
these  occasions  are  the  following : — 

1.  The  Position  of  the  Body. — The  body  may  be  found  in  a  position 
which  the  deceased  could  not  have  assumed  on  the  supposition  of  the 
wound  or  injury  having  been  accidental  or  suicidal.  The  position  of  a 
dead  wounded  body  is  often  only  compatible  with  homicidal  interference, 
either  at  the  time  of  death  or  immediately  afterwards.  In  order  to  deter- 
mine the  probable  time  of  death,  we  should  always  notice  whether  there 
is  any  warmth  about  the  body — whether  it  is  rigid,  or  in  a  state  of  decom- 
position, and  to  what  degree  this  may  have  advanced. 


WOUNDS — POSITION    OF    THE    WEAPON.  265 

2.  The  Position  of  the  Weapon. — If  a  person  has  died  from  an  acci- 
dental or  self-inflicted  wound,  likeh'  to  cause  death,  either  immediately  or 
within  a  few  minutes,  the  weapon  is  commonly  found  either  near  to  the 
body  or  within  a  short  distance  of  it.  If  found  near,  it  is  proper  to  notice 
on  which  side  of  the  body  it  is  lying;  if  at  a  short  distance,  we  must  con- 
sider whether  it  might  have  fallen  to  the  spot,  or  have  been  thrown  or 
placed  there  by  the  deceased.  If  there  has  been  any  interference  with 
the  body,  evidence  from  the  relative  position  of  it  and  the  weapon  will  be 
inadmissible.  In  a  case  which  was  referred  to  the  author  some  years 
since,  a  woman  had  evidently  died  from  a  severe  wound  in  the  throat, 
which  was  homicidally  inflicted  ;  the  weapon,  a  razor,  was  found  under 
the  left  shoulder,  a  most  unusual  situation,  but  which,  it  appears,  it  had 
taken  owing  to  the  body  having  been  carelessly  turned  over  before  it  was 
seen  by  the  surgeon  w^ho  was  first  called. 

It  is  compatible  with  suicide  that  a  weapon  may  be  found  at  some  dis- 
tance, or  in  a  concealed  situation  ;  but  it  is  much  more  frequently  either 
grasped  in  the  hand,  or  lying  by  the  side  of  the  deceased.  In  one  instance 
it  is  stated  the  deceased  was  discovered  in  bed  with  his  throat  cut,  the 
razor  being  cloned  oi"  shut  by  his  side.  In  another  case,  the  bloody  razor, 
closed,  was  found  in  the  deceased's  pocket.  There  is,  however,  one  cir- 
cumstance in  relation  to  the  weapon  which  is  strongly  confirmatory  of 
suicide.  If  the  instrument  is  firmly  grasped  in  the  hand  of  the  deceased, 
no  better  circumstantial  evidence  of  suicide  can  be  offered.  It  is  so  com- 
mon to  find  knives,  razors,  and  pistols  grasped  in  the  hands  of  suicides, 
that  it  is  quite  unnecessary  to  produce  cases  illustrative  of  this  statement. 
The  grasping  of  a  weapon  appears  to  be  owing  to  muscular  spasm  per- 
sisting after  death,  and  manifesting  itself  under  the  form  of  what  has  been 
called  cadaveric  spasm — a  condition,  in  the  opinion  of  the  author,  quite 
distinct  from  rigidity,  although  often  running  into  it  (see  pp.  67,  68,  ante). 
It  does  not  seem  possible  that  any  murderer  could  imitate  this  state,  since 
the  relaxed  hand  of  a  dead  person  cannot  be  made  to  grasp  or  retain  a 
weapon,  like  the  hand  which  has  firmly  held  it  by  powerful  muscular  con- 
traction at  the  last  moment  of  life. 

Experiments  performed  by  Hofmann  (Med.  Leg.,  trad.  dar.  Brouardel, 
p.  601)  completely  confirm  this  statement.  By  a  variety  of  artificial  con- 
trivances— the  use  of  ligatures,  etc. — attempts  were  made  to  cause  the 
hand  of  a  recently  dead  body  to  hold  a  weapon  firmly  as  if  by  a  vol- 
untary contraction  of  the  muscles  during  life  ;  but  these  attempts  utterly 
failed  to  produce  any  such  results.  Although  the  fingers  were  kept  com- 
pletely closed  on  the  object,  it  was  simply  held,  and  not  grasped,  falling 
from  the  hand  immediately  on  the  release  of  the  pressure. 

In  reference  to  the  weapon  being  found  at  a  distance  from  the  body,  all 
the  circumstances  of  the  case  should  be  taken  into  consideration  before 
any  opinion  is  expressed.  If  the  weapon  cannot  be  discovered,  or  it  is 
found  concealed  in  a  distant  place,  this  is  strongly  presumptive  of  homi- 
cide, provided  the  wound  is  of  such  a  nature  as  to  prove  speedily  fatal. 
If  found  near  the  body,  it  will  be  well  to  notice  whether  the  weapon  is 
sharp  or  blunt,  straight  or  bent,  also  whether  the  edge  is  or  is  not  notched. 
These  circumstances  may  throw  a  light  on  the  question  of  suicide  or 
murder. 

3.  Blood  on  Weapons. — The  weapon  with  which  a  wound  has  been 
inflicted  is  not  necessarily  covered  with  blood.  The  popular  view  is,  that 
if  much  blood  is  found  about  a  dead  body  the  weapon  ought  always  to  be 
more  or  less  bloody.  In  reference  to  heavy,  blunt  instruments  applied 
with  force  to  the  bead,  severe  contusions  and  fractures  may  be  produced 


266  BLOOD    AND    HAIR    ON    WEAPONS. 

without  immediate  effusion  of  blood.  Unless  the  bludgeon  is  used  in  a 
subsequent  struggle,  or  handled  by  a  bloody  hand,  no  blood  whatever 
may  be  found  on  the  end  which  produced  the  injuries.  In  rel'erence  to 
stabs,  the  knife  is  frequently  without  any  stains  of  blood  upon  it,  or  there 
is  only  a  slight  film,  which,  on  drying,  gives  to  the  surface  a  yellowish- 
brown  color.  The  explanation  of  these  facts  appears  to  be  that  in  a  rapid 
blow  or  plunge  the  vessels  are  compressed,  so  that  bleeding  takes  place 
only  after  the  sudden  withdrawal,  when  the  pressure  is  removed.  Even 
if  blood  should  be  effused,  the  weapon,  in  being  withdrawn,  is  sometimes 
cleanly  wiped  against  the  edges  of  the  wound,  owing  to  the  elasticity  of 
the  skin.  Thus  the  first  stab  through  the  dress  may  not  present  any 
appenrance  of  blood  on  the  outside,  but  in  a  second  stab,  with  the  same 
weapon,  the  outside  of  the  dress  should  present  a  bloody  mark,  unless  the 
weapon  had  previously  been  wiped  (p.  253).  The  blood  may  have  been 
removed  by  washing  from  the  blade  of  a  knife  or  dagger;  hence  the  handle 
and  inner  portions,  the  dirt  accumulated  between  the  handle  and  blade, 
the  notch  for  opening  the  blade,  and  the  indentations  of  any  letters 
stamped  upon  it,  should  be  closely  examined  with  the  microscope. 

The  blood  on  a  weapon  may  be  wet  or  dry,  in  a  partly  coagulated  state, 
or  diffused  as  a  mere  yellowish-red  film.  If  coagulated,  this  would  render 
it  probable  that  the  blood  had  issued  from  the  body  of  a  living  person  or 
animal,  or  from  a  body  recently  dead.  But  the  blood  of  a  dead  animal 
dried  in  small  spots  on  the  blade  of  a  knife  may  sometimes  present  a 
similar  appearance,  and  thus  lead  to  a  mistake  in  evidence. 

4.  Hair  and  other  Substances  on  Weapons. —  In  some  instances  no 
blood  may  exist  on  a  weapon,  but  a  few  hairs  or  fibres  may  be  found 
adhering  to  it  if  the  weapon  is  of  a  bruising  or  cutting  kind.  The  main 
questions  may  be,  in  such  a  case,  whether  the  hair  is  that  of  a  human 
being  or  of  an  animal,  and  whether  the  fibres  correspond  in  their  nature, 
form,  and  color  to  articles  of  dress  on  the  deceased  or  the  accused.  Be- 
fore any  coagulated  blood  is  removed  from  a  weapon,  it  should  be  exam- 
ined carefully  with  a  powerful  lens.  Hairs  or  fibres  of  linen,  woollen, 
silk,  or  cotton  may  be  found  imbedded  in  the  solidified  blood,  either  on 
the  edge  or  on  the  blade ;  and  evidence  of  this  kind  may  occasionally  be 
of  great  importance.  In  a  case  of  murder  by  manual  strangulation,  so 
much  violence  had  been  employed  by  pressure  with  the  fingers  that  not 
only  was  a  quantity  of  blood  effused,  but  portions  of  cuticle  with  the  fine 
downy  hairs  of  the  neck  of  deceased  had  been  removed.  The  blood  with 
the  abraded  cuticle  and  ^ome  hairs  were  found  upon  a  towel  which  was 
traced  to  the  assailant.  (Vierteljahrsschr  f.  Gerichtl.  Med.,  1873,  2,  p. 
112.)  On  a  trial  for  murder  in  Ireland  in  187*7,  it  was  proved  that  there 
were  hairs  firmly  clenched  in  the  hands  of  the  deceased;  and  when  these 
were  compared  with  a  like  number  of  the  prisoner's  hair,  they  were  found 
to  correspond. 

Foreign  substances  are  sometimes  found  in  contused  and  lacerated 
wounds,  which  may  throw  a  light  on  the  mode  in  which  they  were  in- 
flicted. In  gunshot  wounds  it  is  not  unusual  to  find  portions  of  paper  or 
other  substances  used  as  wadding  for  the  gun  or  pistol.  The  preservation 
of  articles  of  this  description,  or  portions  of  the  projectiles  found  under 
these  circumstances,  has  proved  a  means  of  fixing  the  crime  upon  the 
guilty  person.  When  a  gun  or  pistol  is  discharged  near  to  the  body,  a 
portion  of  the  wadding  is  generally  carried  into  the  large  irregular  M'ound 
produced.  In  a  case  of  stabbing,  a  portion  of  the  weapon  may  be  found 
in  the  wound. 


MARKS    OF    BLOOD    ON    THE    DEAD    EODY.  207 

5.  31arks  of  Blood  on  Clothing  or  Furnitu7^e. — It  is  proper  to  notice 
all  marks  of  blood  on  the  clothes  of  the  deceased  or  in  the  apartment,  and 
to  observe  where  the  greatest  quantity  of  blood  has  been  etl'used ;  this  is 
generally  found  on  the  spot  where  the  deceased  has  died.  The  deceased 
may  have  bled  in  more  places  than  one;  if  so,  it  should  be  noticed  wliether 
there  is  any  communication"in  blood  between  these  different  places.  Blood 
on  distant  clothes  or  furniture  may  show  whether  the  deceased  has  moved 
about,  and  whether  he  has  struggled  much  after  receiving  the  fatal  wound. 
Acts  of  locomotion  by  a  wounded  person  who  has  died  from  the  loss  of 
blood,  or  by  a  criminal  whose  hands  and  feet  are  bloody,  are  generally 
indicated  by  tracks  or  marks  of  blood.  (Reg.  v.  Garry,  Lincoln  Spring 
Ass.,  1883.)  The  observation  of  these  marks,  if  made  at  the  time  that  a 
dead  body  is  found,  is  of  great  importance.  They  may  be  so  situated  as 
to  show  ttiat  the  body  of  the  deceased  has  been  moved  or  been  interfered 
with  after  death,  and  thus  throw  a  light  upon  the  question  whether  the 
act  has  been  one  of  homicide  or  of  suicide.  In  reference  to  clothing,  it  is 
advisable,  if  it  be  possible,  to  have  some  clear  proof  that  the  clothes  sent 
for  examination  were  actually  worn  by  the  accused  or  belonged  to  the 
deceased.  Serious  mistakes  are  sometimes  made,  and  medical  opinions 
should  therefore  be  expressed  with  caution.  It  should  be  noticed  on  these 
occasions  whether  the  blood  is  deposited  in  large  patches  on  clothing,  or 
whether  it  is  sprinkled,  and  also  whether  it  is  in  large  or  small  quantity. 
The  sprinkling  may  have  proceeded  from  a  wounded  artery,  or  from  a 
splashing  of  blood  as  a  result  of  continued  violence.  It  should  likewise 
be  observed  whether,  if  the  wound  is  in  the  throat  or  chest,  blood  has 
flowed  down  in  front  of  the  clothes  or  person,  or  whether  it  has  flowed  so 
as  to  collect  in  the  armpits  or  on  each  side  of  the  neck ;  for  these  appear- 
ances will  sometimes  show  that  the  wound  was  inflicted  when  the  person 
was  standing,  sitting,  or  lying  down.  If  the  throat  is  cut  while  the  person 
is  lying  down,  it  is  obvious  that  the  blood  will  be  found  chiefly  on  one  or 
other  side  of  the  neck,  and  not  extending  down  the  front  of  the  body. 
Few  suicides  cut  the  throat  while  in  a  recumbent  posture,  and  the  course 
which  the  blood  has  taken  may,  therefore,  be  sometimes  rendered  subser- 
vient to  the  distinction  of  a  homicidal  from  a  suicidal  wound.  The  posi- 
tion in  whi(!h  the  body  was  when  a  wound  was  inflicted  is  a  frequent 
question  at  inquests  and  criminal  trials. 

When  spots  of  blood  are  found  upon  articles  of  dress  or  furniture,  their 
form  and  direction  may  occasionally  serve  to  furnish  an  indication  of 
the  position  of  the  wounded  person  with  respect  to  them.  Thus,  if  the 
form  of  a  spot  is  oval  and-  elongated,  the  presumption  is  that  the  person 
was  placed  obliquely  with  respect  to  the  stained  furniture  during  the 
haemorrhage,  (Ann.  d'Hyg.,  1840,  p.  397.)  The  force  with  which  the 
blood  has  been  thrown  out  will  be  in  some  measure  indicated  by  the 
degree  of  obliquity  and  length  of  the  spot.  This  is  in  general  wide  and 
founded  at  the  upper  part,  but  narrow  and  pointed  below. 

6.  Marks  of  Blood  or  Violence  on  the  Dead  Body. — In  examining  a 
dead  body,  attention  should  be  paid  to  the  state  of  the  mouth  and  throat. 
Assailants  who  make  their  attack  during  sleep  sometimes  endeavor  to 
close  the  mouth  or  to  compress  the  throat,  so  as  to  prevent  an  alarm  being 
given.  In  one  instance  there  were  the  marks  of  finger-nails  around  the 
mouth  ;  in  another,  ecchymosed  impressions,  as  if  produced  by  a  hand, 
were  found  upon  the  throat  of  the  deceased.  The  hands  of  a  dead  person 
should  always  be  examined  ;  many  recent  cuts,  excoriations,  or  incisions 
found  upon  them,  esspecially  if  on  the  back  of  the  fingers  or  thumbs,  will 
indicate  that  there  has  been  a  mortal  struggle  with  the  assailant.     In  the 


268  MARKS    OF    ELOOD    OX    THE    ASSAILANT. 

inspection,  the  examination  of  the  stomach  should  not  be  omitted.  The 
presence  or  absence  of  food,  mucus,  or  blood,  may  furnish  evidence  of  con- 
siderable importance  in  the  elucidation  of  the  case.  All  marks  or  stains 
of  blood  or  dirt  on  a  dead  body  require  special  observation.  The  impres- 
sion o^a  hand  or  of  some  of  the  fingers  may  be  found  on  the  skin  in  a 
situation  "where  it  would  have  been  improbable  or  impossible  for  the 
deceased  to  have  produced  it,  even  supposing  that  one  or  both  of  his  hands 
Avere  covered  with  blood.  In  one  case  of  murder  there  was  found  the 
bloody  impression  of  a  left  hand  upon  the  back  of  the  left  hand  of  the 
deceased,  in  such  a  position  that  it  was  quite  impossible  the  deceased  him- 
self could  have  made  the  mark.  In  all  cases  it  should  be  noticed  whether 
the  inside  or  outside  of  the  hand,  or  whether  one  or  both  hands  are  stained 
with  blood,  and  the  size  and  ]iosition  of  the  stains  should  be  described. 
Marks  of  blood  on  the  dress  of  a  wounded  person  or  a  dead  body  may 
often  furnish  important  circumstantial  evidence.  If  there  are  several  stabs 
or  cuts  on  the  body  involving  the  dress,  it  should  be  observed  whether 
the  edges  of  one  or  more  of  them  are  stained  with  blood,  as  if  from  the 
wiping  of  a  weapon,  and  Avhether  the  stain  is  on  the  outside  or  inside  of 
the  article  of  dress.  In  simulated  personal  injuries,  the  stain  of  blood  may 
be,  through  inadvertence,  applied  to  the  outside  of  the  dress — a  fact  which 
might,  in  some  instances,  lead  to  the  detection  of  the  imposture.  (See  case 
Ann.  d'Hyg.,  1847,  t.  2,  p.  219.) 

7.  Marks  of  Blood  on  the  Assailant. — It  is  a  very  common  idea  that 
no  person  can  commit  murder  in  which  blood  is  effused,  without  having 
his  person  and  clothes  more  or  less  covered  with  blood.  Nothing  can  be 
more  erroneous.  On  several  occasions  we  have  been  required  to  examine 
articles  of  clothing  which  have  been  worn  by  persons  subsequently  con- 
victed of  murder  by  wounding,  and  either  no  blood  has  been  found  on  any 
part  of  the  dress,  or  only  small  spots  wholly  out  of  proportion  to  the 
quantity  of  blood  which  most  have  flowed  from  the  deceased.  (Reg.  v. 
Harrington,  Chelmsford  Ass.,  1852;  Reg.  v.  Flack,  Ipswich  Ass.,  1853; 
Reg.  i;.  Cass,  Carlisle  Ass.,  1860;  Reg.  v.  Rowlands,  Beaumaris  Ass., 
1861;  Reg.  V.  Edmonds,  Swansea  Ass.,  1862;  Reg.  v.  Garry,  Lincoln 
Spring  Ass.,  1883  ;  Reg.  v.  Shrimpton,  Worcester  Ass.,  May,  1885  ;  Reg. 
V.  Goodale,  Norwich  Ass.,  Nov.  1885.)  In  the  case  of  Gardner  (C.  C.  C, 
1862),  in  which  there  had  been  a  large  effusion  of  blood  from  a  severe 
wound  in  the  throat,  no  blood-stains  were  found  on  the  clothing  of  the 
man  who  was  convicted  of  the  murder.  Policemen  are  frequently  mis- 
led in  searching  for  criminals  by  looking  for  blood  on  clothing,  as  a 
necessary  accompaniment  of  an  act  of  murder.  This  also  leads  them  to 
magnify  stains  of  red  paint,  iron  rust,  and  fruit-stains  on  the  dress  of  an 
accused  person  into  marks  of  blood.  (Reg.  v.  Moore,  Maidstone  Sum. 
Ass.,  1872.) 

It  is  obvious  that  the  throat  of  a  person  while  standing,  sitting,  or 
kneeling,  may  be  cut  by  a  murderer  from  behind,  and  thus  in  appearance 
simulate  suicide.  Under  these  circumstances  the  clothes  of  the  assasin 
would  escape  being  stained  with  blood.  The  flowing  or  spurting  of  blood 
upon  the  clothes  of  the  as.sailant  will  depend  upon  his  position  in  relation 
to  the  decea.sed  at  the  time  of  inflicting  the  wound,  and  this  must  always 
be  a  matter  of  pure  speculation.  In  entire  violation  of  this  simple  princi- 
ple, the  fact  of  a  prisoner's  clothes  not  being  marked  with  blood  has  been 
on  more  than  one  occasion  urged  as  a  proof  of  his  innocence.  (Reg.  v. 
Dalmas,  C.  C.  C,  June,  1844.)  In  this  case  the  counsel  for  the  prisoner 
wished  to  impress  the  jury  that  no  person  could  cut  the  throat  of  another 
without  having  his  clothes  covered  with  blood ;  and  as  there  was  not 


NO    MARKS    OF    BLOOD    FOUND    ON    THE    ASSAILANT.  269 

proved  to  be  any  blood  on  his  clothes,  the  prisoner  could  not  have  been 
guilty  of  the  crime.  The  facts  were  simply  that  the  throat  of  the  woman 
was  cut  while  she  was  Avalking  across  I3attersea  Bridge,  the  prisoner 
having  inflicted  the  wound  from  behind. 

Another  circumstance  to  be  noticed  is  that  the  accused  may  have  had 
time  to  change  his  clothes  in  spite  of  the  supposed  vigilance  of  the  police. 
This  has  occurred  in  several  trials  for  murder.  (Reg.  v.  Heath,  Bucks 
Lent  Ass.,  1854;  Reg.u  Cass,  Cumberland  Ass.,  1860.)  In  one  case 
the  trousers  taken  from  the  prisoner  soon  after  the  murder  presented  no 
marks  of  blood  ;  but  the  trousers  actually  worn  by  him  were  found  with 
blood  upon  them  pending  the  trial.  In  other  instances,  the  prisoner  may 
have  had  time  to  remove  any  stains  by  washing.  (Reg.  v.  Goodale,  Nor- 
wich Ass.,  Nov.  1885.)  Owing  to  this  erroneous  assumption  that  where 
much  blood  has  been  lost  by  the  deceased,  the  assassin's  clothes  could  not 
have  escaped  being  "  deluged"  with  blood,  juries  have  been  led  to  return 
verdicts  of  acquittal  in  cases  in  which,  although  no  blood-stains  were 
found,  the  circumstances  proved  were  consistent  only  with  the  theory  of 
murder. 

On  the  trial  of  Sub-Inspector  Montgomery  for  the  murder  of  Mr. 
Glasse  (Omagh  Ass.,  July,  1873),  the  absence  of  blood-stains  on  the 
clothing  of  the  prisoner  was  alleged  to  be  a  strong  proof  of  his  innocence 
of  the  crime.  In  this  case  the  contused  wounds  on  the  head  of  the  de- 
ceased were  produced  by  a  bill-hook.  There  was  blood  on  the  floor  around 
the  body,  but  much  of  this  had,  no  doubt,  flowed  from  the  wounds  after 
death.  The  wounds  were  not  likely  to  have  been  attended  Avith  a  great 
spurting  of  blood  or  any  copious  eifusion  at  the  time  of  their  infliction, 
yet  it  was  assumed  that  such  murder  could  not  have  been  perpetrated 
without  the  clothes  of  the  assassin  being  "covered"  with  blood.  As  the 
evidence  against  the  accused  was  entirely  circumstantial,  much  stress  was 
laid  upon  the  state  of  the  clothes  as  a  proof  of  his  innocence.  The 
prisoner  had  been  previously  tried  twice  for  the  crime,  and  the  juries  were 
not  able  to  agree,  chiefly  owing  to  the  fact  that  there  was  no  blood  upon 
his  clothes.  On  the  third  trial  he  was  convicted,  and  the  conviction  was 
immediately  afterwards  justified  by  an  admission  of  his  guilt.  He 
admitted  that  he  had  removed  the  blood-stains  from  his  clothes  with  cold 
water  soon  after  the  perpetration  of  the  crime.  A  case  like  this  is  surely 
sufficient  to  show  the  danger  of  trusting  to  such  a  fallacious  criterion  as  a 
proof  of  innocence. 

The  counsel  who  defended  Courvoisier  for  the  murder  of  Lord  William 
Russell  (Reg.  v.  Courvoisier,  C.  C.  C,  1840)  contended,  in  the  strongest 
terms,  that  the  accused  could  not  have  perpetrated  the  crime  because  there 
were  no  marks  of  blood  on  any  of  his  clothes,  and  no  bloody  weapon  was 
found  in  his  possession  or  in  the  house.  As  all  the  vessels  of  the  throat 
of  the  deceased  had  been  cut  to  the  vertebral  column  while  he  was  lying 
asleep,  it  was  alleged  to  be  impossible  that  the  assassin  could  have  escaped 
from  the  spurting  of  blood  from  the  large  vessels.  After  his  conviction, 
the  prisoner  admitted  that  when  he  committed  the  murder  at  night  he 
wore  no  clothes,  but  was  in  a  state  of  nudity,  and  that  all  he  did  was  to 
w^ash  his  hands.  The  weapon  which  he  employed  was  the  carving-knife 
of  the  house ;  this  he  washed  and  returned  to  the  tray  with  the  other 
knives.  A  similar  defence  was  raised  in  Reg.  v.  Thompson  (Durham 
Wint.  Ass.,  1863),  in  which  the  prisoner  was  charged  with  the  murder  of 
his  wife,  by  cutting  her  throat  with  a  razor.  According  to  the  medical 
evidence,  the  wound  in  the  woman's  throat  was  five  inches  in  length,  and 
in  a  direction  from  left  to  right,  extending  from  the  angle  of  the  left  jaw 


270  EXAMINATION    OF    BLOCD-STAINS. 

to  an  inch  behind  the  ricrht  ear,  dividing  all  the  bloodvessels  and  nerves 
of  the  throat.  The  medical  witness  properly  stated  that  such  a  wound 
could  not  have  been  self-inflicted.  It  proved  rapidly  fatal.  iS^'o  razor  or 
other  weapon  that  could  have  produced  the  wound  was  found  near  the  body. 
The  prisoner  stated  that  the  wounds  had  been  produced  on  herself  by 
deceased  during  a  struggle.  No  blood  was  found  on  the  prisoner's  clothing, 
and  on  this  fact  the  counsel  for  the  defence  mainly  relied  to  show  that  this 
was  not  an  act  of  murder,  but  of  self-destruction.  The  man  was  convicted, 
and  the  case  here  quoted  proved  that  the  defence  was  based  on  a  pure 
fallacy.     (Times  of  Dec.  IT,  1873.) 

The  presence  of  spots  of  blood  on  articles  of  clothing,  knives,  etc.,  taken 
from  the  persons  of  those  who  are  accused  of  murder,  may  be  quite  con- 
sistent with  innocence.  Small  spots  or  stains  have  often  an  undue  im- 
portance attached  to  them.  We  have  known  minute  spots  of  blood  on  the 
shirt  of  a  man  tried  for  murder  by  M-ounding  regarded  as  furnishing  proof 
of  criminality,  until  it  was  explained  that  they  w^ere  probably  derived  from 
flea-bites,  and  that  some  were  on  one  side  and  some  on  the  other  side, 
showing  that  the  shirt  had  been  worn  on  the  two  sides.  The  coarse  cloth- 
ing worn  by  laborers  may  acquire  blood-spots  from  a  variety  of  accidental 
circumstances,  which  the  accused  may  not  always  be  able  to  explain. 
When  he  knows  the  stains  are  there,  and  manifests  great  anxiety  to  give 
some  explanation  of  their  presence,  as  by  falsely  stating  that  he  had 
assisted  in  killing  a  pig,  a  rabbit,  or  that  he  was  carrying  game  about  him, 
there  may  be  strong  ground  for  suspicion  ;  but  a  medical  practitioner 
should  always  make  due  allowance  for  the  accidental  presence  of  blood  on 
the  clothes  of  working  men. 

In  a  case  of  suicide,  in  1872,  by  cutting  the  throat,  the  son,  who  first 
discovered  his  father  \ying  dead,  imagined  that  he  had  broken  a  blood- 
vessel. The  son  lifted  up  the  body,  and  then  went  for  assistance.  In  this 
way  his  hands  and  clothes  became  bloody.  At  the  inquest  he  was  closel}^ 
questioned  on  this  point.  There  could  not  be  the  least  doubt  that  the  act 
was  one  of  suicide,  and  that  the  clothes  of  the  son  had  become  accidentally 
covered  with  blood  in  the  manner  in  which  he  had  stated. 


CHAPTER    XXyil. 

EXAMINATION    OP    BLOOD-STAINS. — CHEMICAL    ALALYSIS. SPF.CTKOSCOPIC    EXAMINATION. — 

BLOOD- CRYSTALS. MICROSCOPICAL    EVIDENCE. BLOOD     OP     MAN    AND     ANIMALS. STAINS 

OF    BLOOD    ON     LINEN     AND      OTHER     STDFFS. AGE     OK      DATE     OF     THE     STAINS. OTHER 

STAINS    RESEMBLING    BLOOD. BLOOD     ON     WEAPONS. ARTERIAL     AND     VENOUS     BLOOD. — • 

VARIETIES    OF    BLOOD. 

Examination  of  Blood-stains. — It  may  appear  at  first  sight  an  easy 
matter  to  say  whether  certain  suspected  spots  or  stains  on  articles  of 
clothing,  furniture,  or  weapons  are  or  are  not  owing  to  blood  ;  but  in 
practice  great  difficulty  is  often  experienced  in  answering  the  question. 
If  the  stains  are  large  and  recent,  most  persons  may  be  able  to  form  an 
opinion  ;  but  the  physical  characters  of  blood  are  soon  changed,  even  when 
the  stuff  is  white  and  otherwise  favorable  for  an  examination.  If  the 
stains,  whether  recent  or  of  old  standing,  are  upon  dark-dyed  woollen  stuffs, 
as  blue,  black,  or  brown  cloth,  or  if  they  appear  in  the  form  of  small  or 


CHEMICAL    PROPERTIES    OF    BLOOD-STAINS.  271 

detached  spots,  or  in  thin  films  on  dark  clothing  or  rusty  weapons,  no  one 
but  a  competent  medical  man  should  be  allowed  to  give  an  opinion. 

Chemical  Analysis. — There  is  no  direct  chemical  process  by  which 
blood  can  be  identified,  but  we  presumptively  establish  its  nature  by  de- 
termining the  presence  and  properties  of  the  red  coloring  matter,  or  hsemo- 
globin.  The  chemical  properties  of  the  red  coloring  matter  of  blood  are 
as  follows  :  1.  It  readily  dissolves  in  cold  water,  forming,  if  recent,  a 
bright-red  solution.  2.  The  red  color  of  this  solution  is  not  changed  to  a 
crimson  or  a  green  tint  by  a  few  drops  of  a  weak  solution  of  ammonia. 
If  the  ammonia  be  concentrated,  or  added  in  large  quantity,  the  red  liquid 
will  acquire  a  brownish  tint.  3.  The  red  liquid  when  boiled  is  coagulated 
— the  color  is  entirely  destroyed,  and  a  muddy-brown  flocculent  precipi- 
tate is  formed,  the  quantity  of  which  will  depend  on  the  quantities  of  col- 
oring matter  and  of  albumen  present.  The  red  coloring  matter  of  blood 
is  always  more  or  less  mixed  with  albumen,  and  it  is  this  substance  which 
gives  to  a  dried  blood-stain  on  linen  or  cloth  a  well-marked  stiffness,  and 
a  glossy  surface.  Stains  from  cochineal  and  the  red  colors  of  wine,  flow- 
ers, and  fruit,  are  dull,  and  do  not  cause  any  stiffening  of  the  fibre  of  the 
stained  stuff",  nor  any  appearance  under  the  microscope  at  all  resembling 
a  dried  coagulum  of  blood.  4.  A  solution  of  the  red  coloring  matter  of 
blood  in  water  produces,  with  freshly-made  tincture  of  guaiacum,  a  red- 
dish-white precipitate  of  the  resin.  On  adding  to  this  an  ethereal  solution 
of  peroxide  of  hydrogen  a  beautiful  blue  color  is  more  or  less  rapidly 
brought  out.  If  a  sufficient  quantity  of  alcohol  or  ether  be  added  the  pre- 
cipitate will  be  dissolved,  and  a  deep  sapphire-blue  solution  will  result. 
Cochineal  and  other  red  coloring  matters,  when  thus  treated,  give  a  red- 
dish color  to  the  resin  of  the  tincture  of  guaiacum,  and  undergo  no  change 
on  the  addi-tion  of  peroxide  of  hydrogen.  They  are  thus  well  marked  and 
distinguished  from  the  red  color  of  blood.  Whether  the  blood  is  new  or 
old,  whether  concentrated  or  much  diluted,  this  test  produces  the  blue 
coloration.  It  produces  the  change  better  in  a  diluted  than  in  a  concen- 
trated state.  A  drop  of  blood  diffused  through  six  ounces  of  water  may 
bo  thus  detected  in  one  or  two  drachms  of  the  mixture.  It  is  to  be  noted 
that  the  blue  color  is  produced  by  blood-pigment  only  with  the  mixture 
ol  guaiacum  and  peroxide  of  hydrogen ;  the  production  of  a  blue  color 
with  guaiacum  alone  is  valueless  as  a  test  for  blood.  In  all  cases  it  must 
first  be  ascertained  that  tincture  of  guaiacum  alone  is  not  colored,  and 
then  that  it  becomes  colored  on  the  subsequent  addition  of  peroxide  of 
hydrogen.  Tincture  of  guaiacum  is  colored  blue  by  milk,  pus,  saliva,  and 
by  many  mineral  compounds.  Such  are  the  chemical  properties  of  blood, 
whether  taken  from  the  human  body  or  from  that  of  any  warm  red-blooded 
animal  (Mammalia). 

Of  the  various  red  coloring-matters  extracted  from  vegetabje  and  animal 
substances  there  are  none  which  to  the  experienced  eye  present  the  pecu- 
liar crimson-red  tint  of  blood,  especially  when  the  substance  is  examined 
in  a  good  light  with  a  low  power  of  the  microscope.  When  solutions  of 
these  red  coloring-matters  are  treated  with  ammonia,  some,  such  as  coch- 
ineal, logwood,  and  the  colors  of  roots  and  woods,  acquire  a  deep  crimson 
tint;  while  others,  such  as  the  coloring-matter  of  the  rose,  and  the  red 
colors  of  flowers  and  fruits,  are  changed  to  a  blue  or  green.  The  red 
colors  are  not  destroyed  by  a  boiling  temperature,  and,  even  when 
mixed  with  albumen,  this  substance  is  simply  coagulated,  while  the  red 
coloring-matter  remains  unchanged.  In  the  case  of  blood,  the  effect  of 
heat  is  to  destroy  the  color  entirely.  When  these  pigments  are  found 
upon  linen  and  similar  stuffs,  they  present  under  the  microscope  the  ap- 


272  SPECTROSCOPIC    EXAMINATION. 

pearance  of  a  uniform  stain  or  dye,  unlike  blood  in  color  There  is  no 
glossy  coagulum  to  be  seen,  and  the  stained  stuff  is  not  stiffened  as  it  is 
by  the  serum  of  dried  blood. 

Spectral  Analysis. — Spectral  analysis  applied  to  blood  has  been  made 
the  subject  of  evidence  on  various  trials  for  murder.  The  great  advantage 
of  this  optical  method  is  that  it  admits  of  the  examination  of  blood  with- 
out in  any  way  interfering  with  the  subsequent  application  of  the  chemical 
tests  already  described.  We  simply  analyze  the  light  as  it  traverses  a 
clear  solution  of  the  red  coloring  matter,  and,  with  a  proper  spectral  eye- 
piece attached  to  a  microscope,  we  notice  whether  the  colored  spectrum 
has  undergone  any  change.  If  the  red  liquid  owes  its  color  to  recent  or 
oxidized  blood,  two  dark  absorption-bands  will  be  seen  breaking  the  con- 
tinuity of  the  colored  spectrum.  These  are  situated  respectively  near  the 
junction  of  the  yellow  with  the  green,  and  in  the  middle  of  the  green.  If 
the  blood  is  quite  recent  and  of  a  bright-red  color  (oxyhsemoglobin),  the 
two  absorption-bands  are  distinct  and  well  defined.  A  good  light,  either 
artificial  or  daylight,  is  required ;  the  colored  liquid  should  be  clear  and  of 
sufficient  intensity,  and  the  spectral  apparatus  properly  adjusted.  The 
blood  sufficiently  diluted  should  be  placed  in  a  glass  tube  for  the  purpose 
of  examination.  The  spectral  eye-piece  allows  of  two  of  these  tubes  being 
examined  at  once,  and  it  is  desirable  to  have  a  specimen  of  blood  mounted, 
for  comparing  the  actual  spectrum  of  blood  with  that  of  the  suspected 
liquid.     The  results  are  the  same  with  the  red  blood  of  all  animals. 

In  the  course  of  an  hour  in  warm  weather,  and  after  a  day  or  two  in 
cold  weather,  the  blood  in  the  tube  undergoes  a  remarkable  change.  It 
loses  its  scarlet,  and  acquires  a  purple  color  (reduced  haemoglobin).  In 
passing  to  this  state  it  has  become  deoxidized,  and  the  coloring  matter  is 
now  called  deoxidized  haemoglobin.  A  small  quantity  of  sulphide  of 
ammonium — or  an  ammoniacal  solution  of  ferrous  tartrate,  made  by  dis- 
solving ferrous  sulphate  in  water,  adding  a  sufficiency  of  tartrate  of  potas- 
sium, and  then  making  alkaline  with  ammonia  (Stokes's  solution) — added 
to  red  blood,  will  produce  the  same  effect  more  rapidly.  In  this  state  the 
two  bands  appear  blended,  and  one  broad,  dark  absorption-band  is  seen 
nearly  in  the  same  situation.  That  the  blood  is  really  deoxidized  is 
proved  by  the  fact  that  on  adding  to  that  which  has  spontaneously 
changed  from  red  to  purple  a  fe\v  drops  of  peroxide  of  hydrogen,  the  blood 
is  re-oxidized,  and  again  acquires  its  red  color,  with  the  manifestation  of 
the  two  absorption-bands.  The  same  result  takes  place  if  the  purple  blood 
is  put  into  a  wider  tube  and  well  shaken  with  air.  The  presence  of  two 
bands,  with  this  power  of  conversion  and  reconversion  by  deoxidizing  and 
oxidizing  agents,  is  characteristic  of  red  blood.  Blood  which  has  been 
kept  shows  one  or  more  bands  in  the  red,  due  to  a  new  body,  methsema- 
glohin. 

When  the  blood,  by  long  exposure  to  the  air,  has  undergone  chemical 
changes,  it  ceases  to  give  any  ivell-defined  absorption-bands.  If  a  solu- 
tion containing  haemoglobin  is  acidified  with  a  vegetable  acid,  the  pigment 
is  destroyed,  a  hcematin,  a  brown-red  pigment,  is  produced.  The  same 
change  is  effected  by  prolonged  exposure  to  air.  If  the  acid  solution  of 
haematin  be  made  alkaline  with  ammonia,  and  Stokes's  solution  (p.  2T2) 
be  added,  two  fine  dark  bands  of  haemochromogen  (reduced  haematin)  make 
their  appearance.  These  are  more  towards  the  blue  end  of  the  spectrum 
than  the  two  bands  of  oxyhaemoglobin.  A  recent  blood-stain,  however 
minute,  may  be  made  to  yield  successively  the  bands  of  oxyhsemoglobin, 
of  reduced  haemoglobin,  and  of  haemochromogen. 

There  can  be  no  doubt  that,  in  the  hands  of  a  competent  person,  and 


BLOOD  —  HiEMIN- CRYSTALS, 


273 


one  skilled  in  micro-spectral  observations,  this  optical  method  will  enable 
him  to  discover  the  minutest  trace  of  blood,  provided  any  red  coloring 
matter  remains.  Thus  Sorby  states  that  a  spot  of  blood  only  one-tenth 
of  an  inch  in  diameter,  or  a  quantity  of  the  red  coloring'  matter  amount- 
ing to  no  more  than  the  1000th  part  of  a  grain,  was  sufficient  to  give  con- 
clusive evidence  of  its  presence  by  spectral  analysis.  J.  Gr.  Richardson 
states  that  by  a  still  more  delicate  process  he  has  been  able  to  detect  the 
oOOOth  part  of  a  grain  of  blood  on  an  axe-handle  supposed  to  have  been 
used  in  a  case  of  murder.  Sorby  detected  blood  in  the  form  of  deoxidized 
hi-ematin  on  the  rusty  blade  of  a  knife  'with  which  a  murder  was  com- 
mitted in  1862,  after  the  lapse  often  years.  Blood-stains  which  have  been 
washed  in  water,  and  blood  which  has  been  even  boiledor  heated  to  212° 
F.,  may  be  thus  detected.  In  the  latter  case  ammonia,  with  the  aid  of  a 
gentle  heat,  should  be  emplo3^ed  to  dissolve  the  matters  rendered  insoluble 
by  boiling.  Spectral  analysis  does  not  enable  us  to  make  any  distinction 
beyond  that  of  recent  and  old  blood,  and  this  distinction  cannot  be  so 
drawn  as  to  enable  us  to  fix  a  specific  or  even  an  approximate  date.  Cer- 
tain accidental  conditions  may  rapidly  produce  on  blood  the  same  effect  as 
exposure  to  air  for  a  long  period  of  time.  It  indicates  no  distinction  in 
tlie  blood  of  the  sexes,  of  the  foetus  and  adult,  or  in  the  blood  of  man  and 
animals.  As  a  corroborative  process  it  furnishes  most  valuable  and  trust- 
worthy evidence,  and  there  is  no  case  in  which  blood  admits  of  a  chemical 
examination  in  which  spectral  analysis  does  not  admit  of  application  be- 
fore the  chemical  tests  are  employed. 

In  a  case  of  alleged  murder,  which  was  the  subject  of  investigation  in 
1866,  some  faint  reddish-colored  stains  on  grey  woollen  cloth,  visible  only 
in  a  strong  light,  were  suspected  to  have  been  caused  by  blood.  Other 
stains  on  an  overcoat  worn  by  the  accused  person  were  also  attributed  to 
blood.  Sorby  examined  some  of  the  stains  by  the  optical  process,  and  he 
obtained  a  distinct  spectrum  characteristic  of  blood.  The  author  exam- 
ined microscopically  and  chemically  other  stained  portions  of  the  gray 
woollen  cloth,  and  came  to  the  same  conclusion  as  Sorb\%  namely,  that 
the  faint  reddish-colored  stains  had  been  caused  by  blood.  The  processes, 
although  widely  different,  agreed  in  the  results,  anxl  it  nuiy  be  mentioned 
that,  from  the  fact  of  the  blood-stains  having  been  wetted  and  sponged,  a 
more  difficult  case  for  investigation  could  hardly  have  presented  itself. 
The  methods  of  examination  also  agreed  in  the  result  thiit  some  suspected 
stains  or  marks  on  the  overcoat  were  not  caused  by  blood.  The  date  of  a 
blood-stain  cannot,  however,  be  determined  with  any  certainty  by  this 
l)rocess,  unless  the  conditions  under  which 
it  has  been  kept  are  known ;  and  it  is  not 
possible  to  distinguish  by  it  animal  from 
human  blood.  (See  Sorby,  Quart.  Jour, 
of  Sci.,  April,  1865,  p.  205  ;  Pop.  Sci. 
Rev.,  Jan.  1866,  p.  66.) 

Hsemin-  Crystals. — Another  process  for 
the  detection  of  blood  consists  in  the  pro- 
duction of  microscopic  cr^^stals  of /?asmm 
(hydrochlorate  of  hoematin).  These  crys- 
tals may  be  produced  by  evaporating  to 
dryness  a  fragment  of  blood-clot  with  an 
excess  of  glacial  acetic  acid  and  a  trace 
of  chloride  of  sodium.  More  acetic  acid 
is  then  added,  and  the  evaporation  re- 
peated, but  more  slowly.  The  residue  is 
18 


Fiff.  41. 


Blood-crystals  as  obtained  from  human 
blood. 


27-1:  MICROSCOPICAL    EVIDENCE. 

examined  under  the  microscope,  with  a  power  of  300  to  500  diameters 
Crystals  like  those  seen  in  Fiii\  41  are  observed. 

Microscopical  Evidence.  Blood  Corpuscles. — Hitherto  the  microscope 
has  been  referred  to  as  an  aid  to  the  examiner  in  drawing  a  distinction 
between  the  appearances  presented  by  blood-stains  in  the  dry  state,  and 
those  caused  by  other  substances.  Its  use,  however,  extends  much 
beyond  this.  The  spots  or  stains  may  be  so  small  as  not  to  admit  of 
removal  for  the  purpose  of  applying  chemical  tests.  If  an  examination 
of  the  dry  stain  with  a  low  power  (20  or  30  diameters)  justifies  further 
proceedings,  we  may  then  employ  the  microscope  for  the  purpose  of  de- 
tecting those  peculiar  bodies  on  which  the  color  of  red  blood  is  known  to 
depend.  The  red  coloring  matter  of  blood  consists  of  minute  colored  cor- 
puscles, floating  in  a  clear  liquid  (serum).  The  engraving  (Fig.  42,  p. 
274)  shows  the  form  which  the  corpuscle  presents  in  the  class  Mammalia. 
a  represents  the  circular  form  when  seen  in  front,  the  shaded  portion  being 
a  depression,  which,  under  a  certain  disposition  of  the  light,  assumes  the 
appearance  of  a  solid  and  opaque  nucleus;  b  represents  the  corpuscle  seen 
edgewise,  in  which  case  it  presents  somewhat  the  outline  of  a  biconcave 
lens.  It  owes  this  form  to  the  central  depression  on  each  face.  Other  red 
coloring  matters,  such  as  madder,  cochineal,  or  lac,  do 
Fig.  42.  not  owe  their  color  to  independent  cells  or  corpuscles. 

Hence,  if  corpuscles,  of  the  form  and  size  of  those 
found  in  mammalian  blood,  are  visible  under  the 
microscope,  there  can  be  no  doubt  that  the  liquid  is 
blood.  Such  evidence  can,  however,  be  safely  re- 
ceived only  from  one  who  has  been  accustomed  to  the 
use  of  this  instrument  and  to  the  examination  of 
°°  maguified.  ^^  ^  blood.  In  Order  to  examine  the  suspected  substance 
for  corpuscles,  the  best  plan  of  proceeding,  when  the 
particles  of  coagulum  are  very  small,  is  to  breathe  several  times  on  a  glass 
slide,  then  place  the  small  fragments  of  coagulum  on  the  slide,  and  again 
breathe  over  them.  A  thin  cover-glass  may  then  be  laid  upon  them.  If 
they  consist  of  blood,  a  red  margin  will  soon  appear,  and  in  the  fluid  por- 
tion, by  the  aid  of  a  magnif5nng  power  of  from  300  to  500  diameters,  some 
of  the  corpuscles  of  the  blood  may  be  recognized.  They  are  seldom  so 
perfectly  spherical  as  in  the  fresh  state,  and  they  appear  small,  and  fre- 
quently shrunk  or  corrugated.  In  some  cases  only  fragments  of  the  en- 
velopes can  be  seen.  The  condensed  moisture  of  the  breath  may  serve 
the  purpose  of  water  in  breaking  up  the  small  portions  of  dried  blood 
without  destroying  the  corpuscles  by  too  much  dilution,  but  in  general 
the  addition  of  a  small  quantity  of  water  with  one-ninth  of  its  volume  of 
glycerine,  or  some  other  liquid  of  the  sp.  gr.  1.028,  is  necessary. 

If  the  suspected  clot  is  in  larger  quantity,  it  may  be  removed  from  the 
stuff  and  macerated  in  one  or  two  drops  of  water  and  glycerine,  as  above, 
on  a  glass  slide.  It  should  be  covered  with  thin  glass,  in  order  to  prevent 
rapid  evaporation.  This  method  of  extracting  the  corpuscles  has  fre- 
qiiently  failed,  owing  to  water  alone  having  been  employed.  Under  these 
circumstances  the  corpuscles  are  distended,  become  of  a  globular  form,  of 
less  diameter,  paler,  and  are  finally  destroyed,  while  the  water  simply  be- 
comes colored.  It  is  by  no  means  easy  in  all  cases  to  obtain  from  dry 
coagula  clear  and  distinct  evidence  of  the  presence  of  these  corpuscles, 
especially  when  the  blood  is  old.  In  dr3nng,  the  blood-cells  lose  their  form, 
and  they  do  not  readily  resume  it  when  again  moistened.  Unless  they 
are  seen  after  a  short  maceration  in  a  very  small  quantity  of  water,  it  is 
probable  they  will  not  be  seen   at  all.     To  accelerate  their  separation, 


BLOOD MICROSCOPICAL    CHARACTER. 


275 


Yis.  43. 


various  chemical  liquids  have  been  recommended.  Thus,  strong  solutions 
of  sulphate  of  sodium,  chloride  of  sodium,  and  iodide  of  potassium  have 
been  employed  as  fluid  media  for  breaking  up  the  dried  clots  of  blood. 
There  are  some  disadvantages  attending  the  use  of  these  saline  solutions. 
A  mixture  of  glycerine  and  water  may  be  employed  in  place  of  them.  The 
most  convenient  proportions  are  one  part  by  measure  of  glycerine  to  nine 
or  ten  parts  by  measure  of  distilled  water.  A  cold  saturated  solution  of 
borax  in  water  is  useful.  A  solution  of  arsenious  acid,  in  the  proportion 
of  four  grains  to  an  ounce  of  distilled  water,  as  recommended  by  Kunze, 
is  also  a  rapid  solvent  of  the  coagula.  When  this  is  used,  the  examina- 
tion should  take  place  as  soon  as  the  liquid  begins 
to  be  colored  at  the  margin,  or  the  corpuscles  may 
be  destroyed,  and  only  fragments  of  their  envel- 
opes seen. 

In  reference  to  stains  on  clothing,  if  they  pre- 
sent any  appearance  of  dry  coagula,  these  should 
be  carefully  scraped  off,  and  treated  in  the  manner 
above  described.  If  no  portions  of  solid  coagula 
can  be  procured,  there  will  be  but  little  hope  of 
obtaining  evidence  of  the  presence  of  corpuscles  in 
the  suspected  stain.  The  stained  portion  may  be  cut  out  and  macerated 
in  a  small  quantity  of  water.  Under  these  circumstances,  the  corpuscles 
may  be  sometimes  seen  aggregated,  or  in  groups,  in  the  fibres  of  the 
stuff,  as  in  the  annexed  engraving  (Fig.  43),  in  which  the  stain  of  blood  was 
on  a  shirt. 

The  subjoined  illustrations  (Figs.  44  and  45)  show  the  appearances 
presented  by  blood-corpuscles  when  examined  by  a  power  of  about  300 
diameters,  and  under  different  methods  of  treatment.     Fig.  44  represents 

Fig.  44. 


,  Corpuscles  of  blood  ia 
linen  fibre;  &,  a  group  de- 
tached. 


Human  blood-corpuscles  with  fibrin. 


Human  blood-corpuscles  from  a  dried  sijeci- 
men,  magnified  319  diameters. 


the  appearance  of  a  drop  of  healthy  human  blood.  The  red  blood-globules 
are  partly  detached,  partly  united  in  rolls,  and  partly  in  irregular  clusters. 
In  the  spaces  between  them  there  are  delicate  threads  of  fibrin.  The  out- 
lines of  the  blood-globules  are  in  some  instances  rendered  indistinct,  by 
reason  of  this  web  of  fibrin  above  them. 

In  Fig.  45  the  corpuscles  are  seen  free  from  fibrin,  and  in  groups  (a) 
as  well  as  singly.  Only  a  small  portion  of  those  w^hich  were  in  the  field 
have  been  engraved.  The  shaded  bodies  (b)  are  the  white  corpuscles  of 
the  blood;  they  are  larger,  but  less  numerous,  not  so  well  defined  in  form, 
and  they  present  an  irregularity  of  surface,  by  which  they  may  be  distin- 
guished from  the  colored  blood-fflobules. 


276  BLOOD    OF    MAN    AND    ANIMALS. 

Some  practice  in  the  use  of  the  microscope  is  required  to  enable  a  med- 
ical man  to  arrive  at  a  correct  conclusion  in  these  investigations.  Gran- 
ules of  starch  and  the  spores  of  vegetables  might  be  mistaken  for  blood- 
corpuscles.  Erdmann  states  that,  in  examining  some  articles  of  clothing 
in  a  case  of  suspected  murder,  he  thought  he  had  detected  blood-globules 
in  the  liquid  which  he  procured,  but  he  found  on  further  inspection 
that  they  consisted  of  the  red-colored  spores  of  an  alga  known  as  the  Por- 
'phyindium  cruentum.  (Edin.  Med.  Jour.,  Oct.  1862,  p.  370.)  The  size 
of  the  bodies  as  well  as  their  shape  will  sometimes  aid  the  observer.  The 
blood-corpuscles  have  a  definite  size :  the  bodies  seen  under  the  micro- 
scope may  be  cither  too  large  or  too  small  to  fall  within  the  exceptional 
range  of  size.  Hence  the  micrometer  is  a  necessary  adjunct  to  the  instru- 
ment. Granules  of  starch  would  be  identified  by  the  blue  color  imparted 
to  them  by  iodine. 

Blood  of  Man  and  Animals. — When  marks  of  blood  have  been  detected 
on  the  dress  of  an  accused  person,  it  is  by  no  means  unusual  to  find  these 
marks  accounted  for  by  his  having  been  engaged  in  killing  a  pig,  bullock, 
or  sheep,  or  in  handling  fish  or  dead  game.  Of  course,  every  allowance 
must  be  made  for  a  statement  like  this,  which  can  be  proved  or  disproved 
only  by  circumstances ;  but  the  question  here  arises  whether  we  possess 
any  cerlain  means  of  distinguishing  the  blood  of  a  human  being  from  that 
of  an  animal. 

There  are  no  ascertained  chemical  differences  between  the  blood  of  man 
and  animals.  The  red  coloring  matter,  the  albumen  and  fibrin,  are  the 
same,  and  chemical  reagents  produce  on  them  precisely  similar  results. 
The  microscopical  differences  refer  to  the  shape  and  size  of  the  corpuscles. 
1.  With  respect  to  shape.  In  all  animals  with  red  blood,  the  globules 
have  a  disc-like  or  flattened  form.  In  the  mammalia,  excepting  the  camel 
tribe,  the  outline  of  the  disc  is  cir^cidar  (Fig.  42  a,  p.  2t4).  In  this  tribe, 
and  in  birds,  fishes,  and  reptiles,  the  corpuscles  have  the  form  of  a  length- 
ened ellipse  or  oval.  In  the  three  last-mentioned  classes  of  animals  they 
have  a  central  nucleus,  which  gives  to  them  an  apparent  prominence  in 
the  centre.  In  applying  the  guaiacum  test  to  this  variety  of  blood,  it  is 
found  that  the  nucleus  acquires  a  deep  blue  color,  while  the  oval  margin 
or  envelope  is  of  a  violet  tint.  In  mammalian  blood  the  round  corpuscle 
acquires  a  uniform  blue  color.  (Amcr.  Jour.  Med.  Sci.,  Jan.  1874,  p. 
128.)  The  blood-corpuscles  of  all  the  mammalia,  including  those  of  the 
camel  tribe,  have  no  central  nucleus,  and  they  appear  depressed  in  the 
centre.  The  microscope,  therefore,  enables  an  observer  to  distinguish  the 
blood  of  birds,  fishes,  and  reptiles  from  that  of  a  human  being  or  from 
mammalian  blood ;  and  this  may  be  of  great  importance  as  evidence. 

In  the  case  of  Reg.  v.  Libbey  (Cornwall  Sum.  Ass.,  1811),  the  pris- 
oner, who  was  indicted  for  the  murder  of  her  child,  alleged  that  some  blood 
found  on  certain  articles  of  clothing  was  fowl's  blood  ;  but  the  medical 
witness  was  able  to  prove  that  this  statement  was  untrue.  He  examined 
the  stains  with  the  microscope,  and  found  that  the  corpuscles  had  not  the 
oval  form  of  those  in  the  blood  of  a  bird  ;  but  he  was  unable  to  say 
whether  they  were  human  or  animal.  This  evidence  tended  to  prove 
the  falsehood  of  the  defence. 

The  chief  microscopical  distinction  between  the  blood  of  man  and  do- 
mestic animals  consists  in  a  minute  difference  in  the  diameter  of  the  cor- 
puscles. This,  however,  is  only  an  average  difference ;  for  the  corpuscles 
are  found  of  dilferent  sizes  in  the  blood  of  the  same  animal.  In  making 
use  of  this  criterion,  it  would  l)e  necessary  to  rely  upon  the  size  of  the 
majority  of  the  corpuscles  seen  in  a  given  area,  and  under  the  same  power 


SIZE    OP    BLOOD-CORPUSCLES.  277 

of  the  microscope.  It  is  a  curious  fact  that  their  size  bears  no  relation  to 
the  t;ize  of  the  animal.  Thus,  in  the  horse,  ox,  ass,  cat,  mouse,  pig,  and 
bat  they  are,  on  an  average,  nearly  of  the  same  size  :  the  difference  is  so 
slight  as  to  be  practically  inappreciable.  In  these  animals  they  are  smaller 
than  in  man  and  in  several  of  the  mammalia.  The  corpuscles  in  man,  the 
dog,  the  rabbit,  and  the  hare  are  of  nearly  the  same  size.  In  the  blood 
of  the  sheep  and  goat  they  are  much  smaller  than  in  other  mammalia, 
while  in  man  they  are  larger  than  in  any  of  the  domestic  mammalia.  The 
size  of  the  corpuscles  bears  no  proportion  to  the  aye  of  the  animal :  thus 
in  the  blood  of  the  human  foetus  they  are  to  be  found  as  large  as  in  that 
of  the  adult. 

The  measured  diameter  of  the  corpuscles  in  human  blood  varies,  accord- 
ing to  Gulliver,  from  l-2000th  to  l-4000th  of  an  inch  (0.00050  to  0.00025 
inch),  the  average  size  in  both  sexes  being  l-3200th  (0.00031)  of  an  inch.- 
In  fresh  human  blood  the  author  found  the  average  diameter  of  the  cor- 
puscles to  be  l-3500th  (0  00029)  of  an  inch,  the  maximum  size  being 
l-3000th  (0.00033),  and  the  minimum  l-5000th  (0.00020)  of  an  inch.  The 
corpuscles  of  human  blood  are  larger  than  those  of  domestic  animals.  The 
subjoined  measurements,  in  fractions  of  an  inch,  are  those  given  by  Gul- 
liver, excepting  those  given  in  italics,  which  are  from  the  author's  own 
observations.  The  average  diameter  is,  in  the  dog,  1.3540th  (0.00029), 
max.  l-4000tli  {0.00025),  min.  l-SOOOLh  {0.00017) ;  in  the  hare,  l-3607th 
(0.00028),  max.  l-2000Lh  {0.00050),  min.  l-SOOOth.  {0.00012),  average 
l-4000th  {0.00025);  in  the  rabbit,  l-J/OOOth  {0.00025);  in  the  mouse, 
1-381 4th  (0.00026);  in  the  ass,  l-4000th  (0.00025)  ;  in  the  pig,  l-4230th 
(0.00024),  which  accords  with  the  authoj-^s  measurements,  l-4250th  ;  in 
the  ox,  l-42fiTth  (0.00023)  ;  in  the  cow,  l-J/OOOth  {0.00025)  to  1-J,200th 
{0.00024) ;  in  the  cat,  l-4400th  (0.00023)  ;  in  the  horse,  l-4fi00th  (0.00022), 
or  l-5000th  {0.00020);  in  the  sheep,  l-5300th  (0.00019),  or  l-6333d 
to  l-6000th  {0.00019  to  0.00017)  ;  in  the  goat,  l-6366th  (0.00016).  These 
measurements  apply  to  recent  blood,  which  has  not  been  allowed  to  be- 
come dry  on  animal  and  vegetable  stufFs.  In  this  case  a  distinction  might 
be  easily  made  between  the  blood  of  a  human  being  and  a  sheep  or  goat. 
With  respect  to  the  dog,  hare,  and  rabbit,  it  would  be,  even  under  these 
favorable  circumstances,  a  matter  of  some  difficulty.  When  blood  is  dried 
on  clothing,  and  it  becomes  necessary  to  extract  the  corpuscles  by  means 
of  a  liquid  of  a  different  nature  from  the  serum,  it  would  be  unsafe  to  rely 
on  minute  fractional  differences,  since  we  cannot  be  sure  that  the  cor- 
pu.scles,  after  having  been  once  dried,  will  ever  reacquire,  in  a  foreign 
liquid,  the  exact  size  which  they  had  in  serum.  (See  Guy's  Hosp.  Rep., 
1851,  vii.  pt.  ii.  p.  414  ) 

It  is  generally  admitted  by  scientific  men  that  we  have  at  present  no 
certain  method  of  distinguishing  human  from  other  mammalian  blood, 
when  it  has  been  once  dried  on  an  article  of  clothing  or  on  a  weapon. 
This  is  the  practical  form  in  which  the  problem  usually  comes  before  a 
medical  jurist.  He  may  be  able  to  state  that  the  shape  and  size  of  the 
corpuscles,  as  seen  by  the  microscope,  are  consistent  with  the  blood  being 
mammalian,  and  probably  human,  but  that  it  is  impossi)3le  to  say  with 
absolute  certainty  that  it  is  not  the  blood  of  an  animal  like  the  ox  or  pig. 

Richardson,  of  Philadelphia,  U.  S.,  has  made  a  considerable  step  in  ad- 
vance on  the  microscopical  examination  of  blood.  (Amer.  Jour.  Med.  Sci., 
July,  1874.)  By  the  use  of  higher  powers  up  to  750  diameters,  and  by 
other  appliances,  he  asserts  that  he  has  been  able  to  distinguish,  under 
favorable  conditions,  the  blood  of  man  from  that  of  such  animals  as  the  ox 
and  pig,  and  to  give  evidence  thereon  on  certain  trials  for  murder. 


278 


BLOOD-COKPUSCLES    OF    MAN    AND    ANIMALS. 


It  will  be  understood  that,  as  the  magnifying  power  increases,  the  re- 
lative difference  in  the  size  of  the  corpuscles  is  more  apparent.  Thus, 
when  at  300  diameters  it  would  be  scarcely  possible  to  distinguish  the 
blood  of  man  from  that  of  the  pig,  at  650  diameters  the  difference  in  size 
is  well  marked.     The  plates  (Figs.  46  and  47),  taken  from  a  photograph. 


Fig.  46. 


Fig.  47. 


Human  corpuscles,  l-3500th. 


Pigs'  corpuscles,  l-4250th. 


by  Seiler,  represent,  under  the  same  power  (650  diameters),  the  corpuscles 
in  the  blood  of  man  and  the  pig.  In  each  of  the  engravings  only  a  small 
portion  of  the  blood  is  represented,  the  whole  of  the  photograph,  with  the 
two  varieties  of  blood  and  the  micrometric  scale,  being  much  too  large  for 
a  page  of  this  work.  Seller's  process  is  described  in  the  Amer.  Med, 
Times,  Feb.  19,  1879,  p.  249.  The  larger  size  of  the  corpuscles  in  human 
blood  (Fig.  46)  is  at  once  perceptible,  and  it  may  be  observed  that  the 
smallest  of  the  human  corpuscles  thus  highly  magnified  is  larger  than  the 
largest  of  those  in  the  pig  (Fig.  47).  This  observation  was  made  on  fresh 
blood,  for  Seiler  candidly  admits  that  he  has  not  been  able  to  obtain  satis- 
factory results  with  dried  blood-stains,  the  problem  which  in  practice  most 
commonly  presents  itself  for  solution. 

[Prof.  Reese  asserts  that  by  the  employment  of  microscopes  of  still 
bijiher  powers  (1200  to  1800  diameters)  he  has  been  able  to  distinguish 
unequivocally  between  the  blood  of  man,  the  pig,  the  ox,  and  the  sheep, 
and  that  there  is  no  difficulty  in  positively  distinguishing  between  the 
human  corpuscle  and  that  of  any  animal  whose  corpuscle  is  less  than 
4J7T0  of  an  inch  in  diameter.] 

From  one  well  experienced  in  the  use  of  the  higher  powers  of  the  micro- 
scope, evidence  of  the  probable  nature  of  the  blood  might  be  receivable, 
but  skilled  experts  of  this  kind  are  rarely  found  among  medical  witnesses, 
and  when  the  blood  is  dried  the  evidence  is  generally  inadmissible. 

In  all  cases  in  which  the  microscope  is  employed  for  the  examination  of 
blood-corpuscles,  a  comparison  of  the  sample  should  always  be  mnde  with 
the  kind  of  blood,  whether  human  or  animal,  which  it  is  supposed  to  rep- 
resent. 

Copeman  has  recently  described  a  method  of  distinguishing  human  from 
all  other  kinds  of  blood  (St.  Thomas's  Hosp.  Rep.,  1888,  p.  95).  He 
asserts  that  human  blood,  as  well  as  that  of  the  monkey,  crystallizes  in  the 
form  of  reduced  haemoglobin,  whilst  that  of  all  other  animals  crystallizes 
in  the  form  of  oxyhajmoglobin  ;  and  that  the  spectroscope  reveals  this 
difference.  A  few  drops  of  putrid  serum  suffice  to  bring  about  crystalliza- 
tion of  the  pigment  in  a  solution  of  blood.     To  distinguish  between  the 


BLOOD-CORPUSCLES    OP    MAN    AND    ANIMALS.  279 

blood  of  man  and  the  monkey,  it  sufBces  to  note  that  the  crystals  of  human 
reduced  hiemoglobiu  are  almost  invariably  rectangular  plates,  whilst  those 
from  monkey's  blood  are  for  the  most  part  diamond-shaped  plates,  or  else 
hexag-onal  plates  like  those  of  the  sheep  and  ox.  This  method  is  not 
altogether  satisfactory  when  applied  to  dried  blood. 

In  general  it  is  found  sufiicient  if  the  witness  can  say  that  the  blood- 
stains on  an  article  of  dress  have  the  characters  of  mammalian  blood,  and 
might  be  blood  of  a  human  being.  The  blood  of  birds,  fishes,  and  reptiles 
presents  no  difficulty,  and  in  trials  for  murder  the  statement  of  a  ])risoner 
is  occasionally  proved  false  by  the  medical  evidence  derived  from  the  mi- 
croscope (Reg.  V.  Libbey,  see  p.  277).  A  prisoner  was  charged  (Reg.  v. 
Ward,  Leeds  Ass.,  Nov.  1878)  with  murder  and  highway  robbery.  The 
deceased  was  found  dead,  with  marks  of  severe  blows  on  the  head.  Among- 
other  circumstances  which  connected  the  prisoner  wnth  this  crime  was  a 
large  spot  of  blood  upon  his  trousers.  When  asked  to  account  for  this,  he 
said  it  was  the  blood  of  a  fowl.  The  medical  witness  was  able  to  state 
that  this  was  not  the  blood  of  a  bird,  but  of  a  mammal.  Poachers  have 
their  clothes  often  stained  with  blood  in  contests  with  gamekeepers.  The 
stains  have  in  these  cases  been  sometimes  referred  to  the  carrying  of 
pheasants  or  partridges,  but  the  medical  evidence  has  shown  that  the  form 
of  the  corpuscles  was  inconsistent  with  this  defence. 

[There  is  a  divergence  of  opinion  among  leading  American  observers 
as  to  the  reliability  of  accepting  average  diameters  of  the  red  corpuscles, 
owing  to  the  effect  of  diseases  upon  the  structure  and  to  other  causes, 
aside  from  the  doubts  thrown  upon  micrometric  measurements  by  Prof. 
Marshall  D.  E well's  researches,  who  disputes  the  views  claimed  by  Dr. 
Richardson  and  Prof.  Formad,  of  Philadelphia. 

"  Micrometric  Study  of  4000  Red  Blood  Corpuscles  in  Health  and  Dis- 
ease," by  Prof.  Marshall  D.  Ewell:  N.  Amer.  Prac,  1890,  pp.  97  and  173; 
."  Study  of  the  Subdivision  of  the  first  Millimeter  of  Centimeter  A.,"  by 
Prof.  M.  D.  Ewell:  Amer.  Soc.  of  Microscopists,  1889,  p.  64. 

The  subject  was  discussed  before  the  Medico-Legal  Society  of  New 
York,  in  a  paper  by  Clark  Bell,  Esq.,  on  "  Blood  and  Blood-Stains,"  May, 
1892,  by  the  leading  American  microscopists. 

The  following  consensus  of  opinion  was  reached : — 

1.  That  there  was  no  difficulty  in  distinguishing  between  human  blood 
and  that  of  birds,  fishes,  and  am|)hibia  generally. 

2.  That  by  careful  and  competent  observers,  with  instruments  of  high 
power,  a  reliable  discrimination  could  be  made  between  human  blood  and 
the  blood  of  mammals,  when  the  size  of  the  red  corpuscles  was  much 
smaller  than  that  of  man,  notably  the  ox,  the  horse,  the  goat,  the  sheep, 
the  pig,  and  most  mammals. 

3.  That  the  blood  of  the  dog,  the  rabbit,  and  the  g-uinea-pig  so  nearly 
resembles  human  blood  in  the  size  or  diameter  of  the  red  corpuscles  that  it 
Avas  more  difficult,  and  divided  opinions  exist  among  observers.  Profs. 
Reese,  Formad,  Reyburn,  and  others  claiming  that  by  the  employment  of 
instruments  of  high  powers,  up  to  10,000  diameters,  the  difference  in 
diameter  becomes  so  great  when  thus  magnified  as  to  make  it  apparent  in 
all  mammals  except  the  guinea-pig  and  the  opossum;  while  Prof.  p]well 
and  others  deny  that  the  results  of  these  investigations  are  such  as  make 
it  certain  and  absolute  when  in  doubtful  cases  human  life  is  at  stake. 

4.  All  concur  in  the  safety  of  the  careful  microscopist,  asserting  posi- 
tively "that  the  blood  examined  is  consistent  with  human  blood,^^  if  un- 
willing to  state  positively  that  it  is  such,  or  agreeing  with  the  dictum  of 
Prof.  Wormley  in  his  masterly  treatise  that  "the  microscope  may  enable 


280  STAINS    OF    BLOOD    ON    LINEN    AND    OTHER    STUFFS. 

US  to  determine  with  great  certainty  that  a  blood  is  not  that  of  a  certain 
animal  and  is  consistent  tvith  the  blood  of  man.''  Although  some  might 
agree  and  some  dissent  from  the  same  author's  assertion  added  to  the 
above  quotation,  "but  in  no  instance  does  it  in  itself  enable  us  to  say  that 
the  blood  is  really  human,  or  indicate  from  what  peculiar  species  or 
animal  it  was  derived:''  Yid.  Med. -Legal  Journal,  vol  10,  No.  1,  p. 
77,  June,  1892;  "Blood  and  Blood-Stains,"  bv  Clark  Bell,  Esq.,  Med.- 
Legal  Journal,  vol.  10,  No.  2,  Sept.,  1892,  p.  128;  Eeese,  Med.  Juris.  & 
Tox.,  Ed.  of  1891,  p.  133  ;  "  Comparative  Studies  of  Mammalian  Blood," 
bv  Prof.  Henry  E.  Eormad,  Journal  of  Comp.  Med.  and  Surgery,  July, 
1888.] 

Stains  of  Blood  on  Linen  and  other  Stuffs.  Their  Age  or  Date. — 
Supposing  the  stuff  to  be  white,  or  nearly  colorless,  the  spot  of  blood,  if 
recent,  is  of  a  bright-red  color;  but  by  exposure  it  sooner  or  later  becomes 
of  a  reddish-brown,  or  of  a  deep  red-brown  color.  This  change  of  color  to 
a  reddish-brown  takes  place  in  warm  weather  in  less  than  twenty-four 
hours.  After  a  period  of  five  or  six  days,  it  is  scarcely  possible  to  deter- 
mine, from  the  appearance,  the  date  of  a  stain  even  conjecturally.  In  a 
large  stain  of  blood  on  linen,  no  change  took  place  during  a  period  of  five 
years ;  it  had  a  reddish-brown  color  at  the  end  of  six  weeks,  which  it  re- 
tained for  the  long  period  mentioned.  Indeed,  it  is  extremely  difficult  in 
any  case,  after  the  lapse  of  a  week,  to  give  an  opinion  as  to  the  actual  date 
of  a  stain.  Upon  colored  stuffs  or  dirty  clothes,  it  is  of  course  impossible 
to  trace  these  physical  changes  in  stains  of  blood;  on  red-dyed  stuffs  the 
stain  appears  simply  darker  from  the  first,  and  in  all  cases  the  fibre  of  the 
stuff  is  more  or  less  stiffened,  as  the  result  of  the  drying  of  the  albumen 
associated  with  the  red  coloring  matter.  In  examining  an  article  of  cloth- 
ing, attention  should  be  paid  to  the  side  of  the  stuff  which  has  first  received 
the  stain  ;  sometimes  both  sides  are  stained.  The  evidence  derived  from 
an  observation  of  this  kind  may  be  occasionally  of  importance. 

The  suspected  stain  should  be  first  examined,  in  a  strong  light,  with 
a  low  power  of  the  microscope.  If  caused  by  blood  it  will  not  be  a  mere 
coloring  of  the  fibres,  but  it  will  have  a  shining  glossy  appearance,  and 
each  fibre  will  be  observed  to  be  invested  with  a  portion  of  dried  coagu- 
lum,  or  clot.  In  other  cases,  minute  coagula,  presenting  the  appearance 
of  dried  red  jelly,  will  be  seen  in  the  meshes  of  the  stained  article  of  cloth- 
ing. In  certain  lights  the  clots  may  appear  of  a  dark-red  color,  but  by 
changing  the  light,  bright  translucent  portions  of  a  peculiar  crimson 
tint  will  come  into  view.  The  crimson  stain  of  blood  is  unlike  that  of 
any  other  red  coloring  matter,  and  when  the  stained  portion  presents  the 
character  of  a  glossy  dry  coagulum,  the  stain  cannot  be  easily  mistaken 
by  a  practised  eye  for  one  caused  by  any  other  red-colored  liquid.  In 
fact,  the  miscroscope  puts  the  observer  of  a  minute  stain  in  the  same  po- 
sition as  a  non-piofessional  person,  who  unhesitatingly  forms  his  judg- 
ment from  a  large  quantity  of  dried  blood.  Portions  of  kino  over  a  dress 
may  present  occasionally  the  appearance  of  coagulated  blood,  but  kino 
differs  in  color  and  in  chemical  properties  from  blood.  The  microscopical 
observation  of  a  suspected  stain  on  linen,  cotton,  or  Avoollen,  however 
small,  is  generally  sufficient  to  enable  an  expert  to  form  an  opinion  either 
in  the  affirmative  or  negative.  The  application  of  chemical  and  spectro- 
scopic tests  should,  however,  be  resorted  to  for  confirmatory  evidence. 

Analysis. — If  the  quantity  of  blood  is  small,  the  stained  substance  may 
be  cut  up  and  macerated  in  a  porcelain  capsule,  with  just  enough  water  to 
keep  it  well  moistened.  After  an  hour  it  may  be  pressed,  and  a  red- 
colored  liquid  will  be  thus  obtained  in  a  fit  state  for  testing.     The  ediior 


BLOOD CHEMICAL    REAGENTS RED    STAINS.  281 

finds  that  a  cold  saturated  solution  of  borax  is  generally  the  best  solution 
for  dissolving-  the  blood-pigment  from  blood-stains.     This  solution,  having 
a  density  of  1.020,  rather  less  than  that  of  blood-serum,  is  well  adapted 
for  the  examination  of  stains  for  blood-corpuscles  under  the  microscope. 
A  solution  of  borax  quickly  dissolves  blood-pigment  from  leather,  iron, 
and  soil;  and,  moreover,  acts  as  a  preservative,  so  that  the  solution  re- 
tains its  character  for  several  days.     It  may  be  olyected  that  red  stains 
resembling  blood  are  occasionly  found  on  linen  and  other  stuffs,  and  may 
give  rise  to  error.     All  such  stains  are  either  entirely  insoluble  in  water, 
or  they  are  soluljle  and  yield  red-colored  liquids.     If  insoluble,  they  can- 
not be  mistaken  for  blood-stains  ;  if  soluble,  no  mistake  can  arise  provided 
the  red  liquid  so  obtained  is  submitted  to  chemical  tests.     Blood-stains 
rendered  insoluble  in  water,  by  heat  or  from  some  other  cause,  must  be 
tested  by  another  method.     When  the  stain  is  of  old  date,  a  solution  in 
water  is  very  slowly  obtained,  and  it  does  not  present  the  bright  red  color 
of  blood.     In  some  cases,  if  the  stain  is  of  very  old  standing,  and  has  been 
much  exposed  to  the  atmosphere,  water  will  have  scarcely  any  solvent 
effect  upon  it,  and  it  may  be  found  impossible  to  obtain  a  red-colored  liquid 
even  after  twenty-four  hours'  maceration.     At  the  most,  the  water  may 
acquire  a  pale-brown  or  yellowish  color,  but  wholly  unlike  that  imparted 
by  blood.     In  such  a  case  it  is  useless  to  add  ammonia.     We  may,  how- 
ever, generally  form  a  correct  judgment  by  the  microscopical  appearance 
of  the  stain  before  wetting  it,  and  by  the  guaiacum  process.     Water  may 
dissolve  sufficient  albumen  (or  serum)  to  become  opaline  by  heat,  or  by 
the  addition  of  nitric  acid,  although  we  may  fail  to  obtain  any  evidence 
of  the  presence   of  corpuscles.     From   the  results  obtained  by  spectral 
analysis,  it  appears  probable  that  acid  and  other  vapors  in  the  atmosphere 
affect  blood-stains  and  alter  their  chemical  properties.     Where  much  coal 
is  burnt,  sulphurous  acid  may  operate  in  this  manner.     Under  other  cir- 
cumstances, when  the  quantity  of  blood  effused  is  moderately  large,  it  may 
be  detected  by  the  process  above  mentioned  after  the  lapse  of  a  consider- 
able time.      We  have  thus  detected  the  blood  of  the  human  body,  and  of 
the  bullock,  on  cotton,  linen,  and  flannel,  after  a  lapse  of  three  years.     The 
spectroscopic  test  should  also  be  applied,  and  the  bands  of  either  haemo- 
globin, or  of  htemochromogen,  or  of  both  bodies  obtained,  if  possible.     A 
portion  of  the  fabric  may  also  be  treated  with  acetic  acid  for  the  obtaining 
of  hgemin-crystals  (see  p.  273,  ante).     If  the  stuff"  be  dyed,  we  should  pro- 
ceed to  examine  the  stains  found  upon  it  by  a  similar  process.     The  dye 
is  commonly  fixed,  and  is  not  soluble  in  Avater.     Thus,  then,  in  testing  for 
blood  we  rely  upon  :   1.   The  solubility  of  the  red  coloring  matter  in  water. 
2.  The  negative  action  of  ammonia.     3.    The  positive  effect  of  heat  in 
entirely  coagulating  and  destroying  the  red  coloring  matter.     4.  The  blue 
color  produced  by  guaiacum  in  the  presence  of  peroxide  of  hydrogen.     5. 
The  appearances  of  the  spectrum.     6.  The  production  of  hsemin-crystals. 
4,  5,  and  6  are  the  most  important  reactions  of  blood. 

There  are  red  stains  bearing  a  resemblance  to  blood,  which  are  insoluble 
in  water.  These  may  be  identified  by  their  special  characters.  Among 
them  are  :  1.  Certain  red  dyes,  as  madder,  which,  when  fixed  by  a  mor- 
dant, is  not  readily  affected  by  ammonia.  2.  Iron-moulds  These  are  of 
a  reddish-brown  color,  sometimes  of  a  bright  or  orange-red  ;  they  are  quite 
insoluble  in  water,  but  are  easily  dissolved  by  maceration  in  diluted  hydro- 
chloric acid,  and  on  adding  ferrocyanide  of  potassium  to  the  solution  the 
presence  of  iron  will  be  at  once  proved  by  the  production  of  Prussian 
blue.  The  acid  used  for  this  purpose  should  contain  no  iron.  Iron- 
moulds  are  generally  distinguished  by  their  brown   color,   and  by  the 


282  BLOOD    ON    WEAPONS. 

absence  of  all  stiffening-  or  glossiness  of  the  fibre  in  the  stained  spot,  3. 
Red  jjaint.  Stains  made  with  red  jDaiut,  containing-  red  oxide  of  iron,  have 
been  mistaken  for  blood.  They  may  be  easily  identified  by  digesting- 
them  in  diluted  hydrochloric  acid,  and  applying  to  the  solution  the  tests 
for  ferric  salts.  Like  those  produced  by  iron-moulds,  they  are  quite 
insoluble  in  water,  and  therefore  cannot  be  confounded  with  blood-stains. 
The  same  may  be  said  of  spots  of  the  ammonia-nitrate  of  silver  changed 
by  light,  which  the  author  has  known  to  be  mistaken  for  old  stains  of 
blood.  The  stuff  on  which  the  spots  of  blood  are  found  may  be  itself 
stained  with  a  red  dye  or  color,  or  it  may  be  dyed  with  iron :  in  this  case 
it  will  be  necessary  to  test  by  the  same  process  a  piece  of  the  colored  or 
stained  portion,  in  order  to  furnish  negative  evidence  that  the  suspected 
stains  are  due  to  blood.  4.  Among  soluble  stains  resembling  those  of 
blood  in  color,  are  the  spots  produced  by  the  juices  of  the  7)iulher7^y ,  cur- 
rant, gooaeherry,  and  other  red  fruits.  They  may  be  sometimes  recog- 
nized chemically  by  dropping  on  them  a  weak  solution  of  ammonia,  when 
the  spot  is  turned  either  a  blueish,  olive-green,  or  green  color.  The  red 
of  cochineal  is  changed  into  a  crimson  on  the  addition  of  weak  ammonia  ; 
but  a  spot  of  blood  treated  with  this  alkali  undergoes  no  change  of  color. 
Eosin,  used  as  a  red  ink,  gives  a  solution  to  water  which  is  strongly  fluo- 
rescent. Diluted  acids  brighten  the  red  colors  of  fruit-stains,  but  they  do 
not  alter  the  color  of  blood.  A  strong  solution  of  chlorine  bleaches  the 
red  colors  from  fruit-stains,  but  Avhen  applied  to  a  stain  of  blood  it  turns 
the  red  coloring  matter  to  a  dark  olive-green  tint  and  does  not  bleach  it. 
Finally,  they  are  not  colored  blue  by  tincture  of  guaiacum  with  peroxide 
of  hydrogen. 

These  changes  of  color  are  only  well  observed  on  colorless  stuffs.  If 
the  stain  is  on  black  cloth,  the  color  may  be  extracted  by  water  and  tested, 
or  the  following  plan  may  be  adopted:  The  stain  is  wetted  with  distilled 
water,  and  after  a  time  several  layers  of  white  blotting-paper  are  firmly 
pressed  upon  it.  The  red  color,  if  present,  is  thus  transferred  to  the  paper, 
and  may  be  tested  b}^  fresh  tincture  of  guaiacum  and  peroxide  of  hydro- 
gen. If  the  guaiacum  alone  is  blued  by  contact,  some  other  method  of 
corroboration  must  be  adopted,  since  the  red  color  of  blood  has  no  action 
on  this  resin  until  after  the  addition  of  peroxide  of  hydrogen.  If  no  red 
or  reddish-brown  color  is  communicated  to  the  paper,  or  if  the  stain  on 
paper  produces  no  blue  color  with  a  mixture  of  guaiacum  and  peroxide,  it 
cannot  be  owing  to  blood.  With  ordinary  precautions  the  guaiacum  pro- 
cess may  be  safely  used,  and,  b}^  the  aid  of  it,  stains  which  have  been 
washed  for  the  purpose  of  obliteration  may  be  detected,  so  long  as  the 
slightest  indication  of  red  color  remains  in  the  washed  fabric.  It  will  even 
give  the  reaction  for  blood  upon  calico  or  linen  which  has  been  so 
thoroughly  washed  as  to  appear  almost  colorless.  In  order  to  guard 
against  any  fallacy,  an  unstained  portion  of  calico,  linen,  paper,  or  cloth 
should  be  first  tested.  In  any  case  a  negative  result  will  fully  justify 
the  opinion  that  there  have  been  no  blood-stains  washed  out  of  the  stuff. 
The  great  use  of  the  guaiacum  process  is  in  enabling  the  operator  to  dis- 
tinguish the  red  coloring  matter  of  blood  from  other  red  coloring  matter. 

Detection  of  Blood  on  Weajoons. — A  knife,  dagger,  or  sword  may  have 
been  used  for  inflicting  a  wound,  and  may  have  no  stains  upon  it,  or  only 
a  slight  yellowish  film  of  dried  serum.  It  may,  in  fact,  have  been  wiped 
by  drawing  it  through  the  wound  or  clothes.  In  other  cases  the  weapon 
may  have  well-marked  stains  upon  it,  and  when  these  ai'e  recent  and  on  a 
clean  or  polished  surface,  they  may  be  easily  recognized  ;  but  when  of  old 
standing,  or  on  a  rusty  piece  of  metal,  it  is  a  matter  of  some  difficulty  to 


AKTERIAL    AND    VENOUS    BLOOD.  283 

distinguish  them  from  the  stains  produced  by  rust  or  other  causes.  If  the 
stain  is  large  and  dry,  a  portion  may  be  scraped  off,  and  placed  in  a  watch- 
glass  with  some  distilled  water,  the  solution  filtered  to  separate  any  oxide 
of  iron,  and  then  tested.  If  the  water  by  simple  maceration  does  not  ac- 
quire a  red  or  red-brown  color,  the  stain  is  probably  not  due  to  blood.  If 
it  acquires  a  red  color,  the  solution  may  be  tested  by  the  methods  de- 
scribed at  p.  281.  Sometimes  the  stain  appears  on  a  dagger  or  knife, 
either  in  the  form  of  a  thin  yellowish  or  reddish  film  or  in  rusty  streaks. 
The  dry  matter  is  scraped  into  a  small  porcelain  dish  and  a  little  water 
poured  on  it.  If  a  red-colored  solution  is  obtained,  this  may  be  pipetted 
off  and  tested  for  blood.  The  residue,  evaporated  to  dryness,  may  be 
treated  with  guaiacum  and  peroxide  of  hydrogen.  The  particles  of  blood 
are  thus  distinguished  from  those  of  iron-rust  by  the  small  zones  of  blue 
color  formed  around  them.  The  rust  is  not  thus  affected.  There  is  a 
remarkable  resemblance  to  the  stains  of  blood  on  metal,  produced  by  the 
oxides  or  certain  vegetable  salts  of  iron.  If  the  juice  or  pulp  of  lemon  or 
orange  is  spread  upon  a  steel  blade,  and  is  exposed  to  the  air  for  a  few 
days,  the  resemblance  to  blood  produced  by  the  formation  of  citrate  of 
iron  is  occasionally  so  strong  that  we  have  known  well-informed  surgeons 
to  be  completely  deceived  :  they  have  pronounced  the  spurious  stain  to 
be  blood.  These  stains,  which  owe  their  color  to  citrate  of  iron,  may 
be  thus  distinguished  :  the  substance  is  soluble  in  water,  forming,  when 
filtered,  a  yellowish-brown  solution,  totally  different  from  the  red  color 
of  blood  under  the  same  circumstances.  The  solution  undergoes  no 
change  of  color  on  the  addition  of  ammonia.  It  is  unchanged  in  color, 
but  may  be  partially  coagulated  at  a  boiling  temperature,  and  is  at  once 
identified  as  a  soluble  salt  of  iron  by  giviiig  a  blue  color  with  ferrocyanide 
of  potassium. 

It  is  not  always  easy  to  distinguish  by  sight  a  stain  of  blood  on  a 
weapon  from  a  mark  produced  by  iron-rust.'  When  strong  suspicion 
exists,  marks  are  often  pronounced  to  be  due  to  blood,  which,  under  other 
circumstances,  would  have  passed  unnoticed.  One  source  of  difficulty  is 
this:  the  iron-rust  on  an  old  knife  maybe  mixed  with  some  article  of 
food  or  even  with  blood  itself.  We  must  here  pursue  the  mode  of  exami- 
nation above  described  to  distinguish  the  rust  from  blood  (p.  281.)  From 
the  foregoing  remarks,  we  may  justly  infer  that  the  chemical  analysis  of 
suspected  spots  or  stains  on  weapons  and  clothing  is  by  no  means  an  un- 
important duty.  If  we  cannot  always  obtain  from  these  experiments 
affirmative  evidence,  they  often  furnish  good  negative  proof,  and  thus  tend 
to  remove  unjust  suspicions  against  accused  persons. 

Arterial  and  Venous  Blood. — It  is  not  possible  to  distinguish  arterial 
from  venous  blood  by  any  physical  or  chemical  characters,  when  it  has 
been  effused  for  some  days,  and  is  in  a  dry  state  upon  articles  of  dress  or 
furniture  ;  but  this,  in  medico-legal  practice,  is  not  often  a  subject  of  much 
importance,  since  there  are  few  cases  of  severe  wounds,  either  in  the  throat 
or  other  parts  of  the  body,  in  which  the  two  kinds  of  blood  do  not  escape 
simultaneously.  The  most  striking  and  apparent  difference  between 
them,  when  recently  effused,  is  the  color ;  the  arterial  being  of  a  bright 
scarlet,  while  the  venous  is  of  a  dark-red  hue;  but  it  is  well  known  that 
the  latter,  when  exposed  to  air  for  a  short  time,  acquires  a  florid  red  or 
arterial  color  ;  and  the  kinds  of  blood,  when  dried,  cannot  be  distinguished 
chemically  by  any  known  criterion.  If  the  coat,  or  other  stuff", 
stained  with  blood,  were  of  a  dark  color,  the  liquid  would  be  absorbed, 
and  speedily  lose  its  physical  characters.  Arterial  coagulates  more  firmly 
than  venous  blood.     The    microscope  shows  no  appreciable  difference  in 


28-4  BLOOD-STAIXS    ON    CLOTHING. 

the  blood-corpuscles,  and  chemistry  does  not  enable  us  to  apply  any  test 
so  as  to  make  a  satisfactory  distinction  between  them.  In  this  deficiency 
of  microscopical  and  chemical  evidence,  an  attempt  has  been  made  to  es- 
tablish a  distinction  by  noticing  the  physical  appearance  of  the  blood- 
stains. Thus,  it  is  alleged,  the  arterial  blood  will  be  indicated  b}^  its  being 
sprinkled  over  surfaces  upon  which  it  has  fallen,  while  the  venous  blood 
is  always  poured  out  in  a  full  stream.  In  most  wounds  which  prove  fatal 
by  hemorrhage,  the  blood  is  poured  out  simultaneously  from  arteries  and 
veins.  The  sprinkled  appearance  of  the  blood,  when  It  exists,  will,  cseteris 
paribus,  create  a  strong  presumption  that  it  was  poured  out  from  a 
living  body — for  after  the  heart  has  ceased  to  act,  the  arteries  lose  the 
power  of  throwing  out  the  blood  in  jets.  The  sprinkling  is  usually 
observed  when  the  wounded  artery  is  small,  and  the  blood  is  effused  at  a 
distance.  This  is  a  fact  which  a  medical  jurist  should  not  overlook, 
although,  for  the  reasons  stated,  too  great  a  reliance  must  not  be  placed 
on  it.  The  spots  of  blood,  if  thrown  out  from  a  living  bloodvessel, 
speedily  consolidate,  and  the  fibrin,  with  the  greater  portion  of  the  color- 
ing matter,  is  found  of  a  deep-red  color  at  the  lower  part  of  the  spot,  the 
upper  portion  being  of  a  pale  red.  The  lower  and  thicker  part  has  com- 
monW  a  shining  lustre,  as  if  gummed,  when  the  spot  is  recent,  and  when 
it  has  been  effused  upon  a  non-absorbent  surface. 

When  blood  falls  upon  porous  articles  of  clothing,  it  is  often  absorbed, 
and  produces  dull  stains.  In  dark-colored  articles  of  dress,  it  is  sometimes 
difficult  b}^  daylight  to  perceive  these  stains.  The  part  appears  stiffened, 
and  has  a  dull  red-brown  color,  which  is  sometimes  more  perceptible  when 
seen  by  the  reflection  of  the  light  of  a  candle.  In  trusting  to  the  coagu- 
lation of  the  sprinkled  blood  as  evidence  of  its  escape  from  a  living  vessel, 
it  must  be  remembered  that  three  hours  may  elapse  before  it  coagulates  in 
the  healthy  body  after  death.  Hence  blood  which  has  escaped  from  a 
recently  dead  body,  although  it  would  not  be  found  diffused  as  if  by 
spurting,  might,  in  so  far  as  coagulation  is  concerned,  assume  the  appear- 
ance of  having  been  effused  from  a  living  body. 

In  spite  of  the  great  advances  made  in  the  construction  and  use  of  the 
microscope,  there  is  no  method  known  by  which  the  blood  of  a  man  can 
be  distinguished  from  that  of  a  woman,  or  the  blood  of  a  child  from  that  of 
an  adult.  The  blood  of  a  child  at  birth  forms  a  thinner  and  softer  coagu- 
lum  than  that  of  the  adult.  A  medico-legal  question  has  arisen,  on  more 
than  one  occasion,  as  to  whether  there  were  any  means  of  distinguishing 
menstrual  blood  from  that  of  the  body  generally.  This  liquid  contains 
fibrin,  although  the  proportion  is  less  than  in  venous  or  arterial  blood,  red 
coloring  matter,  and  the  other  constituents  of  blood.  The  only  differences 
noticed  are  of  an  accidental  kind  :  First,  that  it  is  acid,  owing  to  its  admix- 
ture with  vaginal  mucus  ;  and,  second,  that  under  the  microscope  it  is 
mixed  with  epithelial  scales,  which  it  has  derived  from  the  mucous  mem- 
brane in  its  passage  through  the  vagina.  In  the  bodies  of  women  who 
had  died  suddenly  while  menstruating,  Webber  found  coagulated  blood 
upon  the  uterine  mucous  membrane.  If,  therefore,  menstrual  blood  does 
not  coagulate,  it  is  simply  because  it  has  already  coagulated  Avithin  the 
uterine  cavity,  and  cannot  do  so  again  ;  it  is  more  fluid  than  ordinary 
blood,  because  during  its  trickling  descent  it  becomes  mixed  with  -watery 
uterine  and  vaginal  "mucus.  (Schmidt's  Jahrb.,  1849,  1,  139.)  A  case 
occurred  in  France,  which  induced  the  Minister  of  Justice  to  refer  the  con- 
sideration of  this  question  to  the  Academy  of  Medicine.  The  reporters, 
Adelon,  Moreau,  and  Le  Canu,  came  to  the  conclusion  that  there  were  no 
means  of  distinguishing  menstrual  blood  dried  on  clothing  from  that  Avhich 


WOUNDS — CAUSE    OF    DEATH.  285 

mig-ht  be  met  with  in  a  case  of  infanticide  or  abortion.     (Ann.  d'Hyg., 
184fi,  t.  1,  p.  181.) 

For  a  very  full  description  of  the  methods  to  be  adopted  in  the  exami- 
nation of  supposed  blood-stains  under  various  circumstances,  the  reader  is 
referred  to  a  memoir  by  Dragendorlf.  (Maschka's  Haudb.  der  Gerichtl. 
Med.,  bd.  i.  p.  481.  et  seq.) 


CHAPTER    XXVIII. 

THE    CAUSE    OF  DEATH    FKOM   AVODNDS. — WO0NDS    DIRECTLY   OR  INDIRECTLY  FATAL. — DEATH 

FROM  HEMORRHAGE. INTERNAL   BLEEDING. DEATH    FROM    MECHANICAL     IN.JURY FROM 

SHOCK. DEATH     FROM    NUMEROUS    PERSONAL    INJURIES,    IRRESPECTIVE    OF    ANY    MORTAL 

WOUND.  -. 

It  is  important  for  a  medical  witness  to  bear  in  mind  that,  in  all  cases  of 
wounds  criminally  inflicted,  the  cause  of  death  must  be  certain.  No  man 
is  ever  convicted  upon  mere  medical  probability.  In  general,  there  is  only 
one  real  cause  of  death,  although  other  circumstances  may  have  assisted 
in  bringing  about  a  fatal  result.  Thus  a  person  cannot  die  of  disease  in 
the  bowels  and  a  stab  in  the  chest  at  the  same  time,  nor  of  apoplexy  from 
disease  and  compression  of  the  spinal  marrow  at  the  same  instant.  Hence 
it  is  our  duty,  when  several  apparent  causes  for  death  exist,  to  determine 
which  was  the  real  cause ;  and,  in  stating  it  to  the  court,  to  be  prepared 
to  offer  our  reasons  for  this  opinion.  In  most  cases  of  local  injury,  when 
a  person  dies  speedily,  there  will  be  no  great  trouble  in  settling  whether 
disease  or  the  injury  was  the  cause.  A  difficulty  ma3i,  however,  exist 
when  a  person  has  recovered  from  the  first  effects  of  a  wound,  and  has 
subsequently  died.  Besides,  there  may  be  cases  in  which  the  cause  of 
death,  in  spite  of  the  most  careful  deliberation,  will  be  still  obscure;  or 
sometimes  it  may  happen  that  the  death  of  a  person  appears  to  be  as  much 
dependent  on  bodily  disease  as  on  an  injury  proved  to  have  been  received 
at  the  time  he  was  laboring  under  the  disease, 

[Sometimes  death  is  due  to  Avant  of  medical  skill,  or,  worse,  wrong 
treatment  by  attending  physicians.  The  case  of  James  Fisk,  Jr.,  pre- 
sented a  notable  case  of  this  character.  Modern  surgery  would  have  had 
no  serious  obstacle  in  treating  the  wound  (gunshot  wound  of  the  abdo- 
men), then  by  many  regarded  as  fatal.  Had  Dr.  James  R.  Wood,  the 
eminent  surgeon,  who  was  sworn  on  the  trial  as  an  expert  in  the  case, 
been  in  charge,  he  would  have  had  no  serious  difficulty  in  securing  a  re- 
covery. 

The  monograph  of  Dr.  Eugene  Perugnet,  read  before  the  Medico-Legal 
Society  of  New  York,  demonstrated  that  the  death  was  directly  due  to 
coma,  caused  by  large  doses  of  morphia.  The  bullet  might  have  caused 
death,  but  for  want  of  proper  surgical  treatment  the  morphia  interposed, 
and  actually  caused  the  death  :   Series  2,  Medico-Legal  Papers,  p,  294. 

The  case  of  President  Garfield  presents  similar  considerations  and  reflec- 
tions. Did  he  die  from  the  bullet  of  the  assassin,  or  was  his  death  due 
to  other  causes  i*] 

How  is  an  opinion  to  be  expressed  in  such  a  case  ?  The  course  that  a 
niedical  witness  ought  to  pursue,  provided  he  has  duly  deliberated  on  the 
circumstances  before  he  appears  in  court,  and  his  mind  is  equally  balanced 


286  WOUXDS DEATH  FROM  HEMORRHAGE. 

between  the  two  causes,  is  to  state  at  once  bis  doubt  to  the  jury  without 
circumlocution,  and  not  allow  it  to  be  extracted  from  him  in  cross-exami- 
nation. It  is  the  hesitation  to  assign  a  satisfactory  cause,  or  the  assigning 
of  many  causes  for  death,  that  gives  such  advantage  to  a  prisoner's  case, 
even  when  the  general  evidence  is  entirely  against  him.  Oceasionall}-, 
several  causes  of  death  are  vaguely  assigned  by  a  medical  witness,  among 
which  some  have  a  tendency  to  exculpate,  and  others  to  inculpate,  an 
accused  person  in  a  greater  or  less  degree,  and  it  is  left  to  the  jury  to  select 
from  the  number  one  upon  which  to  found  a  verdict.  In  a  case  of  this 
kind  an  acquittal  is  commonly  obtained. 

Wounds  Dii^ectly  or  Indirectly  Fatal. — A  wound  may  cause  death 
either  directly  or  indirectly.  A  wound  operates  as  a  direct  cause  of  death 
when  the  wounded  person  dies  either  immediately,  or  very  soon  after  its 
iufiictiou,  and  there  is  no  other  cause,  internall}^  or  externally,  to  account 
for  death.  In  wounds  which  cause  death  indirectly,  it  is  assumed  that 
the  person  survives  for  a  certain  period,  and  that  the  wound  is  followed 
by  inflammation,  suppuration,  pyagmia,  gangrene,  tetanus,  erysipelas,  or 
some  other  mortal  disease  which  is  a  direct,  and  not  an  unusual,  conse- 
quence of  the  injury.  Under  this  head  may  be  also  placed  all  those  cases 
which  prove  fatal  b}^  reason  of  surgical  operations  rendered  imperatively 
necessary  for  the  treatment  of  an  injury — presuming  that  these  operations 
have  been  performed  with  ordinar}"  skill  and  care.  We  shall  for  the 
present  consider  only  the  direct  causes  of  death  in  cases  of  wounds.  They 
are  three  in  number:  1.  Hemorrharje,  or  loss  of  blood.  2.  Great  me- 
chanicalivjury  done  to  an  organ  important  to  life.  3.  Shock,  or  concus- 
sion, affecting  the  nervous  centres,  whereby  the  functions  of  one  or  more 
vital  organs  are  arrested,  sometimes  with  but  slight  injmy  to  the  part 
struck  or  wounded.  From  an}"  one  of  these  causes  a  wounded  person  may 
die  immediately  or  within  a  few  minutes. 

1.  Death  froni  Hemorrhage. — Loss  of  blood  operates  by  producing 
fatal  syncope  (p.  63).  A  quantity  of  blood  escaping  from  a  vessel, 
although  insufficient  to  cause  death  by  afiFecting  the  heart  and  circulation, 
may  readily  destroy  life  by  disturbing  the  functions  of  the  organ  or  part 
into  which  it  is  efl'used.  Thus  a  small  quantity  effused  in  or  upon  the 
substance  of  the  brain,  or  at  its  base,  may  prove  fatal  by  inducing  fatal 
compression  ;  and,  again,  if  in  a  case  of  wounded  throat  blood  should  flow 
into  the  windpipe,  it  may  cause  death  by  asphyxia ;  i.  e.,  by  stopping  the 
respiratory  process  (p.  63).  In  these  cases  it  is  obvious  that  the  blood 
acts  mechanically ;  and  in  respect  to  the  last  condition  a  medical  man, 
unless  circumspection  is  used,  may  involve  himself  in  a  charge  of  mala- 
p"axis.  If  he  allows  the  wound  to  remain  open,  the  wounded  person  may  die 
through  hemorrhage;  if  he  closes  it  too  soon,  the  person  may  die  through 
suffocation  ;  and,  in  either  case,  the  counsel  for  a  prisoner  will  not  fail  to 
take  advantage  of  a  plausible  objection  of  this  kind.  In  wounds  of  the 
chest,  involving  the  heart  and  lungs,  death  is  frequently  due,  not  so  much 
to  the  actual  quantity  of  blood  effused,  as  to  the  pressure  which  it  pro- 
duces upon  these  organs.  A  few  ounces  effused  in  the  cavity  of  the  bag 
enclosing  the  heart  (pericardium)  will  entirely  arrest  the  action  of  this 
organ. 

The  absolute  quantity  of  blood  required  to  be  lost  in  order  to  prove 
fatal,  will,  of  coarse,  vary  according  to  numerous  circumstances.  The 
young,  the  aged,  and  those  who  are  laboring  under  infirmity  or  disease, 
will  perish  sooner  from  loss  of  blood  than  others  who  are  healthy  and 
vigorous.  Women,  caeteris  paribus,  are  more  speedily  destroyed  by 
bleeding  than  men.     Infants  are  liable  to  die  from  this  cause,  as  a  result 


DEATH    FROM    INTERNAL    HEMORRHAGE.  287 

of  slight  wounds.  An  infant  has  been  known  to  bleed  to  death  from  the 
bite  of  a  single  leech,  or  from  the  simple  operation  of  lancing-  the  g-unis. 
Even  the  healthy  and  vigorous,  when  their  vital  powers  have  been  de- 
pressed by  maltreatment  or  by  brutal  violence,  will  sink  under  the  loss  of 
a  comparatively  small  quantity  of  blood.  A  medical  jurist  must  not  forget 
that  some  persons  have  a  predisposition  to  excessive  bleeding  from  slight 
injuries;  and  this  condition  is  often  hereditary.  The  slightest  wound  or 
puncture — the  bite  of  a  leech  or  the  extraction  of  a  tooth — will  be  attended 
with  a  loss  of  blood  which  cannot  be  arrested,  and  which  will  slowly  lead 
to  death  by  exhaustion.  Cases  have  been  frequently  recorded  of  fatal 
hemorrhage  following  the  extraction  of  teeth,  when  there  had  been  pre- 
viously nothing-  to  indicate  the  probable  occurrence  of  death  from  so 
trivial  a  cause.  Such  cases  are  without  difficulty  detected  ;  since  a  sur- 
geon may  always  infer  from  the  part  injured  and  the  extent  of  the  injury 
whether  the  bleeding  is  likely  to  be  copious  or  not.  When  a  person  bleeds 
to  death  from  what  would,  under  common  circumstances,  be  a  simple 
wound,  the  admission  of  this  fact  may  in  certain  cases  lessen  the  respon- 
sibility of  an  accused  party. 

A  sudden  loss  of  blood  has  a  much  more  serious  consequence  than  the 
same  quantity  lost  slowly.  A  person  may  fall  into  a  fatal  swoon  from  a 
quantity  of  blood  lost  in  a  few  seconds,  Avhich  he  would  have  been  able  to 
bear  without  sinking  had  it  escaped  slowly.  This  is  the  reason  why  the 
wound  of  an  artery  proves  so  much  more  rapidly  fatal  than  that  of  a  vein. 
Death  speedily  follows  the  wound  of  a  large  artery  like  the  carotid;  but 
it  takes  place  with  equal  certainty,  although  more  slowly,  from  wounds 
of  smaller  arteries.  In  a  case  in  which  one  of  the  intercostal  arteries  was 
wounded  by  a  small  shot,  hemorrhage  caused  death  in  thirty-eight  hours. 
The  loss  of  blood  which  follows  the  division  of  the  smaller  branches  of  the 
external  carotid  artery  is  often  sufficient  to  destroy  life,  unless  timely 
assistance  be  rendered.  If  a  wound  is  in  a  vascular  part,  although  no 
vessel  of  any  importance  be  divided,  the  person  may  still  die  from  bleed- 
ing. It  is  difficult  to  say  what  quantify  of  blood  should  be  lost  in  order 
that  a  wound  may  prove  fatal.  The  whole  quantity  contained  in  the 
body  of  an  adult  is  estimated  at  about  one-thirteenth  of  its  Aveight — i.  e., 
about  twelve  pounds  (Halliburton's  Text-Book  of  Chem.  Physiol.,  ip.  220); 
of  this,  one-fourth  is  considered  to  be  distributed  in  the  heart,  lungs,  large 
arteries,  and  veins.  In  various  animals  the  proportion  of  the  weight  of 
the  blood  to  that  of  the  body  has  been  found  to  vary  considerably  and 
probably  this  holds  good  for  man  also,  within  certain  limits.  According 
to  Watson,  the  loss  of  from  five  to  eight  pounds  is  sufficient  to  prove  fatal 
to  adults.  But  while  this  may  be  near  the  truth,  many  persons  Avill  die 
from  a  much  smaller  quantity;  the  rapidity  with  which  the  effusion  takes 
place  having  a  considerable  influence,  as  well  as  the  age,  sex,  and  bodily 
condition  of  the  wounded  person.  It  has  been  found  by  experiment  that 
a  dog  cannot  bear  the  loss  of  more  blood  than  is  equivalent  to  one-twelfth 
part  of  the  weight  of  its  body. 

Internal  Hemorrhage. — Hemorrhage  may  prove  fatal,  although  the 
blood  does  not  visibly  escape  from  the  body.  In  incised  wounds,  the 
flow  externally  is  commonly  abundant;  but  in  contused,  punctured,  and 
gunshot  wounds  the  effusion  may  take  place  internally,  and  rapidly  cause 
death.  Tn  severe  contusions,  or  contused  wounds,  involving  highly  vascu- 
lar parts,  the  effusion  may  go  on  to  an  extent  to  prove  fatal,  either  in  the 
cavities  of  the  body  or  throughout  the  cellular  membrane  and  parts  adja- 
cent; several  pounds  of  blood  may  thus  be  slowly  or  rapidly  effused.  The 
most  fatal  internal  hemorrhages  are  those  which  follow  ruptures  of  the 


288       DEATH  FROM  MECHANICAL  INJURY SHOCK. 

organs  from  violence  or  disease.  Ruptures  of  the  heart,  lungs,  liver,  and 
kidneys  have  thus  caused  death.  In  Nov.  1864,  a  man  who  had  been 
run  over  was  brought  to  Guy's  Hospital.  He  complained  of  pain  in  the 
back,  but  there  were  no  symptoms  of  severe  injury,  and  no  marks  of  vio- 
lence were  seen  on  the  skin  of  the  back.  He  left  the  hospital,  and  walked 
with  some  assistance  to  his  home.  A  few  hours  afterwards  he  was  found 
dead  in  bed.  On  inspection  there  was  a  large  c^uantit}'  ul  blood  effused 
in  the  abdomen.  This  had  proceeded  from  one  kidney,  which  had  been 
ruptured  transversely  through  its  whole  substance.  In  these  cases  the 
bleeding  is  not  necessarily  immediate;  but  slight  muscular  exertion  may 
increase  it  and  accelerate  death.  In  death  from  severe  flagellation,  blood 
may  be  etfused  in  large  quantity  beneath  the  skin  and  among  the  muscles: 
this  effusion  will  operate  as  fatalh'  as  if  it  had  flowed  from  an  open  wound. 
The  means  of  ascertaining  whether  a  person  has  died  from  bleeding  by 
an  open  wound  are  the.se  :  IJnless  the  wound  is  situated  in  a  vascular  part, 
we  shall  fiud  the  vessel  or  vessels  from  which  the  blood  has  issued,  divided; 
the  neighboring  vessels  empty,  and  the  body  more  or  less  pallid ;  although 
this  last  condition  is,  of  course,  liable  to  be  met  with  in  certain  cases  of 
disease,  as  also  under  copious  venesection — points  easily  determined  by 
an  examination..  The  blood  will  commonly  be  found  more  or  less  clotted 
or  coagulated  on  those  surfaces  on  which  it  has  fallen.  If,  with  these 
signs,  there  is  an  absence  of  disease  likely  to  prove  rapidly  fatal,  and  no 
other  probable  cause  of  death  is  apparent,  this  may  be  fairly  referred  to 
loss  of  blood.  This  opinion  may,  however,  be  materially  modified  in 
reference  to  open  wounds,  by  the  fact  of  the  body,  not  being  seen  on  the 
spot  where  the  injury  was  actually  inflicted,  by  the  wound  having  been 
sponged,  the  blood  removed  by  washing,  and  all  traces  of  bleeding  de- 
stroyed. Under  these  circumstances,  the  case  must  in  a  great  measure  be 
made  out  by  presumptive  proof;  and  here  a  medical  witness  may  have 
the  duty  thrown  upon  him  of  examining  articles  of  dress,  furniture,  or 
weapons,  for  marks  or  stains  of  blood.  It  must  not  be  supposed  that  all 
the  blood  met  with  round  a  wounded  dead  body,  or  in  a  cavity  of  the 
bod}^,  was  actually  effused  during  life.  As  soon  as  the  heart's  action 
ceases,  the  arteries  pour  out  no  more;  but  the  blood,  so  long  as  it  remains 
liquid,  i.  e.,  from  four  to  eight  or  ten  hours  after  death,  and  the  warmth  of 
the  body  is  retained,  continues  to  drain  from  the  divided  veins  and  sm.allcr 
vessels.  The  quantity  thus  lost,  however,  is  not  considerable,  unless  the 
veins  implicated  are  large,  or  the  part  is  highly  vascular,  i.  e.,  full  of  veins 
or  small  vessels. 

2.  Death  from  Great  Ilechanical  Injury  done  to  a  Vital  Organ. — We 
have  instances  of  this  becoming  a  direct  cause  of  death  in  the  crushing  of 
the  heart,  lungs  or  brain,  by  any  heavy  body  passing  over  or  falling  on 
the  cavities,  as  in  railway-  accidents.  The  severe  mechanical  injury  is 
sometimes  accompanied  by  a  considerable  effusion  of  blood,  so  that  the 
person  really  dies  from  hemorrhage  but  in  other  instances  the  quantity 
of  blood  lost  is  inconsiderable,  and  the  fatal  effects  may  be  referred  to 
shock  to  the  nervous  system.  Sometimes  a  slight  amount  of  violence 
ma}'  prove  suddenly  fatal.  These  are,  however,  to  be  regarded  as  excep- 
tional instances. 

3.  Death  from  Shock. — This  is  sometimes  a  direct  cause  of  death  under 
the  infliction  of  external  violence;  and  in  this  case  life  is  destroyed  with- 
out the  injury  being  to  all  appearance  sufficient  to  account  for  so  speedily 
fatal  a  result.  On  several  occasions  jiersons  have  died  in  railway  colli- 
sions from  no  physical  injury,  but  pui'ely  from  shock  to  the  system,  In 
a  collision,  which  took  place  in  1873  at  the  Durham  station,  a  Mrs.  Coble 


DEATH    FROM    SHOCK.  289 

was  among'  the  dead.  On  a  post-mortem  examination  there  was  no  ap- 
pearance of  external  or  internal  violence.  Savory  has  suggested  that 
death  from  shock  is  nothing  more  than  death  from  temporary  exhaustion 
of  nerve-force,  the  result  of  a  violent,  sudden,  and  excessive  expenditure 
of  it.  (Lect.  on  Life  and  Death,  p.  171.)  Whatever  theory  may  be 
adopted  to  explain  it,  there  is  no  doubt  that  a  ])erson  may  die  from  what 
is  termed  shock,  without  any  marks  of  severe  injury  being  discovered  on 
his  body  after  death.  We  have  examples  of  this  mode  of  death  in  acci- 
dents from  lightning,  or  from  severe  burns  or  scalds,  in  which  the  local 
injury  is  often  far  from  sufficient  to  explain  the  rapidly-fatal  consequences. 
As  instances  of  this  form  of  death  from  violence,  may  be  also  cited  those 
cases  in  which  a  person  has  been  suddenly  killed  by  a  blow  upon  the  upper, 
part  of  the  abdomen  or  on  the  pit  of  the  stomach,  an  accident  which  is 
supposed  to  operate  by  producing  a  fatal  impression  on  the  nerves  and 
nerve-ganglia  of  the  cardiac  plexus.  Whether  this  be  or  be  not  the  true 
explanation,  it  is  admitted  by  experienced  surgeons  that  a  person  may  die 
from  so  simple  a  cause  without  any  mark  of  a  bruise  externally,  or  physi- 
cal injury  internally  to  account  for  death.  On  the  skin  there  may  be 
some  abrasion  or  slight  discoloration  ;  but,  as  it  has  been  elsewhere  stated, 
these  are  neither  constant  nor  necessary  accompaniments  of  a  blow. 
Concussion  of  the  brain,  unattended  by  visible  mechanical  injury,  fur- 
nishes another  example  of  this  kind  of  death.  A  man  receives  a  severe 
blow  on  the  head;  he  falls  dead  on  the  spot,  or  becomes  senseless  and  dies 
in  a  few  hours.  On  an  inspection,  there  may  be  merely  the  mark  of  a 
bruise  on  the  scalp ;  in  the  brain  there  may  be  no  rupture  of  vessels  or 
laceration  of  substance,  and  all  the  other  organs  of  the  body  may  be  found 
healthy.  In  railway  accidents  persons  have  died  under  somewhat  similar 
circumstances.  There  has  been  no  physical  indication  of  a  mortal  injury, 
and  no  cause  apparent  to  account  for  death.  This  can  be  referred  only  to 
the  shock  or  violent  impression  which  the  nervous  system  has  sustained 
from  the  blow  or  violence — an  impression  which  the  vital  powers  Avere 
wholly  unable  to  counteract  or  resist.  A  medical  witness  must  give  his 
evidence  with  caution  in  such  cases;  since  it  is  the  custom  to  rely  in  the 
defence  upon  the  absence  of  any  visible  mortal  wound  or  physical  injury 
to  account  for  death,  as  a  proof  that  no  injury  was  done — a  principle  which, 
if  once  unrestrictedly  admitted,  would  leave  a  larger  number  of  deaths, 
undoubtely  occurring  from  violence,  wholly  unexplained. 

There  is  another  form  of  shock  which  is  of  some  importance  in  medical 
jurisprudence.  A  person  may  have  received  mnnj/  injuries,  as  by  blows 
or  stripes,  not  one  of  which,  taken  alone,  could,  in  medical  language,  be 
termed  mortal ;  and  yet  he  may  die  directly  from  the  effects  of  the  vio- 
lence, either  on  the  spot,  or  very  soon  afterwards.  In  the  absence  of  any 
large  effusion  of  blood  beneath  the  skin,  death  is  commonly  referred  to 
exhaustion  ;  but  this  is  only  another  mode  of  expression  ;  the  exhaustion 
is  itself  dependent  on  a  fatal  influence  or  impression  produced  on  the  ner- 
vous system.  A  prize-fighter,  after  having  sustained  during  many  rounds 
numerous  blows  on  the  body,  may  either  at  or  after  the  fight  sink  and  die 
exhausted.  His  body  may  present  marks  of  bruises,  or  even  lacerated 
wounds,  but  there  may  be  no  internal  changes  to  account  for  death.  In 
common  language,  there  is  not  a  single  injury  which  can  be  termed  mortal ; 
and  yet,  supposing  him  to  have  had  good  health  previously  to  the  fight, 
and  all  marks  of  disease  indicative  of  sudden  death  to  be  absent,  it  is 
impossible  not  to  refer  his  death  to  the  direct  effect  of  the  violence.  It  is 
a  well-ascertained  medical  fact,  that  a  number  of  injuries,  each  compara- 
tively slight,  are  as  capable  of  operating  fatally  as  any  single  wound 
19 


290  MORTALITY    OF    WOUNDS. 

whereby  some  bloodvessel  or  organ  important  to  life  is  directly  affected. 
Age,  sex,  constitution,  and  a  previous  state  of  health  or  disease,  may 
accelerate  or  retard  the  fatal  consequences.  In  Reg  v.  Slane  and  others 
(Durham  Wint.  Ass.,  1872),  it  was  proved  that  the  deceased  had  sustained 
severe  injuries  to  the  abdomen  by  iiieks  and  other  violence,  but  there  were 
no  marks  of  bruises.  Ou  a  post-mortem  examination,  all  the  organs  were 
healthly.  JS'evertheless,  death  took  place  twenty  minutes  after  the  mal- 
treatment. Death  was  attributed  to  shock,  and  the  prisoners  were  con- 
victed of  murder.  A  case  of  manslaughter  involving  this  question  was 
tried  (Reg  v.  McGowan  and  others,  Leicester  Ass.,  Nov.  18T7),  where 
three  menwere  charged  with  the  murder  of  the  deceased.  It  was  proved 
that  he  had  been  maltreated  by  kicking,  and  by  blows  inflicted  with  heavy 
stones.  He  died  in  four  days,  obviously  from  the  effects  of  the  violence. 
The  medical  evidence  showed  that  the  nasal  bones  were  much  fractured  as 
by  a  blow  from  a  heav}^  stone,  and  that  there  were  fractures  of  one  clavicle 
and  of  several  ribs.  The  witness  assigned  the  cause  of  death  to  shock  to 
the  system,  from  the  number  of  injuries  received  and  the  inflammation  set 
up  by  them.  The  whole  of  the  injuries  in  his  opinion  combined  to  cause 
death.     The  prisoners  were  convicted. 

From  these  considerations,  it  is  obviously  unreasonable  to  expect  that 
in  every  case  of  death  from  violence  or  maltreatment  there  must  be  some 
specific  and  visible  mortal  iiijury  to  account  for  this  event.  When  the 
circumstances  accompanying  death  are  unknown,  a  medical  opinion  should 
certainly  be  expressed  with  caution;  but  if  we  are  informed  that  the 
deceased  was  in  ordinary  health  and  vigor  previous  to  the  infliction  of  the 
violence,  and  there  is  no  morbid  cause  to  account  for  his  sudden  illness 
and  death,  there  is  no  reason  why  we  should  hesitate  in  referring  death  to 
the  eff"ects  of  a  number  of  injuries.  Among  non-professional  persons  an 
unfounded  prejudice  exists  that  no  person  can  die  from  violence  unless 
there  is  some  distinctly  mortal  wound  actually  inflicted  on  the  body.  B}^ 
this  we  are  to  understand  a  visible  mechanical  injury  to  some  organ  or 
bloodvessel  important  to  life;  but  this  is  obviously  an  erroneous  notion, 
since  death  may  take  place  from  the  disturbance  of  the  functions  of  an 
organ  important  to  life,  without  this  being  necessarily  accompanied  by  a 
perceptible  alteration  of  structure.  The  prevalence  of  this  popular  error 
often  leads  to  a  severe  cross-examination  of  medical  witnesses.  Among 
the  questions  put,  we  sometimes  find  the  following  :  Would  you  have  said, 
from  the  wounds  or  bruises  c/one,  that  they  were  likely  to  have  occasioned 
death  ?  Now,  in  answer  to  this  it  may  be  observed  that  we  cannot  always 
judge  of  the  probability  of  death  ensuing,  from  the  appearance  of  external 
violence  alone.  Because  the  appearances  were  slight,  it  would  be  wrong 
to  infer  that  they  were  not  sufficient  to  cause  death  by  shock.  Then  it 
may  be  inquired,  Were  the  wounds  or  bruises  mortal?  In  the  vulgar 
sense  of  the  word,  i.e.  by  producing  great  loss  of  blood,  or  a  destruction 
of  parts,  they  might  not  be  so;  but  in  a  medical  view  they  may  have 
acted  mortally  by  producing  a  shock  to  the  nervous  system.  Again,  it 
may  be  inquired.  Which  of  the  several  wounds  or  bruises  found  on  the 
body  of  the  deceased  was  mortal?  The  answer  to  this  question  may  be, 
not  one  individually,  but  all  contributed  to  occasion  death  by  syncope  or 
exhaustion.  It  must  be  remembered  that  in  cases  in  which  a  person  has 
sustained  a  number  of  injuries,  the  loss  of  a  much  smaller  quantity  of 
blood  than  in  other  instances  will  suffice  to  destroy  life. 

When  there  are  several  wounds,  it  is  difficult  to  decide  on  their  relative 
degree  of  mortality,  and  on  the  share  which  each  may  have  had  in  causing 
death.     By  a  wound  being  of  itself  mor^a^,  we  are  to  understand  that  it  is 


MORTALITY    OF    WOUNDS.  291 

capable  of  causing-  death  directly  or  indirectly,  in  spite  of  the  best  medical 
assistance.  It  is  presumed  that  the  body  is  healthy,  and  that  no  cause. 
has  intervened  to  bring  about,  or  even  accelerate,  a  fatal  result.  The  cir- 
cumstance of  a  person  laboring  under  disease  when  wounded  in  a  vital 
part,  will  not.  of  course,  throw  any  doubt  upon  the  fact  of  such  a  wound 
being  necessarily  mortal,  and  of  its  having  caused  death.  If  there  should 
be  more  wounds  than  one,  it  is  easy  to  say,  from  the  nature  of  the  parts 
involved,  which  was  likely  to  have  led  to  a  fatal  result.  In  order  to  deter- 
mine, on  medical  grounds,  whether  a  wound  was  or  was  not  mortal,  we 
may  propose  to  ourselves  this  question — Would  the  deceased  have  been 
likely  to  die  at  the  same  time,  and  under  the  same  circumstances,  had  he 
not  received  the  wound  ?  There  can  obviously  be  no  general  rule  for 
determining  the  mortal  nature  of  wounds.  Each  case  must  be  judged  by 
the  circumstances  which  attend  it. 

In  some  Continental  States,  the  law  requires  that  a  medical  witness 
should  draw  a  distinction  between  a  wound  which  is  absolutely  and  one 
which  is  conditionally  mortal.  An  absolutely  mortal  wound  is  defined  to 
be  that  in  which,  the  best  medical  assistance  being  at  hand,  being  sent  for, 
or  actually  rendered,  the  fatal  event  could  not  be  averted.  Wounds  of 
the  heart,  aorta,  and  internal  carotid  arteries,  are  of  this  nature.  A  con- 
ditionally mortal  wound  is  one  in  which,  had  medical  assistance  been  at 
hand,  been  sent  for,  or  timely  rendered,  the  patient  would,  in  all  proba- 
bility, have  recovered.  Wounds  of  the  brachial,  radial,  and  ulnar  arteries 
may  be  taken  as  instances.  The  responsibility  of  an  assailant  is  made  to 
vary  according  to  the  class  of  injuries  to  which  the  wound  may  be  referred 
by  the  medical  witnesses  ;  and,  as  it  is  easy  to  suppose,  there  is  seldom  any 
agreement  on  this  subject.  Our  criminal  law  is  entirely  free  from  such 
subtleties.  The  effect  of  the  wound,  and  the  intent  with  which  it  was 
inflicted,  are  looked  to ;  its  anatomical  relations,  which  must  depend  on 
pure  accident,  are  never  interpreted  in  a  prisoner's  favor.  Some  extenua- 
tion may,  perhaps,  be  occasionally  admitted  when  a  wound  proves  mortal 
through  an  indirect  cause,  as  inflammation  or  fever,  and  medical  advice 
was  obtainable,  but  not  obtained  until  every  hope  of  recovery  had  disap- 
peared. It  appears,  however,  from  the  case  of  Reg.  v.  Thomas  and  others 
(Grloucester  Aut.  Ass.,  1841),  that  the  mere  neglect  to  call  in  medical 
assistance  is  not  allowed  in  law  to  be  a  mitigatory  circumstance  in  the 
event  of  death  ensuing.  The  deceased  died  from  the  effects  of  a  severe 
injury  to  the  head,  inflicted  by  the  prisoners,  but  had  had  no  medical  as- 
sistance. The  judge  said  it  was  possible  that  "if  he  had  had  medical 
advice,  he  might  not  have  died  ;  but  whoever  did  a  wrongful  act  must 
take  the  whole  consequences  of  it.  It  never  could  make  any  difference 
whether  the  party  injured  had  or  had  not  the  means  or  the  mind  to  apply 
for  medical  advice."  The  prisoners  were  convicted.  According  to  Lord 
Hale,  if  a  man  be  wounded,  and  the  wound,  though  not  in  itself  mortal, 
turn  to  a  gangrene  or  fever  for  want  of  proper  applications,  or  from 
neglect,  and  the  man  die  of  gangrene  or  fever,  this  is  homicide  in  the 
aggressor  ;  for  though  the  fever  or  gangrene  be  the  immediate  cause  of 
death,  yet  the  wound,  being  the  cause  of  the  gangrene  or  fever,  is  held 
the  cause  of  death.  These  nice  questions  relative  to  the  shades  of  re- 
sponsibility for  personal  injuries,  occasionally  arise  in  cases  in  which 
persons  have  been  wounded  at  sea  on  board  a  ship  in  which  there  was 
no  suro-eon. 


292  DEATH    FROM    LATENT    DISEASE. 


CHAPTER    XXIX. 

DEATH    OF    WOrXDED    PERSOXS    FROM    XATDRAL    CAUSES. DISTINCTION    BETWEEN    REAL    AND 

APPARENT    CAUSE. DEATH    FROM    AVOUNDS    OR    LATENT  DISEASE. ACCELERATING  CAUSE. 

DEATH    FROM    MOUNDS    AFTER    LONG  PERIODS. AVOIDABLE  CAUSES  OF  DEATH, NEGLECT. 

IMPRUDENCE. UNSKILFUL    TREATMENT. UNHEALTHY    STATE    OF    BODY. 

Death  of  Wounded  Persons  from  Natural  Causes. — It  is  by  no  means 
unusual  for  individuals  who  have  received  a  wound,  or  sustained  some 
personal  injury,  to  die  from  latent  natural  causes;  and  as,  in  the  minds  of 
non-professional  persons,  death  may  appear  to  be  a  direct  result  of  the 
injury,  the  case  can  only  be  cleared  up  by  the  assistance  of  a  medical 
practitioner.  Such  a  coincidence  has  been  witnessed  in  many  instances  of 
attempted  suicide.  A  man  has  inflicted  a  severe  wound  on  himself  while 
laboring  under  disease  ;  or  some  morbid  change  tending  to  destroy  life  has 
occurred  subsequently  to  the  infliction  of  a  wound,  and  death  has  fol- 
lowed. Without  a  careful  examination  of  the  body,  it  is  impossible  to 
refer  death  to  the  real  cause.  The  importance  of  an  accurate  discrimina- 
tion in  a  case  in  which  wounds  or  personal  injuries  have  been  caused  by 
another,  must  be  obvious  on  the  least  reflection.  A  hasty  opinion  may 
involve  the  accused  in  a  charge  of  manslaughter  ;  and  although  counsel 
might  be  able  to  show  on  the  trial  that  death  was  probably  attributable, 
not  to  the  wound,  but  to  the  co-existing  disease,  yet  it  must  be  remem- 
bered that  the  evidence  of  a  surgeon  before  a  coroner  or  magistrate,  in  re- 
mote parts  of  this  country,  may  be  the  means  of  causing  the  person 
charged  to  be  imprisoned  for  some  months  previously  to  the  trial.  This 
is  in  itself  a  punishment,  independently  of  the  loss  of  character  to  which 
he  must  be  in  the  mean  time  exposed. 

Death  from  Wounds  or  Latent  Disease. — A  natural  cause  of  death  may 
be  lurking  within  the  body  at  the  time  that  a  wound  is  criminally  inflicted, 
and  a  close  attention  to  the  symptoms  preceding  and  the  appearances  after 
death,  can  alone  enable  a  surgeon  to  distinguish  the  real  cause.  A  man 
may  be  severely  wounded,  and  yet  death  may  take  place  from  rupture  of 
the' heart,  the  bursting  of  an  aneurism,  from  apoplexy,  phthisis,  or  other 
morbid  causes  which  it  is  here  unnecessary  to  specify.  (Cormack's  Ed. 
Jour.,  1846,  p.  343.)  If  death  can  be  clearly  traced  by  an  experienced 
surgeon  to  any  of  these  diseases,  the  assailant  cannot  be  charged  with 
manslaughter;  for  the  medical  witness  may  give  his  opinion  that  death 
would  have  taken  place  about  the  same  time  and  under  the  same  circum- 
stances whether  the  wound  had  been  inflicted  or  not. 

On  these  occasions  one  of  the  following  questions  may  arise  :  Was  the 
death  of  the  person  accelerated  by  the  wound;  or  was  the  disease  under 
which  he  was  laboring  so  aggravated  by  the  wound  as  to  produce  a  more 
speedily  fatal  termination  ?  The  answer  to  either  of  these  questions  must 
depend"^  on  the  circumstances  of  each  case,  and  the  witness's  ability  to 
draw  a  proper  conclusion  from  these  circumstances.  The  maliciously 
accelerating  of  the  death  of  another,  already  laboring  under  disease,  is 
criminal ;  for  in  a  legal  sense  that  which  accelerates,  causes.  In  Reg.  v. 
Timms  (Oxford  Lent  Ass.,  18T0),  it  was  proved  that  the  prisoner  had 
struck  the  deceased  some  blows  on  the  head  with  a  hatchet.     In  twelve 


DEATH    FROM    LATENT    DISEASE.  293 

days,  under  treatment,  he  had  partly  recovered  from  the  effects;  but  in 
six  weeks  afterwards  he  was  seized  with  inflammation  of  the  brain,  with 
convulsious,  and  died.  On  inspection,  disease  of  the  kidneys  was  found, 
of  which  there  had  been  no  S3'mptoms.  Death,  was  referred  to  this  disease 
and  to  inflammation  of  the  brain  as  the  result  of  the  blows.  The  judge 
directed  the  jury  that  if  they  believed  the  blows  conduced  in  part  to  the 
death  of  the  deceased  it  was  manslaughter,  notwithstanding  that  other 
causes  had  combined  with  the  blows  to  account,  for  death.  The  prisoner 
was  convicted.  But  there  may  be  no  connection  between  the  violence 
and  the  disease  causing  death.  In  this  case  a  charge  of  murder  falls  to 
the  ground.  A  man  struck  his  father  a  blow  upon  the  back  of  the  head 
with  a  hammer,  inflicting  a  scalp-wound,  with  no  signs  of  injury  to  the 
brain  itself  The  avowed  object  was  to  kill  the  father.  As  the  injury 
was  apparently  not  serious,  the  assailant  was  summarily  sentenced  by  a 
magistrate  to  two  months'  imprisonment,  a  punishment  which  the  father — 
a  drunkard — thought  inadequate.  Hereupon  the  father  became  greatly 
e.\'cited — hemiplegic  six  days  after  the  infliction  of  the  wound — and  died 
three  days  later.  On  post-mortem  exaiiiination  the  occipital  bone  was 
found  indented  at  the  seat  of  the  blow,  and  there  was  a  depressed  fracture 
of  the  inner  table  of  the  skull  at  the  point  corresponding  to  the  external 
injury.  There  was  no  effusion  of  blood  on  the  surface  of  the  brain  in  the 
neighborhood  of  the  injury,  but  a  large  clot  was  found  in  the  lateral  ven- 
tricle. Under  these  circumstances  two  medical  men  very  properly  gave  it 
as  their  opinion  that  the  immediate  cause  of  death  was  apoplexy,  the  clot 
being  in  the  usual  position  in  such  cases,  and  that  there  was  nothing  in 
the  liistory  of  the  case,  or  in  the  appearances  after  death,  that  would 
justify  them  in  stating  that  the  effusion  of  blood,  or,  in  other  words,  the 
man's  death,  was  caused  by  the  injui'y  ;  and,  in  spite  of  the  I'emarks  of  the 
judge,  the  prisoner  Avas  acquitted.  (Reg.  v.  Saxon,  Lancashire  Sum. 
Ass,,  1884.  Med.  Chron,,  vol.  i.  p.  118.)  In  Reg.  v.  Thompson  (Liver- 
pool Sum.  Ass.,  187B),  involving  a  charge  of  murder,  it  was  proved  that 
the  prisoner  had  stabbed  his  wife  in  the  cheek,  producing  a  severe  but  not 
a  mortal  wound.  This  was  on  April  1st.  The  deceased  was  taken  to  an 
infirmary,  and  was  there  delivered  of  a  child  on  the  3d.  She  was  at- 
tacked with  puerperal  fever  and  died  on  the  12th  It  was  properly  stated 
by  the  medical  witness  that  there  was  no  necessary  connection  between 
the  wound  and  the  fever.  The  prisoner  was  acquitted  of  the  charge  of 
murder,  and  his  life  was  saved.  He  was  found  guilty  of  wounding  with 
intent  to  murder  In  another  case,  Reg  v.  Hodgson  (Leeds  Sum.  Ass., 
J 876),  the  prisoner  was  charged  with  the  manslaughter  of  his  wife  by 
striking  her  with  a  belt.  A  short  time  after  the  blow  she  fell  back  and 
died  suddenly.  The  proximate  cau.'^e  of  death  was  proved  to  be  heart- 
disease,  the  violence  not  being  sufficient  to  account  for  it  The  prisoner 
was  acquitted  In  1873  an  inquest  was  held  at  Haslar  Hospital  on  the 
body  of  one  Rollings  The  deceased  was  struck  by  a  seaman  and  fell  with 
his  right  arm  under  him,  breaking  the  two  bones  of  his  forearm  just  above 
the  wrist.  He  died  rather  suddenly  soon  after  the  violence,  and  as  this 
did  not  seem  adequate  to  account  for  death,  a  careful  inspection  was  made 
and  it  was  then  found  that  death  had  resulted  from  disease  of  the  heart. 

Lord  Hale,  in  remarking  upon  the  necessity  of  proving  that  the  act  of 
a  prisoner  caused  the  death  of  a  person,  says,  "  It  is  necessary  that  the 
death  should  have  been  occasioned  by  some  corporeal  injury  done  to  the 
party  by  force,  or  by  poison,  or  by  some  mechanical  means  which  occa- 
sioned death  ;  for  although  a  person  may,  in  for  o  coriHcientise,  be  as  guilty 
of  murder  by  working  on  the  passions  or  fears  of  another,  and  as  certainly 


294  WHICH    OF    TWO    WOUNDS    CAUSED    DEATH? 

occasion  death  bv  such  means,  as  if  he  had  used  a  sword  or  pistol  for  the 
purpose,  he  is  not  the  object  of  temporal  punishment."  Several  acquittals 
have  taken  place  of  late  years  in  cases  in  which  the  deaths  of  persons  have 
been  occasioned  by  terror,  or  dread  of  impending'  danger  produced  by  acts 
of  violence  on  the  part  of  the  prisoners,  not,  hov^^ever,  giving  rise  to  bodily 
injury  in  the  deceased.  Under  14  and  15  Yict.,  c.  100,  the  necessity  for 
tracing  death  to  some  corporeal  injur}'  appears  to  be  practically  abolished. 
According  to  sec.  4,  in  any  future  indictment  for  murder  or  manslaughter 
it  shall  not  be  necessary  to  set  forth  the  manner  or  the  means  by  which 
the  death  of  the  deceased  was  caused.  This  question  arose  in  Keg.  v. 
Heany  (Gloucester  Lent  Ass.,  1875).  The  prisoner  was  charged  with 
the  manslaughter  of  his  wife.  She  was  suffering  from  cancerous  disease. 
In  the  course  of  an  altercation  the  prisoner  held  up  a  knife  in  a  threaten- 
ing manner,  but  without  touching  her.  This  produced  a  shock,  and  she 
died  two  days  after  from  fright.  The  prisoner  was  acquitted,  as  there 
was  no  distinct  proof  of  the  acceleration  of  death  by  this  act.  He  was 
convicted  of  an  assault. 

Which  of  Two  Wounds  caused  Death'? — A  man  may  receive  hoo 
wounds  on  provocation,  at  different  times  and  from  different  persons, 
and  die  after  receiving  the  second :  in  such  a  case,  the  course  of  justice 
may  require  that  a  medical  witness  should  state  which  wound  was  the 
cause  of  death.  A  man  receives  during  a  quarrel  a  gunshot-wound  in  the 
shoulder.  He  is  going  on  well,  with  a  prospect  of  recovery,  when  in 
another  quarrel  he  receives  a  severe  penetrating  wound  in  the  chest  or 
abdomen  from  another  person^  and,  after  lingering  under  the  effects  of 
these  wounds,  he  dies.  If  the  gunshot-wound  was  clearly  shown  to  have 
been  the  cause  of  death,  the  second  prisoner  could  not  be  convicted  of 
manslaughter ;  or  if  the  stab  was  evidently  the  cause  of  death,  the  first 
prisoner  would  be  acquitted  on  a  similar  charge.  It  might  be  possible  for 
a  surgeon  to  decide  the  question  summarily,  when,  for  instance,  death 
speedily  followed  the  second  wound  ;  and,  on  inspection  of  the  body,  the 
heart  or  a  large  vessel  is  discovered  to  have  been  penetrated  ;  or,  on  the 
other  hand,  extensive  sloughing,  sufficient  to  account  for  death,  might 
take  place  from  the  gunshot-wound,  and,  on  inspection,  the  stab  might  be 
found  to  be  of  a  slight  nature,  not  involving  any  vital  parts.  In  either  of 
these  cases,  all  would  depend  upon  the  knowledge,  skill,  and  judgment  of 
the  medical  practitioner  ;  his  evidence  would  be  so  important  that  no 
correct  decision  could  ha  arrived  at  without  it ;  he  would  be,  in  fact,  called 
upon  substantially  to  distiniruish  the  guilty  from  the  innocent.  In  Reg.  v. 
Foreman  (C.  C.  C.,  Feb.  1873),  this  question  arose.  The  prisoner,  it  was 
proved,  had  struck  the  deceased  some  severe  blows  on  the  head.  A  fort- 
night afterwards  the  deceased,  who  had  partially  recovered,  had  a  fight 
with  another  man,  during  which  he  again  received  severe  blows  on  his 
head.  In  another  fortnight  he  had  paralysis  of  the  left  side,  and  died  in 
a  hospital  a  ^c\\  days  afterward.  On  inspection  a  large  abscess  in  the 
brain  was  found,  which  Avas  the  cause  of  the  symptoms  and  death.  The 
question  was  whether  this  abscess  had  arisen  from  the  blows  given  by  the 
])risoner,  or  from  the  violence  su.stained  a  fortnight  afterward.  On  this 
])oint  there  was  no  satisfactory  medical  evidence,  and  as  the  deceased  had 
had  no  serious  symptoms  for  a  fortnight  after  the  assault  by  the  prisoner — 
in  fact  not  until  after  the  second  fight — the  jury  acquitted  him. 

On  some  occasions  death  may  appear  to  be  equally  a  consequence  of 
either  or  both  of  the  wounds;  in  which  case  probably  both  parties  would 
be  liable  to  a  charge  of  manslaughter.     (See  Ann.  d'Hyg.,  1835,  t.   2,  p 
432.)     The  second  wound,  which  is  here  supposed  to  have  been  the  act  of 


DEATH    FROM    SLIGHT    PERSONAL    INJURIES.  295 

another,  may  be  inflicted  by  a  wounded  person  on  himself,  in  an  attempt 
at  suicide,  or  it  may  have  an  accidental  origin.  The  witness  would  then 
have  to  determine  whether  the  wounded  person  died  from  the  wound 
inflicted  by  himself  or  from  that  which  he  had  previously  received.  In  the 
Walworth  murder,  which  occurred  in  1873,  a  grocer's  assistant  pursued  a 
man  who  had  stolen  a  parcel  from  a  cart,  and  the  thief  took  refuge  in  a  coal- 
shed,  followed  by  the  assistant.  The  latter  was  stabbed  by  the  former  twice 
in  the  abdomen  on  the  right  and  left  of  the  navel.  The  larger  wound  on 
the  left  suppurated,  whilst  the  smaller  wound  on  the  right  healed  at  once. 
The  man  died  of  peritonitis.  On  post-mortem  examination,  the  editor 
found  that  the  suppurating  wound,  which  had  been  supposed  to  be  the 
fatal  one,  did  not  involve  a  vital  part ;  but  that  the  small  wound  on  the 
right,  made  by  a  knife,  passed  upwards  and  backwards,  transfixing  the 
liver,  and  puncturing  the  gall-bladder.  The  peritonitis  was  conseciuent  on- 
the  escape  of  bile  into  the  abdominal  cavity.  There  was  reason  to  believe 
that  the  non-fatal  stab  was  first  inflicted  purposely,  and  the  second  and 
fatal  wound  might  possibly  have  been  caused  by  the  deceased  rushing 
upon  the  knife,  held  as  it  wei'e  in  self-defence  by  the  thief,  who  has  never 
been  discovered.  It  is  not  difficult  to  conceive  what  complications  might 
arise  in  a  trial  for  murder  under  such  circumstances. 

It  may  happen  that  the  wounded  person  has  taken  poison,  and  has  actu- 
ally died  from  its  effects,  and  not  from  the  injuries  or  maltreatment. 
Again,  a  wounded  person  may  have  been  the  subject  of  subsequent  ill- 
treatment,  and  the  question  will  arise — to  which  of  the  two  causes  his  death 
was  really  due.  It  is  to  be  observed  of  these  cases  that  the  supervening 
disease,  the  poison,  or  the  subsequent  ill-treatment,  should  be  of  such  a 
nature  as  to  account  for  sudden  or  rapid  death;  since  it  would  be  no 
answer  to  a  charge  of  death  from  violence  to  say  that  there  were  marks 
of  chronic  disease  in  the  body,  unless  it  was  of  such  a  nature  as  to  account 
for  the  sadden  destruction  of  life  under  the  symptoms  which  actually 
preceded  death.  In  the  medical  jurisprudence  of  wounds,  there  is  proba- 
ably  no  question  which  so  frequently  presents  itself  as  this:  it  is  admitted 
that  the  violence  was  inflicted,  but  it  is  asserted  that  death  was  due  to 
some  other  cause,  and  the  onus  of  proof  lies  on  the  medical  evidence. 
Among  numerous  cases  which  occurred  in  England  during  a  period  of 
twenty  years,  the  author  found  that  the  latent  causes  of  death  as  regis- 
tered in  wounded  persons  have  been  chiefly  inflammation  of  the  thoracic 
or  abdominal  viscera,  apoplexy,  diseases  of  the  heart  and  large  blood- 
vessels, phthisis,  ruptures  of  the  stomach  and  bowels  from  disease,  internal 
strangulation,  and  the  rupture  of  deep-seated  abscesses.  In  some  of 
these  cases  the  person  was  in  a  good  state  of  health  up  to  the  time  of  the 
violence,  and  in  others  there  was  merely  a  slight  indisposition.  The 
history  was  nearly  the  same  in  all :  it  was  only  by  careful  conduct  on  the 
part  of  the  medical  witnesses  that  the  true  cause  of  death  was  ascertained. 
It  is  obvious  that  questions  of  malapraxis  aud  life  insurance,  giving  rise 
to  civil  actions,  may  have  a  close  relation  to  this  subject. 

Death  following  Slight  Personal  Injuries. — An  imputation  has  occa- 
sionally been  thrown  on  the  master  of  a  school  when  a  boy  has  died  soon 
after  he  has  been  punished  in  an  ordinary  way,  and  when  there  has  been 
no  suggestion  that  an  undue  amount  of  violence  was  used.  In  such  cases 
there  has  been  commonly  some  unhealthy  state  of  the  body  to  explain  the 
fatal  result.  When  the  disease  that  gives  rise  to  doubt  is  seated  in  a  part 
remote  from  that  which  sustained  the  violence,  all  that  is  required  is  that 
the  examination  of  the  body  should  be  conducted  with  ordinary  care.  If 
the  disease  should  happen  to  be  in  the  part  injured  (the  head  or  chest), 


290  DEATH    FROM    WOUNDS    AFTER    LONG     PERIODS. 

the  case  is  more  perplexing.  The  difficulty  can  then  be  removed  only  by 
attentively  considering  the  usual  consequences  of  such  injuries.  The  vio- 
lence may  have  been  too  slight  to  account  for  the  diseased  appearance ; 
and  the  disease  itself,  although  situated  in  the  part  injured,  may  be  re- 
garded as  an  unusual  consequence  of  such  an  injury.  On  the  other  hand, 
the  presence  of  chronic  disease  will  form  no  exculpation  of  acts  of  violenee 
of  this  nature.  In  Reg.  v.  Hopley  (Lewes  Aut.  Ass.,  1860),  there  was 
chronic  disease  of  long  standing  in  the  brain  of  the  diseased  boy,  but  it 
was  proved  that  he  was  quite  well  and  suffered  from  no  unusual  symp- 
toms up  to  the  time  that  a  violent  flogging  was  inflicted,  and  that  this 
was  followed  by  death  in  less  than  three  hours  from  the  commencement 
of  the  violence.  It  was  not  here  a  question  of  acceleration,  for  the  de- 
ceased might  have  lived  for  years  in  spite  of  tbe  existence  of  this  chronic 
disease.  In  some  cases  slight  blows  have  been  followed  by  fatal  conse- 
quences, even  when  no  disease  existed  to  account  for  the  result.  Annan 
describes  a  case  in  which  a  healthy  girl  of  four  received  a  slight  blow  on 
the  shin,  about  three  inches  below  the  knee,  from  the  shaft  of  a  wheel- 
barrow. There  was  pain,  but  no  external  mark  of  violence.  The  injury 
was  considered  to  be  so  slight  as  to  require  no  special  treatment.  On 
the  following  day  there  was  increased  pain.  Severe  constitutional  symp- 
toms set  in,  and  the  child  died  on  the  fourth  day.  (Med.  Times,  1854,  ii. 
p.  238.) 

Death  fi'om  Wounds  after  Long  Periods. — Certain  kinds  of  injuries  are 
not  immediately  followed  by  serious  consequences ;  but  a  wounded  person 
may  die  after  a  longer  or  shorter  period  of  time,  and  his  death  may  be  as 
nmch  a  consequence  of  the  injury  as  if  it  had  taken  place  on  the  spot. 
The  aggressor,  however,  is  just  as  responsible  as  if  the  deceased  had  been 
directly  killed  by  his  violence,  provided  the  fatal  result  can  be  traced  to 
the  usual  and  probable  consequences  of  the  injury.  Wounds  of  the  head 
are  especially  liable  to  cause  death  insidiously — the  wounded  person  may 
in  the  first  instance  I'ecover — he  may  appear  to  be  going  on  well,  when, 
without  any  obvious  cause,  he  suddenly  dies.  It  is  scarcely  necessary  to 
observe  that,  in  general,  an  examination  of  the  body  will  suffice  to  deter- 
mine whether  death  is  to  be  ascribed  to  the  wound  or  not.  In  severe 
injuries  affecting  the  spinal  marrow,  death  is  not  an  immediate  conse- 
quence, unless  that  part  of  the  organ  which  is  above  the  origin  of  the. 
phrenic  nerves  (supplying  the  diaphragm)  is  wounded.  Injuries  affecting 
the  lower  portion  of  the  spinal  column  do  not  commonly  prove  fatal  until 
after  some  days  or  weeks ;  but  the  symptoms  manifested  by  the  patient 
during  life,  as  well  as  the  appearances  observed  in  the  body  after  death, 
will  sufficiently  connect  the  injury  with  that  event.  Death  may  follow  a 
Avound,  and  be  a  consequence  of  that  wound  at  almost  any  period  after  its 
infliction.  It  is  necessary,  however,  in  order  to  maintain  a  charge  of 
homicide,  that  death  should  be  strictly  and  clearly  traceable  to  the  injury, 
and  not  be  dependent  on  any  other  cause.  A  doubt  on  this  point  must, 
of  course,  lead  to  an  acquittal  of  the  accused. 

Many  cases  might  be  quoted  in  illustration  of  the  length  of  time  which 
may  elapse  before  death  takes  place  from  certain  kinds  of  injuries,  the 
injured  person  having  ultimately  fallen  a  victim  to  their  indirect  conse- 
quences. A  case  is  related  by  Astley  Cooper,  of  a  gentleman  who  died 
from  the  effects  of  an  injury  to  the  head  received  about  two  years  pre- 
viously. The  connection  of  death  with  the  wound  was  clearly  made  out 
l)y  the  continuance  of  the  symptoms  of  cerebral  disturbance  during  the  long 
period  which  he  survived.  Another  case  is  mentioned  by  Hoffbauer,  in 
which  a  person  died  from  the  effects  of  concussion  of  the  brain  as  the  result 


SECONDARY    CAUSES    OF    DEATH.  297 

of  an  injury  received  eleven  yetirs  before.  (Ueber  die  Kopfverletzungen, 
1842,  J).  570 

There  is  a  rale  in  our  law  relative  to  the  period  at  which  a  person  dies 
from  a  wound — namely,  that  the  assailant  shall  not  be  adjudged  guilty  of 
murder,  unless  death  takes  place  loithin  a  year  and  a  day  after  the  inflic- 
tion of  the  wound.  To  make  the  killing-  murder,  the  death  must  follow 
within  a  year  and  a  day  after  the  stroke  or  other  cause  of  it.  In  practice, 
the  existence  of  this  rule  is  of  little  importance,  but  in  principle  it  is  erro- 
neous. Most  wounds  leading  to  death  generally  destroy  life  within  two 
or  three  months  after  their  infliction  ;  sometimes  the  person  does  not  die 
for  five  or  six  months ;  and,  in  more  rare  instances,  death  does  not  ensue 
until  after  the  lapse  of  twelve  months,  or  even  several  years.  The  pro- 
tracted cases  occur  especially  in  respect  to  injuries  of  the  head  and  chest. 
In  Reg.  V.  Creuse  (Shrewsbury  Sum.  Ass.,  1873),  the  prisoner  was 
charged  with  the  murder  of  a  policeman  (Lloyd),  by  knocking  him  down 
and  kicking  him  on  the  chest  and  abdomen  on  June  20,  1872.  Lloyd 
appeared  to  be  much  exhausted,  but  at  first  no  serious  injury  was  appre- 
hended. The  assailant  was  brought  before  the  magistrates,  and  imprisoned 
for  the  assault.  The  day  after  the  assault  Lloyd  began  to  spit  blood,  but 
he  continued  to  do  duty  until  Jrly  9th  following.  He  then  got  gradually 
worse,  and  died  on  June  8,  1873,  from  the  effects  of  the  violence  inflicted 
on  him  nearly  a  year  previously.  Had  the  deceased  lived  thirteen  days 
longer  the  prisoner  could  not  have  been  indicted  for  murder,  as  a  year  and 
a  day  would  have  elapsed  after  the  stroke  causing  death.  As  it  was,  the 
jury  found  the  prisoner  guilty  of  manslaughter. 

Secondary  Causes  of  Death. — A  person  who  recovers  from  the  imme- 
diate effects  of  a  wound  may  die  from  fever,  inflammation  or  its  conse- 
quences, pyaemia,  erysipelas,  delirium  tremens,  tetanus,  or  gangrene  ;  or 
from  an  operation  required  during  the  treatment  of  a  wound.  These 
are  what  may  be  called  secondary  causes  of  death,  or  secondary  fatal  con- 
sequences of  a  wound.  The  power  of  deciding  on  the  responsibility  of  an 
accused  person  for  an  event  which  depends  only  in  an  indirect  manner  on 
an  injury  originally  inflicted  by  him,  rests,  of  course,  with  the  authorities 
of  the  law.  But  it  is  impossible  that  they  can  decide  so  difficult  and  nice 
a  question  in  the  absence  of  satisfactory  medical  evidence ;  and,  on  the 
other  hand,  it  is  right  that  a  medical  witness  should  understand  the  im- 
portance of  the  duty  here  recjuired  of  him.  Pyaemia  or  erysipelas  may 
follow  many  kinds  of  serious  wounds,  and  in  some  few  instances  be  dis- 
tinctly traceable  to  them  ;  but,  in  others,  the  constitution  of  a  person  may 
be  so  broken  up  by  dissipated  habits  as  to  render  a  wound  fatal,  which  in 
a  healthy  subject  might  have  run  through  its  course  mildly  and  have 
healed.  When  the  pyemia  or  erysipelas  can  be  traced  to  a  wound,  and 
there  is  no  other  apparent  cause  of  aggravation  to  which  either  of  these 
disordered  states  of  the  body  can  be  attributed,  they  can  scarcely  be  re- 
garded by  a  medical  practitioner  as  unexpected  and  unusual  consequences, 
especially  when  the  injury  is  extensive,  and  seated  in  certain  parts  of  the 
body,  as  in  the  scalp.  If  death  takes  place  under  these  circumstances,  the 
prisoner  will  be  held  as  much  responsible  for  the  result  as  if  the  wound 
had  proved  directly  mortal.  This  principle  has  been  frequently  admitted 
bv  our  law,  and,  indeed,  were  it  otherwise,  many  reckless  offenders  would 
escape,  and  many  lives  would  be  sacrificed  with  impunity.  It  is,  however, 
difficult  to  lay  down  general  rules  upon  a  subject  which  is  liable  to  vary 
in  its  relations  in  every  case ;  but  when  a  wound  is  not  serious,  and  the 
secondary  cause  of  death  is  evidently  due  to  constitutional  peculiarities 
from  acquired  habits  of  dissipation,  the  ends  of  justice  are  probably  fully 


298  COMPARATIVE  SKILL  IN  TREATMENT. 

answered  by  acquittal ;    in  fact,  such  cases  do  not  oiten  pass  beyond  a 
coroner's  inquest. 

Tbe  secondary  causes  of  death  maybe  arranged  under  the  following 
beads : — 

1.  The  cause  is  loi avoidable. — Of  this  kind  are  tetanus,  following 
laceration  of  tendinous  and  nervous  structures ;  erysipelas,  following 
lacerated  wounds  of  the  scalp;  peritoneal  inflammation,  following  blows 
on  the  abdomen  with  or  without  rupture  of  the  bladder  or  intestines, 
and  effusion  of  their  contents;  strangulation  of  the  intestines  (phrenic 
hernia),  following  rupture  of  the  diaphragm  ;  and  others  of  a  like  nature. 
Here,  supposing  proper  medical  treatment  and  regimen  to  have  been 
pursued,  the  secondary  cause  of  death  was  unavoidable,  and  the  fatal 
result  certain. 

2.  The  cause  avoidable  hi/  good  medical  treatment There  are,  it  is 

obvious,  many  kinds  of  wounds,  which,  if  properly  treated  in  the  first 
instance,  may  be  healed  and  the  patient  recover,  but  when  improperly 
treated  they  prove  fatal.  In  the  latter  case  it  will  be  a  question  for  a 
witness  to  determine  how  far  the  treatment  aggravated  the  effects  of  the 
violence,  and  from  his  answer  to  this,  the  jury  may  have  to  decide  on  the 
degree  of  criminality  which  attaches  to  the  accused.  Let  us  suppose,  for 
instance,  that  an  ignorant  person  has  removed  a  clot  of  blood  which  sealed 
up  the  extremity  of  a  bloodvessel,  in  consequence  of  W'hich  fatal  bleeding 
has  ensued,  or  that  he  has  caused  death  by  unnecessarily  interfering  with 
a  penetrating  wound  of  the  chest  or  abdomen  :  it  would  scarcely  be  just 
to  hold  the  aggressor  responsible,  since,  but  for  the  gross  ignorance  and 
unskilfulness  of  his  attendant,  the  wounded  person  might  have  recovered 
from  the  effects  of  the  wound.  When  death  is  really  traceable  to  the  neg- 
ligence or  unskilfulness  of  the  surgeon  who  is  called  to  attend  on  a 
wounded  person,  this  circumstance  ought  to  be,  and  commonly  is,  admitted 
in  mitigation,  supposing  that  the  Avound  was  not  originally  of  a  mortal 
nature.  Lord  Hale  observes,  "  It  is  sufficient  to  constitute  murder,  that 
the  party  dies  of  the  wound  given  by  the  prisoner,  although  the  wound 
was  not  originally  mortal,  but  became  so  in  consequence  of  negligence  or 
unskilful  treatment;  but  it  is  otherwise  where  death  arises,  not  from  the 
wound,  but  from  unskilful  applications  or  operations  used  for  the  purpose 
of  curing  it."  The  medical  jurist  will  perceive  that  a  very  nice  distinc- 
tion is  here  drawn  by  this  great  judge  between  death  as  it  results  from  a 
wound  rendered  mortal  by  improper  treatment,  and  death  as  it  results 
from  improper  treatment  irrespective  of  the  wound.  In  the  majority  of 
cases  such  a  distinction  could  scarcely  be  establisiied,  except  upon  specula- 
tive grounds,  and  in  no  case,  probably,  would  there  be  any  accordance  in 
the  opinions  of  medical  witnesses.  In  slight  and  unimportant  wounds,  it 
might  not  be  difficult  to  distinguish  the  effects  resuUing  from  bad  treat- 
ment from  those  connected  with  the  Avound,  but  there  can  be  few  cases  of 
severe  injury  to  the  person,  wherein  a  distinction  of  this  nature  could  be 
safely  made;  and  the  proliability  is  that  no  conviction  for  murder  would 
now  take  place  if  the  medical  evidence  showed  that  the  injury  was  not 
originally  mortal,  but  only  became  so  by  unskilful  or  improper  treatment. 
In  such  a  case  it  would  be  impossible  to  ascribe  death  to  the  wound,  or  to 
its  usual  or  probable  consequences  ;  and  without  this  it  is  not  easy  to  per- 
ceive on  what  principle  an  aggressor  could  be  made  responsible  for  the 
result. 

3.  Comparative  s^-ill  in  treatment. — If  death  has  been  caused  by  a 
wound,  the  responsibility  of  an  aggressor  is  not  altered  by  the  allegation 
that,  under  more  favorable  circumstances  and  with  more  skilful  treatment. 


DEATH  FROM  IMPRUDENCE  OR  NEGLECT.         299 

a  fatal  result  mif^ht  have  been  averted.  At  the  same  time  it  is  ohvioiis 
that  a  serious  responsibility  is  thrown  on  practitioners  who  undertake  the 
management  of  cases  of  criminal  wounding-.  Any  deviation  from  ordi- 
nary practice  should  therefore  be  made  with  the  greatest  caution,  since 
novelties  in  practice  will,  in  the  event  of  a  fatal  result,  form  one  of  the 
best  grounds  of  defence  in  the  hands  of  a,  prisoner's  counsel.  On  these 
occasions  every  point  connected  with  the  surgical  treatment  will  be  the 
subject  of  rigorons  inquiry  and  adverse  professional  criticism.  In  the  case 
of  a  severe  lacerated  wound  in  the  hand  or  foot,  followed  by  fatal  tetanus, 
it  may  be  said  that  the  wounded  person  would  not  have  died  had  amputa- 
tion iDcen  at  once  performed.  In  this  instance,  however,  a  practitioner 
may  justify  himself  by  showing,  either  that  the  injury  was  too  slight  to 
require  amputation,  or  that  the  health  or  other  circumstances  connected 
with  the  deceased  would  not  allow  of  its  being  performed  with  any 
reasonable  hope  of  success.  On  the  other  hand,  if  the  practitioner  per- 
formed amputation,  and  the  patient  died,  then  it  would  be  urged  that  the 
operation  was  premature,  or  wholly  unjustifiable,  and  that  it  had  caused 
death.  Here  the  surgeon  is  bound  to  show  that  the  operation  was  neces- 
sary according  to  the  ordinary  rules  of  practice.  The  treatment  of  severe 
incised  wounds  of  the  throat,  when  the  windpipe  is  involved,  sometimes 
places  a  surgeon  in  an  embarrassing  position.  If  the  wound  is  left  open, 
death  may  take  place  from  bleeding ;  if  it  be  prematurely  closed,  blood 
may  be  effused  into  the  windpipe  and  cause  death  by  suffocation. 

4.  The  cause  avoidable  but  for  imprudence  or  neglect  07i  (he  part  of 
the  wounded  person. — A  man  who  has  been  severely  wounded  in  a  quarrel 
may  obstinately  refuse  medical  assistance,  or  he  may  insist  upon  taking 
exercise,  or  using  an  Improper  diet,  contrary  to  the  advice  of  his  medical 
attendant;  or  by  other  imprudent  practices  he  may  thwart  the  best  con- 
ceived plans  for  his  recovery.  Let  us  take  a  common  case  as  an  illustra- 
tion. A  man  receives  a  blow  on  the  head  in  a  pugilistic  combat,  from  the 
first  effects  of  which  he  recovers,  but,  after  having  received  surgical  assist- 
ance, he  indulges  in  excessive  drinking,  and  dies.  The  aggressor  is  tried 
on  a  charge  of  manslaughter,  and  found  guilty.  Death  under  these  cir- 
cumstances is  commonly  attributed  by  the  medical  witness  to  effusion  of 
I)lood  on  the  brain  ;  but  it  cannot  be  denied  that  the  excitement  produced 
by  intoxicating  liquors  will  sometimes  satisfactorily  account  for  the  fatal 
symptoms.  (See  Reg.  v.  Saxon,  p.  293,  ante.)  In  the  case  wiiieh  we  are 
here  supposing,  such  an  admission  might  be  made,  and  the  prisoner  re- 
ceive the  benefit  of  it;  for  the  imprudence  or  negligence  of  a  wounded 
person  ought  not,  morally  speaking,  to  be  considered  as  adding  weight  to 
the  offence  of  the  aggressor.  If  the  symptoms  were  from  the  first  un- 
favorable, or  the  wound  likely  to  prove  mortal,  circumstances  of  this  kind 
could  not  be  received  in  mitigation.  Our  judges  have  shown  themselves 
at  all  times  unwilling  to  admit  them.  The  legal  responsibility  of  the 
assailant  is  the  same,  whiether  the  deceased  died  on  the  spot,  or  some  davs, 
weeks,  or  months  afterwards,  unless  it  can  be  distinctly  proved  tliat  his 
death  was  immediately  connected  with  the  imprudence  or  excess  of  which 
he  was  guilty,  and  wholly  independent  of  the  wound.  But,  although  a 
prisoner  should  be  found  guilty  of  manslaughter  under  these  circumstances, 
the  punishment  is  so  adjus'ted  by  our  law  as  to  leave  a  considerable  dis- 
cretionary power  in  the  hands  of  a  judge.  This  is,  indeed,  tantamount  to 
.a  direct  legal  provision,  comprehending  each  different  shade  of  guilt ;  a 
man  is  held  responsible  for  a  wound  rendered  accidentally  mortal  by  events 
over  which  he  could  have  had  no  control,  but  which  in  themselves  ouii-ht 
to  be  regarded  as  in  some  degree  exculpatory.     The  punishment  attached 


300  ABNORMAL    STATES    OF    THE    BODY. 

to  his  offence  may  be  severe  or  slight,  according  to  the  representation  made 
by  a  medical  witness  of  the  circumstances  which  rendered  the  Avound 
mortal ;  if  he  neglect  to  state  the  full  influence  of  imprudence  or  excess  on 
the  part  of  the  wounded  person,  where  either  has  existed,  over  the  progress 
of  the  wound,  he  may  cause  the  prisoner  to  be  punished  with  undue 
severity.  The  humanity  of  our  judges  is  such  that,  when  medical  evi- 
dence is  clear  and  consistent  on  a  point  of  this  nature,  and  there  are  no 
circumstances  in  aggravation,  they  commonly  pass  a  mild  sentence.  The 
neglect  to  call  in  a  medical  practitioner,  or  the  refusal  to  receive  medical 
advice,  will  not,  however,  according  to  the  decision  in  Reg.  v.  Thomas 
(Gloucester  Aut.  Ass.,  1841),  be  considered  a  mitigatory  circumstance  in 
favor  of  the  prisoner,  even  although  the  wound  was  susceptible  of  being 
cured.  A  man  may  receive  a  lacerated  wound  of  a  limb,  which  is  followed 
by  tetanus  or  gangrene,  and  thus  proves  fatal ;  he  may  have  declined  re- 
ceiving medical  advice,  or  have  obstinately  refused  amputation,  although 
proposed  by  his  medical  attendant.  This  would  not  operate  as  a  mitiga- 
tory circumstance  on  the  part  of  an  assailant,  because  a  wounded  person 
is  not  compelled  to  call  for  medical  assistance,  or  to  submit  to  an  operation, 
Avhile  a  medical  witness  could  not  always  be  in  a  position  to  swear  that 
the  operation  would  have  certainly  saved  his  life  ;  he  can  merely  state  that 
it  might  have  afforded  him  a  better  chance  of  recovery.  Again,  a  person 
may  receive  a  blow  on  the  head  producing  fracture,  with  great  depression 
of  bone  and  symptoms  of  compression  of  the  brain  ;  a  surgeon  may  pro- 
pose the  operation  of  trephining  to  elevate  the  depressed  bone,  but  tlie 
friends  of  the  wounded  man  may  not  permit  the  operation  to  be  per- 
formed. In  such  a  case,  the  line  of  duty  of  the  witness  will  be  to  state 
the  facts  to  the  court,  and  it  is  probable  that,  in  the  event  of  conviction, 
there  would  be  some  mitigation  of  punishment;  because  such  an  injury, 
if  left  to  itself,  must  in  general  prove  mortal,  and  no  doubt  could  exist  in 
the  mind  of  any  surgeon  as  to  the  absolute  necessity  for  the  operation. 
But  the  neglect  or  improper  conduct  of  a  person  who  receives  a  wound 
thus  rendered  fatal  does  not  exculpate  the  aggressor.  The  crime  is  either 
murder  or  manslaughter. 

5.  The  cause  avoidable  but  for  an  abnormal  or  unhealthy  state  of  the 
body  of  the  wounded  person. — Wounds  which  are  comparatively  slight 
sometimes  prove  indirectly  fatal,  owing  to  the  person  being  in  an  unhealthy 
condition  at  the  time  of  their  infliction.  In  bad  constitutions,  compound 
fractures  or  slight  wounds,  which  in  a  healthy  person  would  have  a  favor- 
able termination,  are  followed  by  gangrene,  pyajmia,  or  erysipelas,  proving 
fatal.  Here  the  responsibility  of  an  assailant  for  the  death  may  become 
reduced,  so  that,  although  found  guilty  of  manslaughter,  a  mild  punish- 
ment might  be  inflicted.  The  consequence  might  be,  medically  speaking, 
unusual  or  unexpected,  and,  but  for  circumstances  wholly  independent  of 
the  act  of  the  accused,  would  not  have  been  likely  to  destroy  life.  In 
general,  in  the  absence  of  malice,  this  appears  to  be  the  point  to  which  the 
law  closely  looks,  in  order  to  make  out  the  responsibility  of  the  accused — 
namely,  that  the  fatal  secondary  cause  must  be  something  not  unusual  or 
unexpected  as  a  consequence  of  the  particular  injury.  The  medico-legal 
question  presents  itself  under  this  form — Would  the  same  amount  of  in- 
jury have  been  likely  to  cause  death  in  a  person  of  ordinary  health  and 
vigor?  A  man  otherwise  healthy,  laboring  under  rupture,  may  receive  a 
blow  on  the  groin,  attended  with  laceration  of  the  intestines,  gangrene, 
and  death;  another  with  a  calculus  in  the  kidney  may  be  struck  in  the 
loins  and  die,  in  consequence  of  the  calculus  perforating  the  bloodvessels 
and  causing  fatal  bleeding  or  subsequent  inflammation.  In  these  cases  the 


ABNORMAL    STATES    OF    THE    BODY.  301 

effects  of  the  violence  must  be  reg-avded  as  somethino:  unexpected  ;  it  would 
not  have  produced  serious  mischief  in  an  ordinarily  healthy  person,  and 
hence  the  responsibility  of  an  assailant  becomes  much  diminished.     The 
crime  is  undoubtedly   manslaughter,   but  the  punishment  may  be  of  a 
lenient  description.     A  defence  of  this  kind  will,  however,  be  limited  by 
circumstances.     A  case  is  reported,  in  which  a  Dr.  Fabricius  was  tried  at 
the  Old  Bailey  for  the  murder  of  his  servant  by  striking^  her  a  blow  be- 
hind the  ear  whereby  a  larg-e  abscess,  situated  at  that  part,  Avas  ruptured, 
and  this  ultimately  caused  her  death.    The  chief  question  at  the  trial  was, 
whether  the  deceased  had  died  from  the  effects  of  the  violence,  or  from  the 
disease  under  which  she  was  at  that  time  laboring.  The  doctor  ingeniously  •• 
urged  in  his  defence  that  he  had  struck  the  blow  merely  for  the  purpose 
of  opening  the  abscess.     The  jury,  however,  did  not  agree  in  taking  this 
professional  view  of  the  matter,  and  they  found  him  guilty  of  manslaughter.. 
It  must  be  evident  that  there  exist  numerous  internal  diseases,  such  as 
aneurism  and  various  morbid  affections  of  the  heart  and  brain,  which  are 
liable  to  be  rendered  fatal  by  slight  external  violence.     The  law,  as  ap- 
plied to  these  cases,  is  thus  stated  by  Lord  Hale:     "It  is  sufficient  to 
prove  that  the  death  of  a  person  was  accelerated  by  the  malicious  act  of 
the  prisoner,  although  the  former  labored  under  a  mortal  disease  at  the 
time  of  the  act.  "     In  those  cases  in  which  a  slight  degree  of  violence  has 
been  followed  by  fatal  consequences,  it  is  for  a  jury  to  decide,    under  all 
the  circumstances,  upon  the  actual  and  specific  intention  of  the  prisoner  at 
the  time  of  the  act  which  occasioned  death.     According  to   Starkie,    "it 
seems  that  in  general,  notwithstanding  any  facts  which  tend  to  excuse  or 
alleviate  the  act  of  the  prisoner,  if  it  be  proved  that  he  was  actuated  by 
prepense  and  deliberate  malice,  and  that  the  particular  occasion  and  cir- 
cumstances upon  which  he  relies  were  sought  for  and  taken  advantage  of 
merely  with  a  view  to  qualify  actual  malice,   in  pursuance  of  a  precon- 
ceived scheme  of  destruction,   the  offence  will  amount  to  murder."     In 
most  of  these  cases  there  is  an  absence  of  intention  to  destroy  life,  but  the 
nature  of  the  wound,  as  well  as  the  means  by  which  it  was  inflicted,  will 
often  suffice  to  show  the  intention  of  the  prisoner.     An  accurate  descrip- 
tion of  the  injury,  if  slight,   may  afford  strong  evidence  in  favor  of  the 
accused,  since  the  law  does  not  so  much  regard  the  means  used  by  him  to 
perpetrate  the  violence,  as  the  actual  intention  to  kill,  or  to  do  great  bodily 
harm.     Serious  injury,  causing  death  by  secondary  consequences,  will  ad- 
mit of  no  exculpation  when  an  assailant  Avas  aware,  or  ought  to  have  been 
aware,  of  the  condition  of  the  person  whom  he  struck.     Thus  if  a  person 
notoriously  ill,  or  a  woman  while  pregnant,  be  maltreated,  and  death  ensue 
from  a  secondary  cause,  the  assailant  will  be  held  responsible;  because  he 
ought  to  know  that  violence  of  any  kind  to  persons  so  situated  must  be 
attended  with  dangerous  consequences.     So,  if  the  person  maltreated  be 
an  infant  or  a  decrepit  old  man.  or  one  laboring  under  a  mortal  disease,  it 
is  notorious  that  a  comparatively  slight  degree   of  violence  will  destroy 
life  in  these  cases,  and  the  prisoner  would  properly  be  held  responsible. 
A  wound  which  accelerates  death  causes  death,  and  may  therefore  render 
the  aggressor  responsible  for  murder  or  manslaughter,  according  to  the 
circumstances.     The  Commissioners  appointed  to  define  the  criminal  law 
on  the  subject  of  homicide  thus  express  themselves:     "Art.  3.  It  is  hom- 
icide, although  the  effect  of  the  injury  he  merely  to  accelerate  the  death  of 
one  laboring  under  some  previous  injury   or  infirmity,   or   although,   if 
timely  remedies  or  skilful  treatment  had  been  applied,  death  might  have 
been  prevented."     This  is  conformable  to   the  decisions  of  our  judges. 
According  to  Lord  Hale,  if  a  man  has  a  disease  which  in  all  likelihood 


302  DEATH    FROM    TETANUS. 

would  terminate  his  life  in  a  short  time,  and  another  gives  him  a  wound  or 
hurt  which  hastens  his  death,  this  is  such  a  killing  as  constitutes  murder. 

6.  Abnormal  Conditions. — When  an  assailant  could  not  have  been 
aware  of  the  existence  of  a  diseased  or  abnormal  condition  of  parts  in  the 
wounded  person,  the  question  is  somewhat  ditt'ei-ent.  In  many  persons 
the  skull  is  preternaturalh^  thin,  and  in  most  persons  it  is  so  in  those 
places  corresponding  to  the  Pacchionian  bodies.  In  a  case  of  this  kind  a 
moderate  blow  on  the  head  might  cause  fracture,  accompanied  by  effusion 
of  blood,  depression  of  bone,  or  subsequent  inflammation  of  the  brain  and 
its  membranes,  any  of  which  causes  might  prove  fatal.  In  some  persons, 
all  the  bones  of  the  body  are  unusually  brittle,  so  that  they  are  fractured 
b\^  the  slightest  force.  Inflammation,  gangrene,  and  death  may  follow, 
when  no  considerable  violence  has  been  used;  but  these  being  unexpected 
consequences,  and  depending  on  an  abnormal  condition  of  parts  unknown 
to  the  prisoner,  his  responsibility  may  not,  cseteris  paribus,  be  so  great  as 
under  other  circumstances.  This  condition  of  the  bones  can  be  determined 
only  by  a  medical  practitioner.  Facts  of  this  kind  show  that  the  degree 
of  violence  used  in  an  assault  cannot  always  be  measured  by  the  effects, 
unless  a  careful  examination  of  the  injured  part  is  previously  made. 

7.  Difficulty  of  proof  in  death  from  secondary  causes. — When  a  per- 
son is  charged  with  having  caused  the  death  of  another  through  violence 
terminating  in  some  fatal  disease,  the  case  often  admits  of  a  skilful  de- 
fence, and  this  in  proportion  to  the  length  of  time  after  the  violence  at 
which  the  deceased  dies.  This  disease,  it  may  be  urged,  is  liable  to  ap- 
pear in  all  persons,  even  the  most  healthy;  or  it  may  arise  from  causes 
unconnected  with  the  violence.  In  admitting  these  points,  it  must  be  re- 
membered that  death  may  be  proved  to  have  been  indirectly  a  consequence 
of  the  wound  by  the  facts:  (1)  that  the  supervention  of  the  secondary 
cause,  although  not  a  common  event,  lay  in  the  natural  course  of  things; 
(2)  that  there  did  not  exist  any  accidental  circumstances  which  were  likely 
to  have  given  rise  to  this  secondary  cause  independent  of  the  wound.  The 
proof  of  the  first  point  amounts  to  nothing,  unless  the  evidence  on  the  sec- 
ond point  is  conclusive. 


CHAPTER   XXX. 

WOUNDS      IXDIRECTLT     FATAL. TETANUS      FOLLOWING     WOUNDS. — ERYSIPELAS. DELIRIUM 

TREMENS. GANGRENE. DEATH  FROM  SURGICAL  OPERATIONS. ANAESTHETICS. PRIMARY 

AND      SECONDARY      CAUSES      OF      DEATH.  —  UNSKILFULNESS     IN      OPERATIONS. PYEMIA. 

MEDICAL    RESPONSIBILITY  IN  REFERENCE    TO    OPERATIONS. ACTIONS    FOR    MALAPRAXIS. 

Tetanus  following  wounds. — Tetanus  frequently  presents  itself  as  a 
secondary  fatal  consequence  of  wounds,  especially  of  those  which  are 
lacerated  or  contused,  and  affect  nervous  or  tendinous  structures.  It  has 
often  occurred  as  a  result  of  slight  bruises  or  lacerations,  when  the  injury 
was  so  slight  as  to  excite  no  alarm  ;  and  it  is  a  disease  which  gives  no 
warning  of  its  appearance.  Tetanus  may  come  on  spontaneously,  i.  e. 
independently  of  the  existence  of  any  wound  on  the  body.  Cases  have 
been  brought  into  the  London  hospitals,  in  which  the  only  cause  of  this 
disease  appeared  to  be  exposure  to  cold  or  wet,  or,  in  some  instances,  ex- 
posure to  a  current  of  air.     It  is  scarcely  possible  to  distinguish,  by  the 


WOUNDS  —  DEATH    FROM    ERVSIPELAS.  SOo 

syni]>toms,  tetanus  from  wounds  Ctraumatic)  from  that  which  occurs  spon- 
taneously as  a  result  of  natural  causes  (idiopathic).  Ju  endeavoring  to 
connect,  its  appearance  with  a  particular  wound  or  personal  injury,  it 
should  be  observed  (1  )  whether  there  were  any  symptoms  indicative  of  it 
before  the  maltreatment;  (2)  whether  any  probable  cause  could  have 
intervened  to  produce  it,  between  the  time  of  its  a])pearance  and  the  time 
at  which  the  violence  was  inflicted  ;  C3)  whether  the  deceased  ever  rallied 
from  the  effects  of  the  violence.  The  time  at  which  tetanus  usually  makes 
its  appearance,  when  it  is  the  result  of  a  wound,  is  from  the  third  to  the 
sixth  day  ;  but  it  may  not  appear  until  three  or  four  weeks  after  the  injury, 
and  the  exciting  cause  may  still  be  traced  to  the  wound,  which  may  have 
healed.     When  resulting  from  a  wound,  it  is  generally  fatal. 

A  medical  practitioner  is  bound  to  exercise  great  caution  before  he  pro- 
nounces an  opinion  that  a  fatal  attack  of  tetanus  has  arisen  either  from 
spontaneous  causes,  or  from  slight  blows  or  personal  injuries.  A  rigorous 
inquiry  should  be  made  into  all  the  attendant  circumstances.  Slight 
punctured  wounds,  operating  as  a  cause  of  tetanus,  have  been  overlooked 
or  only  discovered  by  accident  after  death,  and  it  is  highly  probable  that 
many  cases  have  been  set  down  as  idiopathic  tetanus  in  which,  by  proper 
inquiry,  the  disease  might  have  been  traced  to  a  wound  or  some  personal 
injury.  In  one  instance  the  tetanus  was  at  first  considered  to  be  idio- 
pathic ;  but  shortly  before  death  a  small  black  mark  was  observed  on  the 
thumb-nail.  On  making  inquiry,  it  was  found  that  a  few  days  previously 
to  the  attack  a  splinter  of  wood  had  accidentally  penetrated  the  thumb. 
The  patient  attached  so  little  limportance  to  the  acc'dent  that  he  did  not 
mention  the  circumstance  to  his  medical  attendant.  This  was  no  doubt 
the  cause  of  the  disease.  (For  two  similar  cases,  see  Brit.  Med.  Jour., 
18Y2.  ii.  p.  594.)  Many  trials  for  murder  and  manslaughter  have  occurred 
in  this  country  in  which  tetanus  was  the  immediate  cause  of  death  ;  and 
the  defence  has  generally  rested  upon  the  probable  origin  of  the  disease 
from  accidental  causes. 

Erysipelas,  like  tetanus,  may  be  a  fatal  result  of  slight  injuries  "Wounds 
affecting  the  scalp  are  liable  to  be  followed  by  this  disease.  Burns  and 
scalds  sometimes  prove  fatal  through  this  secondary  cause.  Some  persons 
are  particularly  prone  to  erysipelatous  inflammation,  and  thus  wounds 
comparatively  slight  may  have  a  fatal  termination.  When  a  wounded 
person  has  died  from  this  disease,  an  assailant  cannot  be  made  responsible 
for  the  fatal  result,  unless  the  erysipelas  is  clearly  traced  to  the  injury. 
The  medical  facts  that  the  person  assaulted  has  never  recovered  from  the 
effects  of  the  violence,  and  that  the  inflammation  set  up  has  suddenly  as- 
sumed an  erysipelatous  character,  are  sufficient  to  establish  this  connec- 
tion. If  there  has  been  recovery,  and  an  interval  of  some  days  has 
elapsed,  a  doubt  may  arise  respecting  the  connection  of  the  erysipelas 
with  the  violence  inflicted.  This  disease  is  occasionally  idiopathic,  i.  e.  it 
appears  like  tetanus  without  any  assignable  cause.  In  Reg.  v.  Jones 
(Monmouth  Lent  Ass.,  1873),  the  prisoner,  a  collier,  was  convicted  of 
manslaughter  under  the  following  circumstances :  the  prisoner  was  fight- 
ing with  another  man,  and  the  deceased,  a  woman,  endeavored  to  part 
them.  The  prisoner  fixed  his  teeth  savagely  on  her  thumb,  and  bit  her 
severely.  The  wound  was  poulticed.  It  was  not  until  the  fourth  day 
that  she  had  medical  advice.  Erysipelas  had  then  commenced,  and  had 
caused  great  swelling  of  the  limb  up  to  the  shoulder.  She  died  in  three 
weeks.  The  medical  evidence  was  to  the  effect  that  she  had  died  of  ery- 
sipelas from  the  wound,  but  the  fatal  result  was  in  a  great  measure  due 


304  DEATH  FROM  SURGICAL  OPERATIONS. 

to  an  impaired  state  of  health  from  excessive  drinking.  The  prisoner  was, 
notwithstanding,  found  guilty. 

It  is  sometimes  difficult  to  establish  the  connection  of  erysipelas  wjth  a 
wound,  especially  when  the  disease  occurs  some  time  after  its  infliction, 
and  in  a  remote  part  of  the  body  not  implicated  in  the  wound.  When 
this  connection  cannot  be  distinctly  made  out,  there  Avill  be  an  acquittal. 

Delirium  tremevs  is  a  disease  which  frequently  presents  itself  as  a 
secondary  consequence  of  injuries  in  persons  of  intemperate  habits. 
Whether  the  injury  be  slight  or  severe,  this  disease  may  easily  supervene 
arid  prove  fatal.  It  is  observed  occasionally  as  a  consequence  of  opera- 
tions required  for  the  treatment  of  wounded  persons.  The  remarks  made 
at  p.  300  upon  the  influence  of  unhealthy  constitutions  on  wounds,  apply 
with  especial  force  to  case's  of  this  description 

Death  from  Surgical  Operatio7is. — In  the  treatment  of  wounds,  sur- 
gical operations  are  frequently  resorted  to,  and  a  wounded  person  may  die, 
either  during  the  performance  of  an  operation,  or  from  its  consequences. 
A  question  will  thence  arise,  whether  the  person  who  inflicted  the  wound 
should  be  held  responsible  for  the  fatal  result.  The  law  regards  a  sur- 
gical operation  as  a  part  of  the  treatment,  and  if  undertaken  bona  Jide,  and 
performed  with  reasonable  care  and  skill,  the  aggressor  will  be  held  re- 
sponsible, whatever  may  be  the  result.  The  necessity  for  the  operation, 
and  the  mode  of  performing  it,  will  be  left  to  the  operator's  judgment. 
As  the  defence  may  turn  upon  the  operation  having  been  performed  un- 
necessarily, and  in  a  bungling  and  unskilful  manner,  it  will  be  right  for  a 
practitioner,  if  possible,  to  defer  it  until  he  has  had  the  advice  and  assist- 
ance of  other  practitioners.  According  to  Lord  Hale,  if  death  takes  place 
from  an  unskilful  operation,  performed  for  the  cure  of  a  wound,  and  not 
from  the  wound,  the  responsibility  of  the  prisoner  ceases  f  but  he  does  not 
appear  to  have  considered  that  death  may  take  place  as  a  consequence  of 
the  most  skilful  operation  required  for  the  treatment  of  a  wound,  and  yet 
be  wholly  independent  of  the  wound  itself. 

If  the  operation  has  been  performed  by  the  medical  witness  himself,  and 
the  necessity  for  its  performance  is  questioned  by  counsel  for  the  prisoner, 
it  is  open  to  the  witness  to  give  the  requisite  explanation  in  his  evidence. 
It  would  appear  from  a  case  tried  before  Shee,  J.,  that  the  necessity  for 
an  operation  will  not  be  assumed;  but  if  called  in  question,  it  must  be 
proved  by  witnesses  for  the  pro=ecution.  In  Eeg.  v.  Moreland  (C.  C.  C, 
Sept.  1865),  the  prison  threw  the  deceased  on  the  ground  and  fractured 
his  leg.  The  limb  was  am])utated,  and  the  man  subsequently  died. 
Counsel  for  the  prisoner  asked  the  surgeon  from  the  hospital,  who  spoke  to 
the  death  of  the  deceased,  whether  an  operation  was  really  necessary.  The 
witness  said  he  could  not  tell,  as  he  had  not  had  charge  of  the  case  previous 
to  the  operation.  Counsel  then  raised  the  question  whether  prisoner  or  the 
doctors  had  caused  the  man's  death.  The  counsel  for  the  prosecution 
suggested  that  the  court  might  accept  as  a  fact  that  amputation  would  not 
have  been  performed  had  it  not  been  necessary  ;  but  the  judge  said  that 
would  not  do.  Tiiey  must  deal  with  the  case  on  the  evidence  before 
them.  He  then  observed  to  the  jury  that,  althouiih  undoubtedly  am- 
putation would  not  be  adopted  at  such  a  place  as  the  London  Hospital 
without  the  necessity  for  it,  yet  evidence  to  that  effect  must  be  before 
them  on  oath.  They  could  not  act  on  what  they  had  every  reason 
to  believe;  therefore  they  must  acquit  the  prisoner.  The  failure  of 
justice  in  this  case  rested  with  those  who  were  concerned  for  the  prose- 
cution. The  operator,  who  could  probably  have  satisfied  the  court 
that  he  had  not  cut  off  the  wrong  leg,  and  that  there  were  good  reasons 


DEATH  FROM  SURGICAL  OPERATIONS.  305 

for  performing  the  operation,  was  not  called  as  a  witness ;  but  in  his 
place  a  witness  was  summoned  who  could  not  answer  these  necessary 
questions. 

Death  is  by  no  means  an  unusual  result  of  severe  operations,  the  secondary 
consequences  under  which  the  patient  may  die  being  very  numerous  even 
when  the  case  is  skilfully  managed.  Sometimes  the  patient  will  .die  on 
the  table,  although  but  little  blood  may  have  been  lost.  Fear,  pain, 
and  sudden  shock  to  the  nervous  system  have  caused  death  under,  these 
circumstances.  The  most  common  indirect  causes  of  death  after  severe 
operations  are  secondary  hemorrhage,  erysipelas,  tetanus,  delirium 
tremens,  pyasraia,  and  gangrene  of  the  stump. 

Should  an  operation  be  unnecessarily  or  unskilfully  performed,  the  re- 
sponsibility of  an  aggressor  would,  it  is  presumed,  cease,  if  the  death  of  a 
wounded  person  could  be  clearly  traced  to  it.  Thus  if,  in  carelessly  bleed- 
ing, the  brachial  artery  should  be  laid  open  (Ann.  d'Hyg.,  1834,  t.  2,  p. 
445),  or  if,  in  performing  amputation,  a  large  artery  be  improperly  secured, 
so  that  the  patient  in  either  case  dies  from  loss  of  blood,  the  ])risoner  could 
not  be  equitably  held  responsible  ;  because  it  would  be  punishing  him  for 
an  event  depending  on  the  unskilfulness  of  a  medical  practitioner.  Ac- 
cording to  Plat,  B.,  a  prisoner  will  be  held  responsible,  if  the  original 
wound  were  likely  to  produce  death,  although  unskilfully  treated.  Sup- 
posing the  bleeding  or  amputation  to  be  performed  with  ordinary  care 
and  skill,  and  yet,  in  the  one  case,  inflammation  of  the  veins,  and  in  the 
other  erysipelas,  tetanus,  gangrene,  or  fever  should  destroy  life,  the 
prisoner  will  be  liable  for  the  consequences.  The  practice  of  the  law  is 
strictly  consistent  with  justice.  Should  the  operation  be  considered  to  be 
absolutely  required  for  the  treatment  of  a  wound,  which,  according  to  all 
probability,  would  prove  mortal  without  it ;  should  it  be  performed  with 
ordinary  skill,  and  still  death  ensue  as  a  direct  or  indirect  consequence — 
it  is  only  just  that  the  person  who  inflicted  the  injury  should  be  held 
responsible  for  the  r'esult.  It  is  presumed  in  these  cases  that,  were  the 
patient  left  to  himself,  he  would  in  all  probability  die  from  the  effects 
of  the  wound.  If,  therefore,  a  surgeon,  knowing  that  an  operation  would 
give  a  chance  of  saving  life  on  such  an  occasion,  did  not  perform  it,  it 
might  be  contended,  in  the  defence,  that  the  deceased  had  died,  not  from 
the  wound,  but  from  the  incompetency  and  neglect  of  his  medical  attendant. 
Hence  it  follows  that  if,  during  this  necessary  treatment,  unforeseen  though 
not  unusual  causes  cut  life  short,  no  exculpation  should  be  admitted,  if  it 
went  to  attack  the  best-directed  ciforts  made  for  the  preservation  of  life, 
(See  Ann.  d'Hyg.,  1835,  t.  1,  p.  231.)  If  an  operation  is  rendered  neces- 
sary  by  reason  of  the  improper  treatment  of  the  wound,  the  responsibility 
of  an  assailant  for  a  fatal  result  ceases. 

In  another  part  of  this  work  (p.  48)  we  have  referred  to  the  case  of 
Kelly,  who  was  tried  for  the  murder  of  Talbot.  (Reg.  v.  Kelly,  Dublin 
Commis.  Court,  Nov.  1871.)  The  facts  of  this  case,  although  made  a 
subject  of  the  most  violent  contention  in  a  medical,  legal,  and  political 
view,  were  really  of  a  very  simple  kind.  On  July  12,  the  deceased  re- 
ceived a  pistol-shot  wound  at  the  back  of  his  neck,  and  died  from  the 
effects  on  July  16.  The  bullet  fractured  and  splintered  the  atlas,  wounding 
and  crushing  the  soft  parts  of  the  neck,  and  leading  to  the  formation  of 
an  abscess  in  this  part.  The  actual  cause  of  death  was  inflnramation  of 
the  spinal  cord  and  its  membranes,  Stokes,  who  attended  the  deceased, 
considered  it  necessary  to  enlarge  the  wound  for  the  purpose  of  removing 
the  bullet,  which  was  then  supposed  to  be  lying  Avithin  reach.  In  this 
operation  a  small  artery  (the  occipital)  was  divided,  but  the  quantity  of 
20 


30G  DEATH    FROM    ANESTHETICS    IN    OPERATIONS. 

blood  lost  was  small ;  the  bleeding-  was  stopped  by  compression,  and  this 
bleeding  had  no  influence  in  causing  death.  The  defence  was  that  the 
wound  would  not  have  proved  fatal. but  for  the  bad  surgical  treatment; 
that  the  probing  of  the  wound  was  unnecessary,  and  that  it  was  unskil- 
fully performed.  There  was  the  evidence  of  experts  on  both  sides;  but 
the  facts  proved,  apart  from  the  opinions  expressed,  could  leave  no  reason- 
able doubt  that  Stokes  had  treated  the  case  with  bona  fides  and  with  com- 
petent skill.  The  prisoner  was  positively  identified  by  the  deceased  and 
others,  and  yet  upon  this  evidence  the  jury,  returned  a  verdict  of  not 
guilty.     (See  Brit.  Med.  Jour.,  18T1,  ii.  p.  716.) 

The  failure  of  justice  in  this  case  appears  to  have  been  chiefly  owing  to 
the  fact  that  the  jury  were  allowed  to  form  their  opinions  on  the  surgical 
treatment  pursued,  whereas  the  rule  of  law  is  clear  as  to  responsibility ; 
and  the  only  question  which  should  have  been  submitted  to  them  was, 
Avhether  the  prisoner  was  or  was  not  the  man  who  fired  the  pistol-shot. 
The  English  practice,  as  already  quoted  above,  is  that  if  a  man  unlawfully 
inflicts  a  dangerous  Avound  on  another,  and  the  wounded  person,  after 
being  treated  by  qualified  practitioners  acting  with  bona  fides,  and  apply- 
ing themselves  with  the  best  of  their  ability  to  the  case,  dies  of  the  wound, 
the  man  inflicting  it  is  really  guilty  of  murder,  even  although  an  erroneous 
treatment  of  the  case  by  the  practitioner  may  have  been  the  cause  of  death. 
In  fact,  under  no  other  rule  would  a  medical  man  be  safe  in  dealing  with 
a  case  of  criminal  wounding.  If  Kelly's  case  were  taken  as  a  precedent, 
no  surgical  treatment  should  be  adopted  under  these  circumstances.  The 
-wound" should  be  allowed  to  take  its  mortal  course. 

Death  from  Ansesthetics  in  Surgical  Operations. — In  a  large  number 
of  operations  it  is  now  the  general  practice  among  surgeons  to  administer 
chloroform,  ether,  or  other  ancesthetics,  not  only  to  allay  pain,  but  to 
prevent  that  exhaustion  to  the  patient  which  is  likely  to  arise  from  pro- 
tracted surgical  pi'oceedings.  In  spite  of  care  on  the  part  of  the  operator, 
these  vapors  are  liable  to  destroy  life  in  an  unexpecfed  manner,  and  the 
patient  may  die  either  before  the  operation  is  commenced,  or  during  its 
performance.  The  facts  may  leave  no  doubt  that  the  wounded  person  died 
from  the  anfesthetic,  and  not  from  the  wound  or  the  operation.  On  in- 
spection of  the  body,  the  heart  may  be  found  in  an  unhealthy  state,  a  fact 
which  is  usually  considered  sufficient  to  account  for  the  fatal  effects  of 
chloroform  vapor.  In  a  case  of  this  kind,  what  becomes  of  the  responsi- 
bility of  the  person  who  inflicted  the  original  wound?  No  decision,  so 
far  as  we  know,  has  ever  been  given  on  this  point.  Was  the  use  of  chlo- 
roform vapor  in  a  professional  view  a  necessary  part  of  the  treatment? 
Was  it  skilfully  and  properly  administered?  Could  the  diseased  condi- 
tion of  the  heart  which  rendered  the  effects  of  the  vapor  more  fatal  than 
usual  have  been  detected  by  the  operator,  so  as  to  show  the  impropriety 
of  administering  it  in  this  case?  These  questions  should  receive  satisfac- 
tory answers  before  the  aggressor  is  rendered  responsible  for  death  under 
such  peculiar  circumstances. 

An  action  was  brought  against  a  medical  man  (Absolom  v.  Statham, 
Q.  B.,  Nov.  186*7)  for  forcibly  administering  chloroform  to  the  plaintiff 
against  her  will,  and  extracting  six  of  her  teeth;  also  for  careless  and  un- 
sidlful  treatment,  whereby  her  health  was  injured.  The  medical  evidence 
showed  that  the  woman  had  consented  to  the  operation,  and  that  it  had 
l)ecn  properly  performed;  also  that  her  health  had  sustained  no  injury  by 
the  chloroform  or  the  operation,  and  that  most  of  her  symptoms  were  due 
to  hysteria,  Cockburn,  C.  J.,  in  summing  up  the  case,  said  that  the  two 
charges  or  complaints  were  entirely  distinct  and  different — one  being  for 


OPERATIONS    UNDER    A    MISTAKEN    OPINION.  307 

an  assault,  and  the  other  for  malpractice.  The  law  was  clear  as  to  both. 
No  surgeon  had  a  right  to  perform  any  operation  against  the  will  of  the 
patient,  so  long  as  the  paiient  pref^erved  conscioasness  and  will;  and  if, 
therefore,  the  jury  believed  the  plaintiff's  story,  then  she  was  entitled  to  a 
verdict,  although  the  amount  of  the  damages  would  depend  upon  their  im- 
pression as  to  the  extent  of  the  injury.  Then  as  to  the  other  ground  of 
complaint,  the  law  was  equally  clear,  that  every  medical  practitioner  was 
bound  to  bring  a  reasonable  amount  of  skill  and  care  to  the  performance 
of  the  duty  he  undertook.  The  jury  found  for  the  defendant  on  both 
grounds.  This  shows  the  state  of  the  law  in  reference  to  the  responsi- 
bility of  medical  men  who  undertake  operations  under  anaesthetics. 

But  there  is  another  form  in  which  a  question  of  medical  responsibility 
may  present  itself.  This  is  illustrated  in  the  case  of  Lamb  v.  Barton  and 
Bennett  (Wicklow  Sum.  Ass.,  1873).  This  was  an  action  by  a  widow  to 
recover  damages  for  the  death  of  her  husband  under  chloroform  b}'  reason 
of  the  negligence  and  unskilfulness  of  the  surgeons  in  administering  it. 
Amputation  was  rendered  necessary  by  an  accident;  chloroform  was  ad- 
ministere  ;  and  the  man  died  in  five  minutes,  before  the  operation  could 
be  performed.  The  proof  of  negligence  failed,  and  a  verdict  was  returned 
for  the  defendants.     (Brit.  Med.  jour.,  1873,  ii.  p.  IGO.) 

By  an  o\)eva,tion  he'ing  ahsolutelij  7^eqinred,  are  we  to  understand  that 
it  is  necessary  to  preserve  life,  i  e.,  that  the  wound  will  probably  prove 
fatal  without  it?  Unless  it  could  be  sworn  that  the  treatment  was  re- 
quired, in  the  judgment  of  the  surgeon,  for  the  prese7'valion  of  life  from 
the  injury  inflicted,  it  is  doubtful  whether,  in  the  event  of  death  occurring 
from  such  operation,  the  assailant  would  be  held  responsible  for  the  fatal 
result.  From  cases  hitherto  decided,  it  would  appear  that  the  law  regards 
three  circumstances  in  death  following  surgical  operations:  First,  the 
necessity  of  the  operation  itself  second,  the  competency  of  the  operator; 
and,  third,  whether  the  wound  would  be  likely  to  prove  mortal  without  it. 

Operations  under  a  llistaken  Opinion. — It  may  happen  that  the  wound 
is  not  of  a  mortal  nature,  and  that,  although  an  operation  was  skilfully 
performed,  it  was  not  necessary  to  save  life;  in  other  words,  the  wounded 
person  may  die  from  the  immediate  results  of  a  serious  operation,  per- 
formed under  a  mistaken  view  of  the  case.  A  cancerous  tumor  has  been 
occasionally  mistaken  for  aneurism ;  or  an  artery  has  been  secured,  and 
death  has  followed.  A  case  occurred  in  which  the  carotid  artery  was  tied  ; 
and  another  in  which  the  operation  Avas  performed  on  the  common  iliac 
artery  for  supposed  aneurisms:  in  both  of  these  instances  the  patients 
sank,  and  after  death  the  tumors  were  proved  not  to  have  been  aneurismal. 
The  operations  were  not  necessary,  they  proved  fatal,  and  they  had  been 
performed  under  a  mistake.  In  a  case  reported  by  Syme,  the  carotid 
artery  was  tied,  and  the  patient  died  in  a  few  days  from  loss  of  blood. 
After  death  it  was  found  that  the  tumor  was  not  an  aneurism,  but  a  C3^st. 
(Dub.  Med.  Press.,  1847,  p.  302.) 

Let  us  assume  that  a  man  laboring  under  a  slight  aneurism  of  a  large 
artery  receives  a  blow  on  the  part,  the  tumor  gradually  increases,  and  is 
mistaken  for  an  abscess  by  three  or  four  surgeons,  whose  professional 
standing  would  prevent  their  general  competency  from  being  questioned. 
Under  a  wrong  diagnosis,  it  is  opened,  and  the  patient  dies  on  the  spot. 
In  such  a  case  it  would  be  unjust  to  make  the  aggressor  liable  ;  for,  even 
admitting  that  the  aneurism  had  resulted  from  the  blow,  and  that  a  com- 
petent surgeon  acted  Avith  bona  fides,  the  treatment  \vould  be  unskilful, 
and  the  case  would  fall  under  the  rule  laid  down  by  Lord  Hale  (ante,  p. 
298).     The  real  facts,  however,  may  not  transpire  until  after  the  death  of 


308  DEATH    FROM    PYiEMrA. 

the  wounded  person ;  and  it  mny  then  be  alleged  by  a  prisoner's  counsel 
that  the  operation  was  not  necessary  to  save  lile,  and  that  the  wounded 
man  might  have  recovered  without  it.  From  the  ruling  of  our  judges  on 
various  occasions  in  which  this  question  has  arisen,  it  Avould  ai)pear  that 
the  relative  degree  of  skill  possessed  by  medical  men  is  not  a  question  for 
a  jury  in  a  criminal  case;  although  in  a  civil  case,  as  in  an  action  for 
malapraxis,  the  whole  of  the  medical  facts  are  invariably  submitted  to 
their  judgment.  This  difl'erence  can  only  be  justified  by  the  assumption 
that  a  man  who  inflicts  a  wound  must  take  all  the  consequences — good  or 
bad.  No  operation  would  have  been  required  but  for  the  injury,  and  the 
prisoner  ought  not  to  escape  on  account  of  want  of  skill  in  a  surgeon,  or 
of  a  mistake  made  by  a  skilful  operator.  It  was  decided  in  the  cases  of 
Rex  V.  Quain  and  Reg.  v.  Pym,  that,  although  the  indictment  alleged  that 
the  deceased  died  of  the  wound,  while  in  fact  he  died  from  the  results  of 
an  operation,  yet  it  was  good  in  point  of  law. 

When  a  wounded  "person  is  taken  to  a  hospital  in  which  gangrene  or 
er3^sipelas  is  spreading,  and  he  is  attacked  by  one  of  these  di^eases  before 
or  after  the  performance  of  an  operation,  and  dies,  a  prisoner  may  be  held 
responsible  for  the  fatal  result.  It  might  be  contended  that  the  transpor- 
tation of  the  wounded  man  to  such  a  locality  was  not  absolutely  necessary 
for  his  treatment,  or  for  the  preservation  of  his  life,  and  that  he  Avould  not 
have  died  but  for  the  accidental  presence  of  an  infectious  disease.  Cases 
of  this  kind  cannot  easily  be  determined  by  any  general  rules. 

Pyaemia. — In  addition  to  erysipelas  and  tetanus,  there  is  another  cause 
of  death  which  is  liable  to  follow  personal  injuries  and  operations,  namely 
pysemia,  or  the  introduction  of  pus  into  the  blood  by  absorption  or  by  the 
mouths  of  divided  bloodvessels.  The  purulent  matter  acts  as  a  poison. 
According  to  Wilks's  observations,  pyaemia  is  seldom  observed  after- super- 
ficial injuries  during  the  process  of  healing,  or  after  wounds  resulting  from 
simple  operations;  but  it  occurs  frequently  when  a  bone  is  involved, 
either  from  the  injury  or  as  the  result  of  an  operation.  Inflammation  of 
the  cellular  membrane  surrounding  bone  is  a  condition  highly  favorable 
to  its  occurrence.  The  medical  witness  must  remember  that  pyaemia,  like 
tetanus  and  erysipelas,  may  arise  from  causes  totally  irrespective  of 
wounds  or  personal  injuries.     (Guy's  IIosp.  Rep.,  1859,  p.  179.) 

The  modern  antiseptic  treatment  of  wounds  has  greatly  reduced  the  risk 
of  purulent  infection  and  blood-poisoning ;  and  it  is  not  improbable  that 
the  omission  to  employ  antiseptic  treatment  in  cases  of  wounding  may 
hereafter  be  largely  made  use  of  for  the  purposes  of  defence. 

Questions  relative  to  responsibility  in  death  following  operations  would 
come  more  frequently  before  courts  of  law,  were  it  not  that  the  cases  are 
stopped  in  coroners'  courts  by  verdicts  of  accidental  death.  (Lond.  Med. 
Gaz.,  vol.  19,  p.  15t.)  It  often  unfortunately  happens  that  on  these 
occasions  there  is  a  great  difference  of  opinion  among  medical  witnesses 
respecting  the  connection  of  the  disease  with  the  death,  and  indeed  the 
necessity  for  the  operation  itself.  The  evidence  of  opinion  in  favor  of  the 
prosecution  is  sometimes  balanced  by  that  urged  in  defence,  and,  under 
these  circumstances,  the  only  course  open  to  the  court  is  to  direct  an 
acquittal.  Differences  of  opinion  upon  these  subjects  among  members  of 
the  profession  tend  to  convey  to  the  public  the  impression  that  there  are 
no  fixed  principles  upon  which  medical  opinions  are  based,  and,  conse- 
quently, that  it  would  be  dangerous  to  act  upon  them.  Thus  it  is  that 
we  are  accustomed  to  hear  of  a  medical  prosecution  and  a  medical  defence, 
as  if  the  w^hole  duty  of  a  medical  jurist  consisted  in  his  making  the  best  of 
a  case  on  the  side  for  which  he  happens  to  be  engaged — adopting  the  legal 


MEDICAL    RESPOXSIBILITY    FOR    OPERATIONS.  309 

rule  for  suppressing-  those  points  which  are  against  him,  and  giving  an 
undue  prominence  to  others  Avhich  may  be  in  his  favor.  This  is  an  un- 
fortunate condition  of  things,  for  which  at  present  there  appears  to  be  no 
adequate  remedy. 

Medical  Hesponsibillfi/  for  Operations.  Malapraxis. — This  is  a  verv 
wide  subject,  but  it  can  here  be  only  glanced  at  in  a  few  of  its  leading- 
features.  It  was  held  by  Lord  EUenborough  that,  if  a  person  acting  in  a 
medical  capacit}^  be  guilty  of  misconduct,  arising  either  from  gross  ignor- 
ance or  criminal  inattention,  by  which  a  patient  dies,  he  is  guilty  of  man- 
slaughter. Faults — such  as  omissions,  or  errors  iu  judgment,  to  which 
all  are  liable — are  not  visited  with  this  amount  of  criminalitv.  The  same 
rule  applies  to  the  licensed  as  to  the  unlicensed  practitioner  ;  but  it  would 
appear,  from  the  charge  of  Williams,  J.  (Winchester  Spring  Ass.,  184"), 
that  a  degree  of  unskilfulness  v.'hich  might  lead  to  the  conviction  of  a 
licensed,  would  justify  the  acquittal  of  an  unlicensed  person.  This  was  in 
the  case  of  a  midwife  alleged  to  have  caused  the  death  of  a  woman  on 
whom  she  had  been  called  to  attend.  "The  charge,"  said  the  judge, 
"appeared  to  be  that  bv  want  of  skill  or  attention  to  her  duties,  she  had 
caused  the  death  of  the  woman  upon  whom  she  was  attending.  In  order 
to  constitute  this  offence,  it  must  be  show^n  that  the  party  was  guilty  of 
criminal  misconduct,  either  arising  from  gross  ignorance  or  want  of  skill, 
or  gross  inattention.  With  respect  to  the  degree  of  want  of  skill,  he  must 
say  that  it  was  not  to  be  expected  that  a  midwife,  who  was  called  in  to 
attend  a  person  in  the  humble  class  of  the  deceased,  a  soldier's  wife, 
should  exhibit  what  a  regular  medical  practitioner  would  call  competent 
skill.  It  was  enouiih  if  she  applied  that  humble  skill  which,  in  ordinary 
cases,  would  lead  to  a  safe  deliver^^  She  was  not  bound  to  have  skill 
sufficient  to  meet  peculiar  and  extraordinary  exigencies,  although  in  the 
case  of  a  regular  medical  man  such  skill  might  be  required.  The  class  of 
this  humble  practitioner  was  absolutely  necessary  for  the  poorer  classes, 
and,  although  on  the  one  hand  it  was  fit  the  law^  should  protect  a  patient 
by  punishing  a  person  for  gross  want  of  skill,  yet  he  thought  there  would 
be  much  to  be  lamented  if  it  was  applied  with  such  severity  as  to  render 
a  party  not  possessing  skill  of  this  kind  liable  to  punishment  for  man- 
slaughter." These  observations  would  scarcely  be  strictly  applicable  in 
the  present  day,  when  certified  midwives  are  generally  available,  at  all 
events  iu  our  large  towns. 

Charges  of  manslaughter  have  frequently  been  brought  against  medical 
practitioners  in  cases  of  midwifery.  In  some  instances  gross  mismanage- 
ment has  been  proved;  the  womb,  and  even  parts  of  the  viscera,  have 
been  torn  away,  and  in  such  cases  convictions  have  properly  followed.  It 
is  well  known,  however,  that  much  difference  of  opinion  exists  among  the 
most  eminent  ])ractitioners  of  midwifery  respecting-  the  treatment  to  be 
pursued  in  certain  cases  of  difficulty,  as  where  the  afterbirth  presents 
(placenta  praevia).  There  are  eminent  accoucheurs  who  advise  in  this 
case  entirely  opposite  modes  of  practice,  and  who  look  upon  that  pursued 
by  the  other  as  of  the  most  dangerous  kind.  When  death  is  really  not  a 
result  of  the  medical  treatment,  an  action  for  damages  may  be  brought 
against  the  practitioner  on  a  charge  of  malapraxis. 

It  has  been  a  question  whether  slight  deviations  from  the  ordinary 
mode  of  performins;  operations  should  involve  a  medical  men  in  a  charge 
of  malapraxis.  We  are  not  aware  that  this  question  has  been  hitherto 
raised  in  England. 

When  on  these  occasions  there  is  a  division  of  opinion  among  men  of 
equal  experience  respecting  the  necessity   for  an  operation  or  the  proper 


310  CICATRICES    FROM    AVOUNDS. 

performance  of  it,  a  practitioner  who  is  made  defendant  has  a  right  to  ex- 
pect that  a  verdict  will  be  returned  in  his  favor  ;  since  it  is  not  to  be  sup- 
posed that,  in  order  to  answer  a  charge  of  unskilfulness,  a  man's  practice 
should  receive  the  unanimous  approval  of  the  ivhole  of  his  professional 
brethren,  especially  in  cases  in  which  there  is  an  acknowledged  difference 
of  opinion  respecting  the  treatment.  All  that  appears  to  be  expected  is  a 
reasonable  accordance  in  treatment  with  received  professional  doctrines. 


CHAPTER    XXXI. 

\ 

CICATRIZATION  OF  WOUNDS.  —  EVIDENCE  FROM  CICATRICES. CHANGES  IN  AN  INCISED  'WOUND. 

IS    A    CICATRIX    ALWAYS    A   CONSEQUENCE  OF    A  WOUND  ? ARE    CICATRICES   WHEN  ONCE 

FORMED    INDELIBLE  ? CHARACTERS    OF    CICATRICES. THEIR    AGE  OR    DATE. CICATRICES 

FROM  BLEEDING. CUPPING,   SETONS,   AND    ISSUE? CICATRICES    FROM    BURNS — CICATRICES 

FROM  DISEASE  DISTINGUISHED  FROM  THOSE  OF  WOUNDS. 

Cicatrization  of  Wouvds. — The  time  at  which  a  particular  wound  was 
inflicted  may  become  a  medico-legal  question,  both  in  relation  to  the  living 
and  the  dead.  The  identity  of  a  person,  and  the  correctness  of  a  state- 
ment made  by  an  accused  party,  may  be  sometimes  determined  b}-  an 
examination  of  a  wound  or  its  cicatrix.  So,  .if  a  dead  body  be  found  with 
marks  of  violence  upon  it,  and  evidence  adduced  that  the  deceased  was 
maltreated  at  some  particular  period  before  his  death,  it  will  be  necessary 
for  a  practitioner  to  state  whether,  from  the  appearance  of  the  injuries, 
they  could  or  could  not  have  been  inflicted  at  or  about  the  time  assigned. 
A  case  was  tried  (Reg.  v.  Raynon,  Taunton  Spring  Ass.,  1851)  wherein 
evidence  of  this  kind  served  to  disprove  a  statement  made  by  the  accused. 
The  prisoner  was  charged  with  maliciously  cutting  and  wounding  a 
woman.  There  was  a  cut  upon  his  thumb,  which  he  accounted  ior  by 
saying  it  was  from  an  accident  that  had  occurred  three  weeks  before.  The 
medical  witness  declared,  on  examining  it,  that  it  could  not  have  been 
done  more  than  two  or  three  days,  which  brought  the  period  of  its  inflic- 
tion to  about  the  time  of  the  murderous  assault.  This  with  other  circum- 
stances led  to  a  conviction. 

An  incised  wound  inflicted  on  the  living  body,  not  treated  antisepti- 
cally,  gradually  heals  b}^  adhesion,  when  no  circumstances  interfere  to 
]irevent  the  union  of  the  edges.  For  eight  or  ten  hours  the  edges  remain 
bloody  ;  they  then  begin  to  swell,  showing  the  access  of  inflammation.  If 
the  parts  are  not  kept  well  in  contact,  a  secretion  of  a  serous  liquid  is 
poured  out  for  about  thirty-six  or  forty-eight  hours.  On  the  third  day 
this  secretion  acquires  a  purulent  character.  On  the  fourth  and  fii'th  days 
suppuration  is  fully  established,  and  it  lasts  five,  six,  or  eight  days.  A 
fibrous  layer,  which  is  at  first  soft  and  easily  broken  down,  then  makes  its 
appearance  between  the  edges  of  the  wound:  this  causes  them  gradually 
to  unite,  and  thus  is  produced  what  is  termed  a  cicatrix.  Cicatrization 
is  complete  about  the  twelfth  or  fifteenth  day  if  the  wound  is  simple,  of 
little  depth  and  width,  and  aff'ecting  only  parts  endowed  with  great 
vitality.  The  length-  of  time  required  for  these  changes  to  ensue  will 
depend:  1.  On  the  situation  of  the  wound;  wounds  on  the  legs  are 
longer  in  healing  than  those  on  the  upper  part  of  the  body.  If  a  wound 
is  situated  near  a  joint,  so  that  the  edges  are  continually  separated  by  the 


IS    A    CICATRIX    ALWAYS    A    RESULT?  311 

motion  of  the  parts,  cicatrization  is  retarded.  2.  On  tlie  extent ;  a  deep 
or  wide  wound  is  long-  in  undergoing  cicatrization.  Wounds  involving 
many  and  diflerent  structures  are  also  longer  in  healing  than  those  simply 
affecting  the  skin  and  muscles.  3.  On  the  age  and  health  of  the  wounded 
person  ;  the  process  of  cicatriz-ation  is  slow  in  old  persons,  as  well  as  in 
those  who  are  diseased  and  infirm.  In  an  incised  wound  the  cicatrix  is 
generally  straight  and  regular;  but  it  is  semilunar  if  the  cut  is  oblique. 
It  has  been  said  that  the  cicatrices  of  incised  wounds  are  rectilinear,  but 
this  is  not  always  the  case.  In  general,  they  are  more  or  less  elliptical, 
being  wider  in  the  centre  than  at  the  two  ends — this  appears  to  be  due 
principally  to  the  elasticity  of  the  skin  and  the  convexity  of  the  subjacent 
parts;  thus  it  is  well  known  that  in  every  wound  on  the  living  body  the 
edges  are  more  separated  in  the  centre  than  at  the  ends,  and  this  physical 
condition  influences  the  process  of  cicatrization.  When  the  wound  is  in  a 
hollow  surface,  or  over  a  part  where  the  skin  is  not  stretched,  as  in  the 
armpit  or  groin,  then  the  cicatrix  may  be  rectilinear,  or  of  equal  width 
throughout.  If  there  were  any  loss  of  substance  in  an  incised  wound,  or 
if  the  wound  was  lacerated  or  contused,  the  cicatrix  would  be  irregular, 
and  the  healing  would  proceed  by  granulation  The  process  might  then 
occupy  five,  six,  or  eight  weeks,  according  to  circumstances.  When 
healed,  the. cicatrix  would  be  white,  and  if  there  had  been  a  loss  of  sub- 
stance it  would  be  depressed  and  present  a  puckered  appearance  ;  the  sur- 
face of  the  skin  would  be  uneven.  (See  Kriigelstein  Henke's  Zeitschr.  der 
S.  A.,  1844,  b.  2,  s,  75.)  Under  antiseptic  treatment,  suppuration  of 
wounds  is  in  a  great  measure  avoided. 

Is  a  Cicatrix  always  a  Consequence  of  a  WouncU — Assuming  that  the 
term  "  wound"  implies  a  breach  of  continuity  affecting  the  layers  of  the 
true  skin  (cutis),  a  cicatrix  is  always  produced  in  the  process  of  healing. 
Slight  punctures  or  incisions  with  a  lancet,  and  even  leech-bites,  affecting 
only  the  surface  of  the  cutis,  may  leave  no  trace  after  a  few  weeks  or 
months.  In  an  even  cut  made  by  a  very  sharp  instrument,  especially  if  it 
is  in  the  direction  of  the  fibres  of  subjacent  muscles,  and  the  parts  are  kept 
in  close  contact,  the  cicatrix  is  even,  linear,  and  sometimes  so  small  as  to 
be  scarcely  perceptible;  and,  if  the  skin  is  white,  it  may  be  easily  over- 
looked. Wounds  of  this  kind  are  not,  however,  commonly  the  subject  of 
medico-legal  inquiry.  If,  on  examining  a  part,  where  at  some  previous 
time  a  stab,  cut,  or  burn  involving  the  cutis  is  alleged  to  have  been  in- 
flicted, we  find  no  mark  or  cicatrix,  it  is  fair  to  assume  that  the  allegation 
is  false,  and  that  no  wound  has  been  inflicted,  making  due  allowance  for 
the  fact  that  mere  abrasions  of  the  cuticle,  or  very  slight  punctures  and 
incisions,  often  heal  without  leaving  any  well-marked  cicatrices. 

A  trial  took  place  at  the  Old  Bailey  in  1834,  in  which  a  man  was 
wrongly  charged  with  being  a  convict,  and  with  having  unlawfully  re- 
turned from  transportation.  The  chief  clerk  of  Bow  Street  produced  a  certifi- 
cate, dated  in  1817,  of  the  conviction  of  a  person,  alleged  to  be  the  prisoner, 
under  the  name  of  Stuart.  The  governor  of  the  gaol  in  which  Stuart  was 
confined  believed  the  prisoner  to  be  the  person  who  was  then  in  his  cus- 
tody. The  guard  of  the  hulks  to  which  Stuart  was  consigned  from  the 
gaol,  swore  most  positively  that  the  prisoner  was  the  man.  On  the 
cross-examination  of  this  witness,  he  admitted  the  prisoner  Stuart,  who 
was  in  his  custody  in  1817,  had  a  wen  on  his  left  hand;  and  so  well 
marked  was  this  that  it  formed  a  part  of  his  description  in  the  books  of  the 
convict-hulk.  The  prisoner  said  his  name  was  Stipler  ;  he  denied  that  he 
was  the  person  named  Stuart,  but  from  the  lapse  of  years  he  was  unable 
to  bring  forward  any  evidence.     The  recorder  was  proceeding  to  charge 


312  PERMANENCE    OF    CICATRICES. 

the  jury,  when  the  counsel  for  the  defeuce  requested  to  be  permitted  to 
put  a  question  to  an  eminent  surg'eon,  Carpue,  who  happened  accidentally 
to  be  present  in  court.  He  deposed  that  it  was  impossible  to  remove  avch 
a  loen  as  had  been  described  wiUiout  leaving  a  viark  or  cicatrix.  Both 
hands  of  the  prisoner  w^ere  examined,  but  no  wen,  nor  any  mark  of  a  wen 
having  been  removed,  was  found.  Upon  this  the  jury  acquitted  the 
prisoner. 

The  cicatrices  resulting  from  wounds  after  the  performance  of  surgical 
operations  are  commonly  well  indicated  by  their  regular  form  and  their 
situation.  They  may  present  the  characters  of  punctured  or  incised 
wounds,  or  a  mere  division  of  parts  for  the  excision  of  tumors.  As  the 
healing  process  is  assisted  by  art,  the  cicatrices  are  commonly  marked  by 
great  regularity.  The  identity  of  a  living  person,  or  of  a  dead  body,  may 
be  proved  by  the  existence  of  a  cicatrix  which  has  been  the  result  of  a 
surgical  operation.  There  can  be  no  pretence  for  saying  that  such  cica- 
trices, when  they  have  involved  the  true  skin,  disappear.  Whether  the 
part  is  wrinkled  or  unusually  fat,  the  cicatrix  may  be  found  if  it  has  ever 
existed. 

A  case  in  which  this  question  respecting  the  permanency  of  cicatrices 
from  wounds  was  raised,  was  referred  to  the  author  under  the  following 
circumstances.  (Reg.  v.  Reed  and  Donelan,  Chelmsford  Spring  Ass., 
1842.)  The  medical  evidence  was  to  the  effect  that  "  there  w^as  a  wound 
on  the  nose  of  the  woman,  apparently  inflicted  by  some  sharp  instrument, 
and  the  bridge  of  the  nose  was  broken  down.  The  weapon  had  entered 
half  an  inch,  and  had  caused  profuse  bleeding.  The  wound  was  so  deep 
that  if  it  had  entered  a  little  higher  up  in  the  Qje,  it  might  have  caused 
death."  In  the  defence  it  was  urged  that  no  w^eapon  had  been  used  ;  and 
that,  although  the  male  i)risoner  had  struck  the  wounded  woman  a  blow, 
the  female  prisoner  had  taken  no  share  in  the  assault.  It  does  not  appear 
that  any  medical  evidence  was  called  to  show  in  what  state  the  assailed 
person  was  at  the  time  of  the  trial.  It  was  assumed  that  a  w^eapon  must 
have  been  used,  and  the  prisoners  were  convicted,  the  one  of  stabbing, 
and  the  other  of  aiding  and  abetting.  About  six  months  after  the  alleged 
stabbinjr,  and  some  weeks  after  the  prisoners  had  been  convicted  and  sen- 
tenced to  punishment,  the  face  of  the  injured  w^oman  was  examined  by 
two  surgeons  (one  of  them  a  practitioner  of  twenty -eight  yeai"s'  standing), 
and  they  both  deposed  that  there  was  no  mark  of  a  cicatrix  from  a  stab, 
or  fracture  of  the  nose,  or  of  any  personal  injury  whatever.  Other  sur- 
geons were  requested  to  examine  her  face,  but  this  she  declined  permitting ; 
and,  as  there  was  no  power  to  co,mpel  her,  the  medical  facts  of  the  case 
were  referred  to  Quain,  Guthrie,  Key,  and  the  author.  The  evidence  of 
the  surgeons  at  the  trial  was  laid  before  them,  with  the  statements  of  the 
two  surgeons  who  subsequently  examined  the  woman.  They  all  agreed 
that,  if  such  a  wound  as  that  described,  in  the  medical  evidence  had  been 
inflicted,  there  would  have  been  a  visible  cicatrix  and  a  ridge  or  prominence 
indicative  of  the  situation  where  the  bridge  of  the  nose  was  stated  to  have 
been  broken  ;  and  as  no  such  marks  could  be  perceived  by  two  well-in- 
formed surgeons,  they  considered  it  improbable  either  that  such  a  wound 
as  that  described  could  have  been  inflicted,  or  that  a  weapon  could  have 
been  used  in  the  assault.  The  question  really  to  be  decided  was — Could 
all  traces  of  such  a  w^ound  as  that  above  described  be  efi'aced  in  a  period 
of  six  months  or  even  during  the  life  of  a  person?  Either  the  wound 
must  have  been  misdescribed,  or  some  marks  of  its  past  existence, 'in  the 
form  of  a  cicatrix,  would  unquestionably  have  been  found.  In  Barnett  v. 
Roberts  (Court  of  Exch.,  Nov.  1867),  an  action  was  brought  by  a  surgeon, 


CHARACTERS    OF    CICATRICES.  313 

for  injury  resulting  from  an  assault  by  the  defendant.  It  appeared  from 
the  evidence  that  the  defendant  struck  the  plaintiff  two  violent  blows  on 
the  head  with  the  handle  of  his  umbrella.  It  was  alleged  that  this  had 
caused  a  fracture  of  the  skull,  and  had  produced  a  long  and  painful  illness. 
Erichsen  and  Winslow  gave  evidence  for  the  plaintiff  to  the  effect  that  in 
their  judgment  the  skull  was  fractured,  the  brain  organically  injured,  and 
the  plaintiff's  recovery  rendered  practically  hopeless.  On  the  other  hand, 
for  the  defence,  Partridge  and  Wood,  with  other  witnesses,  deposed  that 
the  skull  was  not  fractured,  and  that  the  depression  supposed  to  indicate 
the  fracture  was  congenital  and  not  the  result  of  a  blow  or  accident.  A 
skull  with  a  natural  depression  in  it  was  produced  and  shown  to  the  jury. 
The  plaintiff's  head  was  examined  in  court  by  Partridge.  He  could  feel 
no  cicatrix  in  the  alleged  seat  of  injury,  but  there  was  a  thickening  over 
the  depression.  On  this  evidence  the  jury  could  not  agree.  There  would 
be  no  difficulty  in  such  a  case  if  a  careful  examination  was  made  soon  after 
the  assault ;  but  when  surgical  opinions  are  taken  some  weeks  or  months 
afterwards,  the  witnesses  may  disagree.  Even  if  there  had  been  a  cicatrix 
on  this  occasion,  this  would  not  have  proved  that  the  skull  had  been 
fractured.  The  injury  to  the  brain  might  well  have  been  a  result  of  the 
violence,  although  there  had  been  no  fracture. 

Characters  of  Cicatrices.  Their  Age  or  Date. — In  an  early  stage  a 
cicatrix  is  softer  and  redder  than  the  surrounding  skin,  but  after  some 
months  or  years  it  becomes  white,  hard,  smooth,  and  shining.  The 
fibrous  substance  of  which  it  is  formed  receives  less  blood  than  the  un- 
injured skin;  hence,  on  compressing  the  skin  around  an  old  cicatrix,  its 
situation  and  form  are  well  marked  by  reason  of  the  blood  not  readily 
entering  into  it  on  removal  of  the  pressure.  As  the  age  of  a  cicatrix  in- 
creases, it  becomes  smaller,  thicker,  whiter,  more  shining,  and  less  sensi- 
tive. It  is  fibrous  in  structure,  dense,  without  sebaceous  follicles,  adipose 
cells,  or  hairs,  and  it  contains  but  few  absorbents  and  exhalants.  The 
time  required  for  these  changes  to  take  place  cannot  be  defined.  In  one 
person  they  may  be  observed  in  a  few  months,  and  in  another  only  after 
some  years.  The  tissue  of  which  an  old  cicatrix  is  formed  is  different 
from  that  of  the  skin  ;  it  is  harder,  contains  less  blood,  and  is  destitute  of 
any  colored  pigment,  so  that  its  whiteness,  which  is  remarkable  on  the 
cicatrized  skin  of  a  negro,  is  retained  through  life.  If  any  cicatrices  were 
easily  obliterated,  it  would  be  those  which  are  even  and  regular — the 
results  of  incised  wounds  by  sharp  instruments  ;  but  cicatrices  of  this  kind 
have  certainly  retained  their  characters  unchanged  in  one  instance  for 
twenty,  and  in  another  for  twenty-five  years.  According  to  the  observa- 
tions of  Dupuytren  and  Delpech,  the  substance  of  a  cicatrix  is  not  converted 
into  true  skin — it  never  acquires  a  rete  mucosum,  i.e.  the  membrane  which 
gives  color  to  the  skin.  Although  this  is  generally  true  of  incised  and 
punctured  wounds,  yet  contused  and  lacerated  wounds  on  the  legs  of 
persons  advanced  in  life  frequently  present  a  brown  discoloration.  In  the 
cicatrices  of  lacerated  and  contused  wounds,  the  form  of  the  weapon  with 
Avhich  the  wound  was  inflicted  is  sometimes  indicated.  It  is  not,  however, 
easy  to  distinguish  the  cicatrix  of  a  stab  of  old  date  from  that  produced 
by  a  pistol-bullet  fired  from  a  distance.  In  both  cases  the  edges  may  be 
rounded  and  irregular,  and  the  cicatrix  puckered,  unless  the  stab  has  been 
produced  by  a  broad-bladed  weapon.  If  no  mark  of  cutting  can  be  ])er- 
ceived  within  a  few  months  of  the  period  at  Avhich  a  severe  wound  is 
alleged  to  have  been  inflicted,  it  is  reasonable  to  infer  that  there  has  been 
some  mistake,  or  that  the  circumstances  have  been  exaggerated.  Cica- 
trices increase  in  size  during  the  process  of  growth.     Adams  found,  in 


314  CICATRICES  FROM  DISEASE. 

the  case  of  an  infant  who  had  been  operated  on,  a  cicatrix  doubled  in 
length  and  greatly  increased  in  width  after  eighteen  years.  Yaccination 
scars  in  the  adult  are  frequently  seen  from  one-half  to  three-quarters  of 
an  inch  in  diameter,  the  increased  size  from  the  original  puncture  arising 
from  the  growth  of  the  cicatrix.  (Brit.  Med.  Jour.,  1873,  ii.  p.  174.)  Paget 
has  made  a  similar  observation.  The  growth  takes  place  pari  passu  with 
the  body.     (Lect.  on  Path.,  vol.  i.  p.  49.) 

It  is  important  to  observe  that  all  cicatrices  are  of  smaller  size  than  the 
original  wound,  for  there  is  a  contraction  of  the  skin  during  the  process  of 
healing.  This  is  especially  noticed  with  regard  to  the  cicatrix  of  a  stah, 
which  is  frequently  of  a  triangular  form.  A  recent  stab,  owing  to  the 
elasticity  of  the  skin,  is  smaller  than  the  weapon  ;  and  the  resulting  cica- 
trice is  always  smaller  than  the  Avound.  Hence  it  is  difficult  to  judge  of 
the  size  of  the  stabbing  instrument  from  an  examination  of  an  old  cicatrix. 
Cicatrices  arising  from  a  loss  of  substance  in  the  cutis  or  true  skin  are 
usually  indicated  by  a  depression.  In  gunshot-wounds,  if  the  projectile 
has  been  fired  from  a  distance,  the  cicatrix  is  of  smaller  dimensions  than 
the  ball.  It  represents  a  disli  depressed  in  the  centre,  and  attached  to  the 
parts  beneath,  while  the  skin  is  in  a  state  of  tension  from  the  centre  to  the 
circumference.  The  amount  of  depression  is  great  in  proportion  to  the 
quantity  of  cellular  membrane  beneath.  If  the  bullet  has  been  fired  near 
to  the  body,  the  cicatrix  is  large,  deep,  and  very  irregular.  In  this  case 
there  may  be  the  bluish  mark  of  tattooing  from  the  gunpowder  carried 
into  the  skin.  If  the  projectile  has  made  two  apertures,  the  aperture  of 
exit  is  known  by  the  greater  size  and  irregularity  of  the  cicatrix.  (See 
Edin.  Month.  Jour.,  1854,  vol.  10,  p.  370.) 

There  are  no  appearances  in  a  cicatrix  which  will  allov;  us  to  fix  the 
date  at  which  the  wound  leading  to  its  production  was  inflicted,  and  it  is 
often  most  difficult  to  say  how  or  by  what  means  it  was  inflicted.  If  the 
person  is  living,  he  may  give  a  description  of  the  injury  and  the  date  of 
its  production,  w^hich  may  be  consistent  or  inconsistent  with  the  appear- 
ances presented.  As  Caspar  justly  remarks,  it  requires  more  than  two, 
three,  or  four  weeks  to  produce  the  hard,  white,  shining  appearance  of  an 
old  cicatrix  ;  but  when  it  has  once  acquired  these  characters,  there  are  no 
medical  data  for  enabling  us  to  determine  whether  the  injury  Avas  inflicted 
two,  three,  or  even  ten  years  before.  A  proper  attention  to  the  number, 
situation,  and  appearances  presented  by  cicatrices  on  the  living  or  dead 
body,  will,  hoAvever,  sometimes  enable  a  medical  witness  to  establish  or 
disprove  the  identity  of  persons. 

Cicatrices  from  Wounds  or  Disease.  Imputed  Cicatrices. — As  there 
are  imputed  wounds,  so  there  may  be  imputed  cicatrices.  It  is  rare  to 
hear  of  frauds  of  this  description  :  the  wound  must  be  made  in  anticipa- 
tion at  a  long  date  in  order  to  give  the  appearance  of  an  old  cicatrix  ;  the 
part  wounded  must  be  selected  in  order  to  carry  out  the  fraud  ;  and  the 
person  producing  the  wound  may  carry  the  incision  or  puncture  too  deeply 
or  too  superficially,  and  thus  lead  to  detection.  It  is  more  likely  that  an 
impostor  may  seek  to  gain  his  object  either  by  attributing  the  cicatrices 
of  wounds  accidentally  received  to  other  causes,  or  by  ascribing  cicatrices 
which  have  resulted  from  disease  to  some  particular  cause  occurring  in 
early  life.  Thus  an  impostor  with  old  scars  upon  his  person  may  make 
use  of  them  as  proofs  of  identity.  Such  scars  may  really  ex*ist ;  they  may 
1)0  clearly  proved  to  be  of  old  date,  and  they  may  be  assigned  to  causes 
which  cannot  be  disproved  except  by  a  close  medical  examination.  The 
pcars  or  cicatrices  may  have  arisen  from  scrofulous  ulcers  or  abscesses, 
in  which  case  it  would  not  be  difficult  to  distinguish  them  from  the  cica- 


CICATRICES  FROM  DISEASE.  315 

trices  of  wounds.  In  the  case  of  Smyth  i;.  Smyth  (Gloucester  Sum.  Ass., 
1853),  the  plaintiff  claimed  to  be  the  rightful  heir  to  certain  estates  occu- 
pied by  the  defendant.  He  based  his  claim  upon  some  deeds  (alle;^ed  by 
the  defendant  to  have  been  forged),  in  which  it  was  stated  that  the  lost 
heir  to  these  estates  would  l)e  known  by  certain  njarks  on  his  right  hand 
and  wrist,  suggested  to  have  been  received  at  the  time  of  his  birth,  iu 
1797,  by  reason  of  his  having  been  brought  into  the  world  with  instru- 
ments. It  was  one  of  the  curious  features  of  this  extraordinary  case  of 
imposture  that  no  medical  opinion  was  taken  or  required  by  the  claimant, 
on  the  probable  nature  and  origin  of  these  marks.  When  requested  at 
the  trial  to  show  his  hand  to  the  jury,  the  mark  had  the  appearance  of  a 
puckered  cicatrix  from  a  scrofulous  ulcer  near  the  wrist.  Similar  marks  from 
scrofulous  sores  were  seen  upon  his  neck.  His  statements  regarding  him- 
self, and  the  circumstances  on  which  he  based  his  claim,  were  so  improbable- 
and  contradictory  that  the  case  speedily  broke  down.  A  question  of  this 
kind  may  occasionally  present  some  difficulty,  but  a  close  examination  of 
the  cicatrix,  with  a  consideration  of  the  statement  of  the  person  on  its 
mode  of  production,  will  enable  a  practitioner  to  arrive  at  a  satisfactory 
conclusion  respecting  its  origin.  Scrofulous  ulcers  are  generally  observed 
to  leave  irregular  and  deeply-furrowed  cicatrices,  with  smooth  depressions, 
surrounded  by  hard  and  uneven  margins.  According  to  Schneider,  the 
scorbutic  cicatrix  is  at  first  dark,  bluish-red  in  color,  soft  to  the  touch, 
somewhat  raised  and  rather  painful  ;  in  the  course  of  time  it  becomes  flatter, 
of  a  reddish-brown  color,  very  thin  and  easily  injured.  Syphilitic  cica- 
trices are  characterized  by  great  loss  of  substance  ;  they  approximate  the 
margins  of  the  deep  ulcers  before  their  granulations  have  had  time  to 
reach  the  surface.  G la77 d ula r  cicatv'iQen  are  irregularly  tumefied,  generally 
deep,  hardened,  and  of  a  reddish-brown  color.  These  varieties  cannot 
easily  be  mistaken  for  the  cicatrices  of  wounds  ;  but  it  is  not  so  easy  to  dis- 
tinguish them  from  each  other.  Malle  remarks  that  the  form  and  shape 
of  the  cicatrix  depend  less  on  the  cause  producing  it  than  on  its  anatomi- 
cal position.  The  elasticity  of  the  skin,  the  looseness  or  density  of  the 
cellular  tissue  beneath  the  depression  or  convexity  of  the  surface,  and  the 
tension  of  the  muscles,  are  circunistances  which  will  modify  the  form  of 
the  ulcer  and  the  cicatrix  proceeding  from  it.  (Ann.  d'Hyg.,  1840,  t.  1, 
430.)  An  expert  can  seldom  do  more  than  distinguish  the  cicatrices  of 
ulcers  arising  from  morbid  causes  from  those  which  have  resulted  from 
violence.  Cicatrices  in  the  inguinal  regions  raise  a  presumption  that  they 
are  of  si/philitic  origin,  but  it  is  impossible  to  say  that  they  may  not  have 
been  derived  from  simple  abscesses.  The  cicatrices  of  scrofulous  ulcers 
have  some  resemblance  to  those  produced  by  firearms,  but  it  mav  be  pre- 
sumed that  they  are  of  a  scrofulous  origin  when  they  are  situated  in  the 
region  of  the  neck,  below  the  jaw,  or  in  the  course  of  the  parotid  gland, 
especially  when  there  is  any  enlargement  of  the  neighboring  glands.  A 
puckered  and  folded  state  of  the  skin  around  the  cicatrix  would  confirm 
this  opinion. 

Is  a  cicatrix,  when  once,  formed,  ever  removed  or  so  altered  by  time 
as  to  be  no  longer  recognizable? — This  is  a  question  which  sometimes  pre- 
sents itself  to  a  medical  jurist  both  in  civil  and  criminal  proceedings. 
When  a  cicatrix  has  been  produced  by  the  healing  of  a  wound  involving 
a  loss  of  substance  in  the  cutis  or  true  skin,  it  is  permanent.  In  wounds 
involving  the  whole  substance  of  the  skin,  the  cicatrix  which  is  once  formed 
does  not  disappear,  althouizh  it  may  undergo  some  changes  and  become 
less  distinct  in  after-life.  Wounds  which  heal  by  suppuration  and  granu- 
lation generally  leave  behind  them  cicatrices  which  remain  for  life.     The 


316  PERMANENCE    OP    CICATRICES. 

marks  arising  from  the  pustules  of  vaccination,  smallpox,  herpes  zoster 
(shingles),  and  those  produced  by  setons  and  issues,  leave  cicatrices  easily- 
recognizable  at  any  period.  Cicatrices  of  wounds  made  after  the  com- 
pletion of  growth  do  not  increase  in  size  :  they  retain  the  same  proportions 
through  life.  When  the  substance  of  the  skin  has  been  penetrated,  it  re- 
tracts, owing  to  the  yellow  elastic  fibrous  tissue  which  it  contains,  and 
the  gap  thus  made  is  filled  up  with  white  fibrous  or  cicatricial  tissue, 
which  forms  a  marked  contrast  with  the  surrounding  skin.  This  may  be 
seen  in  the  cicatrices  of  the  apertures  made  by  bleeding,  or  in  the  scars 
left  by  herpes  zoster.  This  cicatrix  tissue,  or  connective  tissue,  as  it  is 
called,  when  once  formed,  is  permanent.     It  never  wears  out  or  wastes. 

A  man  may  allege,  in  proof  of  his  identity,  that  at  a  former  period  of 
his  life  he  was  bled  in  the  arm,  foot,  or  tempoi'al  artery,  that  he  had 
undergone  cupping,  or  that  he  had  had  a  seton  or  issue  in  his  arm.  The 
simple  questions  for  a  medical  witness  will  then  be  :  Are  the  marks  left  by 
these  operations  present  ?  Are  they  visible  in  the  situations  in  which 
such  operations  are  usually  performed  ?  Do  they  present  such  cicatrices 
as  would  be  likely  to  result  from  the  alleged  operations?  If  not  visible 
at  the  time  of  examination,  is  it  or  is  it  not  probable  that  they  may  have 
spontaneously  disappeared  by  lapse  of  time?  These  simple  questions  may 
carry  wi-th  them  momentous  issues,  either  in  a  civil  or  criminal  case. 

With  regard  to  cupping,  when  the  operation  is  properly  performed,  the 
numerous  small  and  slightly  elliptical  cicatrices  are  well  indicated  by  their 
whiteness  and  symmetrical  position.  The  cicatrix  left  by  the  use  of  the 
lancet  in  bleeding  from  a  vein  in  the  arm  or  foot  is  similar  to  that  of 
cupping — white,  linear,  slightly  elliptical,  with  its  length  in  the  direction 
of  the  vessel,  and  not  across  it.  About  sixty  years  ago  bleeding  from  the 
arm  was  a  frequent  operation,  the  same  person  requiring  to  be  bled  at 
spring  and  fall.  The  cicatrices  that  resulted  were  always  perceptible;  in 
some  instances,  when  the  person  had  been  bled  several  times  in  or  near 
the  same  part  of  the  vein,  a  hard  or  knotted  white  cicatrix  was  produced, 
rising  above  the  level  of  the  skin.  There  is  no  reason  to  believe  that  such 
a  mark,  involving  as  it  does  the  Avhole  cutis,  ever  disappears.  Beck 
quotes  the  case  of  a  child  (Noiseu),  which  had  been  bled  in  the  right  arm 
when  sixteen  months  old.  When  nearly  four  years  old  the  child  was  lost, 
and  two  years  subsequently  the  godmother,  seeing  two  boys  pass,  was 
struck  by  the  voice  of  one  of  them  ;  she  called  him  to  her,  and  was  con- 
vinced that  it  was  her  lost  godson.  The  identity  was  also  considered  to 
be  proved  by  the  discovery  of  a  cicatrix  from  bleeding  in  the  right  arm, 
and  a  cicatrix  from  an  abscess  in  the  left  knee,  both  of  which  were  present 
in  the  lost  child,  and  also  in  the  one  that  was  found.  The  latter,  however, 
bad  upon  his  body  marks  of  the  smallpox,  while  no  marks  of  this  kind 
were  on  the  child  when  lost.  The  child  was  claimed  by  a  widow  (Labrie), 
and  many  witnesses  deposed  that  it  was  really  her  son.  The  Court  de- 
cided in  her  favor,  chiefly  on  the  ground  that  the  lost  child  was  not 
marked  with  the  smallpox  (Beck's  Med.  Jur.,  2d  ed.,  p.  222).  It  was 
admitted  that  the  found  child  had,  on  the  arm, and  knee,  cicatrices  similar 
to  those  w'hich  were  known  to  exist  in  the  one  that  was  missing,  and  had 
the  medical  witnesses  agreed  about  the  causes  of  them,  it  is  probable  that 
the  decision  would  have  been  different.  The  cicatrix  on  the  knee  was 
ascribed  to  the  use  of  caustics  by  some  of  the  surgeons,  and  to  a  slight 
abrasion  by  others.  The  widow  admitted  that  her  child  had  never  been 
bled  in  the  arm,  while  the  missing  child  had  certainly  undergone  this 
operation  ;  but  on  the  question  as  to  the  presence  of  a  cicatrix  from  bleed- 
ing, there  was  a  conflict  of  medical  opinion.    Three  surgeons  examined  the 


MEDICAL    EVIDENCE SCARS.  317 

cieatrix,  and  declared  that  it  had  been  made  with  a  sharp  instrument. 
Others  deposed  that  it  was  not  a  cicatrix  from  bleeding,  but  from  the 
opening  of  an  abscess.  As  the  child  had  been  missing-  two  years,  it 
might  have  had  the  smallpox  in  the  meantime.  If  a  proper  examination 
of  the  two  cicatrices  had  been  made  by  medical  assessors  appointed  by  the 
Court  this  conflict  of  medical  opinion  would  not  have  arisen,  and  the  de- 
cision might  have  been  ditterent. 

According  to  Caspar,  the  cicatrix  left  by  venesection  may  sometimes 
disappear,  although  he  adduces  no  fact  in  proof  (Gerichtl.  Med.,  vol.  i.  p. 
113) ;  and  ordinary  surgical  experience  is  against  it.  Devergie  correctly 
states  that  every  Avound  which  involves  the  thickness  of  the  skin  (cutis) 
leaves  a  cicatrix  which  is  indelible.  (M^d.  Leg.,  vol.  ii.  p.  217.)  Accord- 
ing to  him,  it  may  become  less  distinct  by  time,  but  it  never  entirely  dis- 
appears. In  all  contested  cases  of  this  kind,  where  there  is  ample  room 
for  a  difference  of  opinion,  it  would  be  more  satisfactory  to  take  the  evi- 
dence of  skilled  medical  assessors  appointed  by  the  Court,  than  to  receive 
that  of  medical  men  specially  selected  by  solicitors  to  uphold  their  different 
views  of  the  case.  This  would  be  giving  its  true  value  to  medical  testi- 
mony, in  aiding,  by  a  proper  interpretation  of  physical  signs,  to  clear 
awavthe  doubts  which  necessarily  arise  by  trusting  to  a  supposed  remem- 
brance of  the  features,  voice,  and  gesture,  after  the  lapse  of  many  years. 

At  the  celebrated  Tiehborne  trial  (Reg.  v.  Castro,  Q.  B.,  1813),  the 
possibility  of  the  disappearance  of  scars  was  made  a  matter  of  great  im- 
portance as  bearing  upon  identity.  Roger  Tiehborne,  the  missing  baronet, 
whilst  on  the  ship  Pauline,  met  with  an  accident  by  which  a  fish-hook 
passed  clean  through  one  eyelid,  and  had  to  be  pulled  through  and  out; 
and  it  was  truly  alleged  that  such  a  wound  would  leave  a  scar,  and  that 
this  would  probably  be  indelible.  He  had  also  been  bled,  an  operation 
which  usually  leaves  indelible  scars.  It  was  also  certain  that,  when  a  lad, 
Roger  had  either  an  issue  or  a  seton  on  his  left  arm.  According  to  the 
prosecution  it  was  an  issue,  and  Avas  kept  open  by  a  pea.  According  to 
the  defence  it  was  a  seton.  On  the  defendant's  arm  there  was  no  mark 
either  of  an  issue  or  of  a  seton.  Moreover,  there  was  no  scar  on  the  eye- 
lid such  as  would  have  been  produced  by  the  fish-hook.  Further,  Roger 
had  his  temporal  vein  opened  when  a  young  man  ;  and  there  was  no  scar 
on  the  defendant's  temples.  Although  it  must  be  admitted  that  a  A^ene- 
section-mark  may  disappear  in  the  course  of  time,  it  is  in  the  highest  de- 
gree improbable  that  several  cicatrices  such  as  have  been  described  Avould 
all  disappear.  The  defendant  was  convicted  of  the  attempted  imposture; 
or  rather  of  perjury  in  swearing  at  the  first  (civil)  trial  that  he  Avas  the 
veritable  Sir  Roger  Tiehborne  (see  p.  325,  790^^).  In  the  case  of. vene- 
section-marks a  medical  jurist  may  be  required  to  give  an  opinion  on  the 
cause  and  date  of  their  production;  and  in  the  cai^e  of  the  alleged  disap- 
pearance of  scars,  he  may  be  required  to  say  Avhether — assuming  them  to 
have  once  existed — they  could  have  disappeared,  either  from  natural  causes, 
or  from  chemical  or  other  means  employed  to  obliterate  them.  In  some 
countries  it  is  the  custom  to  brand  convicts,  and  the  cicatrix  from  the 
brand-mark — a  letter  burnt  into  the  skin — is  regarded  as  the  strongest 
proof  of  identity. 

B}"  a  remarkable  coincidence,  two  persons  may  have  cicatrices  on  or 
about  the  same  part  of  the  body,  produced  by  cuts,  punctures,  or  abscesses 
in  early  life;  and  serious  mistakes  may  be  made  under  these  circum- 
stances. A  case  is  reported  to  have  occurred  in  France,  in  1194,  in  Avhich 
a  man  named  Lesurgues  Avas  tried,  convicted,  and  executed  for  robbery 
and  murder.     There  Averc  some  doubts  at  the  time  as  to  his  identity  ;  and 


818        CICATRICES    FROM    SEIONS,    ISSUES,    AND    PUSTULES. 

strong  exertions  ■u'ere  made  to  save  his  life.  Soon  after  his  execution,  the 
real  murderer  was  discovered,  between  whom  and  Lesurgues,  who  had  had 
no  hand  or  part  in  the  crime,  there  existed  a  wonderful  resemblance  in 
stature,  complexion,  and  features.  But  the  most  extraordinary  part  of  the 
case  was  that  Lesurgues,  like  the  real  criminal,  had  a  cicatrix  or  scar  on 
the  forehead,  and  another  on  the  hand ;  and  there  is  no  doubt  that  these 
points  of  resemblance,  Avhich  upon  a  proper  scientific  examination  might 
have  been  proved  to  be  really  different,  became  the  turning-point  of  the 
case,  and  led  to  the  conviction  of  an  innocent  person. 

The  parts  selected  for  scions  or  iasues  are  generally  about  the  shoulder, 
the  nape  of  the  neck,  or  the  upper  arm.  The  situation  of  the  cicatrices 
may  thus  serve  to  throw  some  light  on  their  origin.  The  cicatrix  left  by 
an  issue  cannot  be  mistaken  for  the  cicatrix  caused  by  a  seton.  In  the 
first  place,  it  is  single,  depressed  below  the  level  of  the  skin,  and  rounded 
in  its  margin  ;  and,  as  in  all  cases  in  which  the  cutis  is  destroyed,  it 
remains  as  an  indelible  mark.  It  is  impossible  by  any  process  to  restore  to 
the  skin  its  uniformity  and  evenness  of  surface.  Malle  has  pointed  out 
that  the  double  cicatrix  which  is  left  by  the  application  of  a  seton  may 
present  an  appearance  which  might  be  mistaken  for  the  entrance  and  exit- 
apertures  of  a  Imllet,  since  in  both  cases  a  band  of  hardened  lymph  may 
be  felt  between  the  two  cicatrices.  "When  a  hard  band  of  connection  can- 
not be  felt  between  them,  the  marks  cannot  be  owing  either  to  a  builet  or 
a  seton,  but  they  may  be  due  to  a  bite,  or  to  separate  wounds  produced 
in  the  skin  at  or  about  the  same  time. 

With  respect  to  blisters,  they  produce  only  a  superficial  and  temporary 
reddening  of  the  cutis.  They  do  not  commonly  leave  a  scar,  unless  their 
irritant  action  has  extended  to  the  substance  of  the  cutis,  and  has  led  to 
ulceration  and  suppuration  ;  the  ulcerated  being  separated  from  the  non- 
ulcerated  portions  of  the  skin,  and  indicated,  according  to  Dupuytren,  by 
an  indelible  brown  mark. 

The  cicatrices  left  as  a  result  of  the  application  of  the  true  vaccine  lymph 
have  a  peculiar  irregular  honeycombed  appearance,  with  white  streaks 
slightly  depressed  below  the  level  of  the  surrounding  skin.  The  spurious 
vaccine-mark  is  of  a  reddish  color,  not  depressed,  and  not  presenting  the 
honevcombed  appearance  and  white  streaks  of  the  cicatrix  of  the  true 
pustule. 

The  scars  produced  by  smallpox  are  in  the  form  of  deep  depressions, 
showing  a  complete  destruction  of  the  cutis. 

Independently  of  the  cicatrices  from  local  injury,  these  cases  of  contested 
identity  may  present  other  physical  signs,  such  as  violes,  nsevi  (mother's 
marks),  and  other  congenital  defects  to  which  ordinary  witnesses  may  be 
able  to  testify.  There  can  be  no  fallacy  of  memory  touching  the  form, 
size,  and  position  of  such  marks,  and  they  differ  from  cicatrices  in  this — 
they  cannot  be  artificially  imitated.  They  may,  it  is  true,  be  removed, 
but  only  by  actual  or  the  electric  cautery,  or  by  caustic  applications.  If 
thus  removed,  a  cicatrix  is  left  in  the  skin  which  is  indelible.  A  case  is 
reported  by  Beck,  in  which  a  girl,  Salom^  Muller,  had  been  sold  as  a 
slave,  but  her  identity  as  the  child  of  German  parents  was  proved  after 
many  years  by  two  marks  resembling  moles  about  the  size  of  coffee-grains, 
on  the  inside  of  the  thighs.  They  were  proved  to  have  existed  in  the  child, 
and  they  were  proved  to  exist  in  the  same  parts  of  the  body  of  the  girl 
eighteen  years  afterwards.  After  much  litigation,  she  was,  upon  this 
evidence,  pronounced  to  be  a  free  woman.     (Med.  Jur.,  vol.  i.  p.  G62.'i 

Cicatrices  from  Burns. — This  subject  has  been  fully  investigated  by 
Malle.     (Ann.  d'llyg.,  1810,  t.  1,  422.)     A  superficial  burn,  in  healing, 


TATTOO- MARKS.  319 

produces  a  broad  irreg'ular  cicatrix,  varyin,!^  from  the  form  of  the  burning 
body.  If  the  burn  has  extended  to  some  depth  behjvv  the  cutis,  the  cica- 
trix is  deep,  and  has  a  rounded  margin  ;  but  in  the  depression  it  is  irregu- 
lar and  contracted  in  proportion  to  its  depth.  Solid  caustics  produce 
cicatrices  with  regular  edges,  as  the  corrosive  substance  easily  penetrates 
uniformly  through  the  deep  layers  of  the  skin.  Caustic  liquids  produce 
only  superficial  marks,  unless  they  have  been  allowed  to  penetrate  deeply, 
when,  by  the  destruction  of  parts,  they  may  give  rise  to  deep  and  irregu- 
lar cicatrices.  When  the  cutis  is  destroyed,  an  indelible  cicatrix  remains, 
whether  it  is  the  result  of  a  burn  from  a  heated  solid,  or  from  the  chemical 
action  of  a  highly  corrosive  liquid.  In  a  case  in  which  the  strongest 
nitric  acid  was  applied  to  the  skin  for  the  removal  of  a  mole,  the  cicatrix 
produced  was  visible  after  twenty-five  years. 

In  the  Whitechapel  murder  case  (Reg.  v.  Wainwright,  C.  C.  C,  Nov. 
1775),  the  body  of  the  deceased  woman,  Harriet  Lane,  was  identified, 
spite  of  decomposition,  and  a  year  after  death,  by  the  presence  of  an  old 
scar  on  the  leg,  the  result  of  a  burn. 

The  subject  of  cicatrices  as  they  are  found  in  the  neck,  whether  arising 
from  wounds,  scrofulous  disease,  or  burns,  has  been  fully  examined  by 
GUtterbock,  in  an  elaborate  paper.  (Vierteljahrsscbr,  fiir  Gerichtl.  Med., 
1873,  2,  p.  84.) 


CHAPTER  XXXII. 

MEDICAL   EVIDEXCE    OF    IDENTITY    FROM     COLORED     CICATRICES     OR     TATTOO-MARKS. MODE 

AND    DATE    OF    PRODUCTION. DURABILITY    OF    THESE    MARKS. THEIR    ALLEGED    SPONTA- 
NEOUS   DISAPPEARANCE. CASES    OF    IDENTITY    FROM    TATTOOING. SIMULATED    MARKS. 

TATTOO-MARKS    ON    THE    DEAD. MEDICAL    RESPONSIBILITY. 

The  subject  of  tattooing  has  been  noticed  by  medical  jurists.  Several 
trials  have  occurred  of  late  years  in  France  and  Germany,  which  show  the 
great  importance  of  this  subject  in  cases  of  contested  personal  identity. 
The  Tichborne  case  (see  pp.  317,  325),  which  occupied  our  law-courts  for 
nearly  two  years,  involved  some  issues  of  importance  in  relation  to  iden- 
tity from  cicatrices  and  the  marks  of  tattooing.  The  presence  of  tattooed 
or  colored  marks  on  the  skin  of  a  person,  verified  by  a  competent  observer, 
may  become  the  strongest  possible  proof  of  identity,  and  their  proved  ab- 
sence, if  not  accounted  for  or  explained,  may  furnish  the  most  convincing 
evidence  of  non-identity.  An  escaped  convict  may  allege  that  he  never 
was  tattooed.  There  may  be  no  colored  marks  on  his  skin,  but  a  medical 
expert  may  be  able  to  demonstrate  that  there  have  been  such  marks,  and 
that  traces  of  them  still  exist.  A  man  who  is  found  to  be  tattooed  may, 
in  order  to  escape  punishment,  pass  himself  off  as  another  person,  also 
tattooed.  In  this  case  medical  evidence  must  be  derived  from  a  compari- 
son of  the  color,  form,  and  situation  of  the  marks  in  the  two.  A  tattooed 
man  may  claim  an  estate,  and  adduce  the  tattoo  marks  as  a  proof  of  his 
identity.  It  would  be  difficult  for  an  impostor  setting  up  a  false  claim  to 
simulate  marks  of  this  kind.  The  operation  would  require  time  and  an 
accurate  imitation  of  the  color  and  design,  as  well  as  of  the  part  of  the 
body  selected.  Members  of  the  family  would  be  able  to  say  whether  they 
were  or  were  not  such  marks  as  those  which  had  existed  on  their  missing 


820  DURABILITY  OF  THE  MARKS. 

•I 

relative.  There  may  be  satisfactory  proof  that  the  missing  person  was 
tattooed,  while  an  impostor  may  allege  that  he  had  not  been  tattooed. 
The  fact,  however,  may  be  that  at  some  former  period  of  his  life  a  man 
had  undergone  this  operation,  and,  to  prevent  a  discovery  of  his  identit}-, 
he  had  removed  the  marks  b}^  cautery  or  other  means.  As  the  presence 
of  tattoo-marks,  and  theii- correspondence  in  situation,  color,  and  design 
Avith  those  on  a  missing  person,  would  furnish  the  strongest  possible  evi- 
dence of  identit}^,  so  their  absence  in  a  given  case,  unless  clearly  explained, 
must  be  considered  as  the  best  proof  of  non-identity: 

Colored  Cicatrices.  Mode  and  Date  of  Production. — These  marks 
arise  from  small  punctured  wounds  made  into  the  true  skin  with  three  or 
four  sharp  needles  closely  bound  together.  The  needles  are  dipped  in 
coloring  matter  at  each  time  that  the  punctures  are  made.  When  the  sub- 
stance of  the  cutis  is  penetrated,  as  it  ought  to  be  in  order  to  leave  a  per- 
manent mark,  there  is,  in  a  few  hours,  much  swelling  of  the  skin,  with 
general  inflammation.  The  colors  commonly  employed  in  tattooing  are 
charcoal  (gunpowder),  China-ink,  vermilion,  and  indigo.'  Other  vegetable 
coloring  matters  of  a  fugitive  kind  are  sometimes  used.  China-ink  and 
charcoal,  although  black,  produce  designs  on  a  white  skin  which  have  a 
bluish  tint.  The  coloring  matter  thus  deposited  mechanically  in  these 
minute  punctured  wounds,  after  the  first  attack  of  inflammation  has  passed 
off,  remains  permanently  encysted  in  the  substance  of  the  cutis  or  true 
skin  and  in  the  cellular  membrane  below  it.  It  has  been  there  found  after 
death.  According  to  Berchon,  the  local  symptoms  of  irritation  and  in- 
flammation last  about  a  fortnight.  At  the  end  of  the  first  month  the  lines 
of  color  appear  wider  than  they  will  be  ultimately.  About  the  sixth  week, 
the  cuticle  begins  to  scale  off;  and  at  the  end  of  about  two  months,  or  a 
somewhat  longer  period,  the  skin  acquires  its  normal  condition.  The  de- 
signs in  vermilion  are  at  this  early  time  much  more  intense  than  those  in 
China-ink.  When  the  local  symptoms  have  subsided,  the  tattoo-marks 
are  fixed,  and  it  is  impossible  to  assign  a  date  to  them. 

Durability  of  the  Marks.  Alleged  Spontaneous  Disappearance. — In 
imperfect  cases  of  tattooing,  when  soluble  and  fugitive  colors  are  used, 
and  the  surface  of  the  cutis  only  is  penetrated,  the  marks  may  disappear 
or  be  removed  by  artificial  means.  Not  so  when  the  coloring  matter  is 
carried  completely  into  the  substance  of  the  cutis  or  true  skin.  It  there 
forms  an  intimate  combination  with  the  fibrous  structure  of  the  skin,  and 
remains  permanently  fixed.  Rayer  has  shown  by  the  maceration  of  tat- 
tooed skin  that  the  cuticle  may  be  removed,  and  it  is  colorless,  as  in  ordi- 
nary skin.  This,  therefore,  proves  that  the  coloring  matter  is  firmly  im- 
bedded in  the  cutis  and  cellular  tissue  below  it.  (Ann.  d'Hyg.,  1855,  t.  1, 
p.  194.)  A  maceration  of  the  skin  in  water  for  two  months  did  not  affect 
the  color  of  the  tattoo-marks,  and  Tardieu  found  that  no  solvent  could  re- 
move the  coloring  matter  without  at  the  same  time  destroying  the  texture 
of  the  skin.  Tattoo-marks  are  not  removed,  because  the  coloring  matter 
is  insoluble  and  cannot  permeate  the  roots  of  the  vessels.  Silver  marks 
are  equally  indelible  when  deposited  fi'om  taking  nitrate  of  silver  inter- 
nally. Finely-divided  substances,  such  as  mercury,  may  penetrate;  also 
finely-divided" charcoal  taken  into  the  intestines,  has  been  found  in  the 
mesenteric  veins.  In  18U,  there  was  a  case  in  Guy's  Hospital  that  well 
illustrated  the  dural)ility  of  these  marks.  The  man,  fet.  50,  had  been  a 
sailor,  and  while  in  the' China  seas  from  1842  to  1847  he  was  tattooed  at 
different  times.  There  were  numerous  designs  on  both  arms  and  the 
front  of  the  chest,  some  of  them  artistically  representing  floAvers  and 
leaves,  a  flower-pot,  and  human  figures.     There  were  only  two  colors. 


ALLEGED    DISAPPEARANCE    OF    TATTOO-MARKS.  S21 

blue-black  and  red,  the  former  done  with  China-ink,  the  latter  with  ver- 
milion. The  operation  had  been  ]ierl'ormed  by  an  English  sailor.  Three 
needles  were  used — these,  dipped  into  the  color,  were  introduced  deeply 
into  the  skin  sideways,  or  in  a  valvular  form,  and  the  ink  mixed  with 
water  was  then  well  rubbed  over.  The  vermilion  was  rubbed  in  as  a 
])owder.  Some  blood  flowed,  and  after  a  few  days  Jhe  parts  cicatrized, 
the  scabs  came  away,  and  the  man  sulfered  no  inconvenience.  The  marks 
were  deeply  imbedded  in  the  cutis;  some  were  deeper  in  tint  and  blacker 
than  others,  this  result  depending  on  the  strength  of  the  China-ink  used. 
The  colors  had  undergone  no  change  up  to  1874,  although  one  of  them  at 
the  back  of  the  hand,  representing  a  flower-vase  with  flowers,  had  been 
exposed  to  light  and  to  frequent  contact  with  water  and  other  liquids,  in- 
cluding naphiha,  but  it  had  made  no  difference  in  its  appearance.  The 
vermilion  had  also  retained  its  color.  It  is  a  remarkable  coincidence  that' 
on  his  left  arm  were  the  capital  letters  "  R.  C.  T  ,"  but  these  did  not  cor- 
respond to  the  initials  of  the  name  of  the  patient.  The  marks  were  un- 
changed after,  at  the  lowest  estimate,  twenty-six  years. 

In  most  anatomical  museums,  preparations  of  tattooed  skin  may  be  seen. 
In  Guy's  Hospital  Museum  there  are  many.  The  designs  have  been  pro- 
duced with  gunpowder,  and  some  small  portions  with  vermilion.  In  one 
of  them,  which  has  been  preserved  in  spirit  for  fifty  years,  the  marks  on 
the  skin  of  the  leg  represent  an  animal  like  a  goat ;  they  are  of  a  bluish- 
black  color.  In  the  part  from  which  the  cuticle  has  been  removed  the 
color  appears  much  more  intense.  There  is  nothing  to  indicate  that  this 
preparation  has  undergone  the  slightest  change  of  color  during  its  long 
maceration  in  spirit.  This  and  the  other  preparations  also  show  that  no 
color  is  removed  by  removing  the  cuticle;  on  the  contrary,  the  color 
becomes  brighter  and  more  intense  by  contrast  with  the  white  surface  of 
the  cutis.  Another  preparation  of  the  skin  of  the  arm  represents  in  blue- 
black  (carbon)  and  red  (vermilion)  the  Crucifixion,  with  the  date — Nantes, 
1808.  In  this  also  the  cuticle  has  been  removed  in  part,  with  the  efl'ect 
of  bringing  out  the  colors  more  strongly.  Eighty-three  years  have  passed 
since  these  marks  were  produced,  but  neither  while  living  nor  in  under- 
going maceration  in  water  and  spirits  after  death,  is  there  any  appearance 
of  change  in  the  depth  of  color  or  in  the  outlines  of  the  design.  In  a  third, 
the  skin  was  taken  from  the  arm  of  a  sailor  who  died  in  Guy's  Hospital 
in  1857.  The  designs  represent  the  arms  of  England,  Adam  and  Eve, 
the  tree  of  life,  and  the  serpent.  It  has  been  noticed  with  regard  to  this 
preparation  that  the  red  or  vermilion  color  has  become  less  marked  during 
the  years  that  it  has  been  in  the  museum.  Another  preparation  of  the 
skin  from  over  the  scapula  has  simply  a  large  letter  "D,"  the  brand  of  a 
deserter.  This  was  removed  from  a  dead  body  in  1860.  A  fifth,  of  the 
date  of  about  twenty-two  3'ears,  represents,  in  a  very  perfect  manner,  a 
ship  in  full  sail,  with  the  figure  of  a  woman.  This  portion  of  skin  was 
taken  from  the  body  of  a  sailor.  These  facts  show  how  durable  the  car- 
bonaceous colors  are  when  the  substance  has  once  penetrated  the  cutis. 
No  amount  of  maceration  appears  in  any  way  to  affect  or  alter  them. 

A  surveyor  accidentally  punctured  tlie  skin  of  the  back  of  his  hands 
with  a  sharp  steel  pen  charged  with  China-ink.  A  bluish-black  spot  was 
formed  after  the  healing  of  the  wound;  this  was  quite  visible  and  un- 
changed after  six  years,  and  it  would  no  doubt  continue  for  life.  A  near 
relative  of  the  author  was  tattooed  with  China-ink  on  the  inside  of  the 
arm.  The  designs,  which  were  of  a  bluish  color,  remained  unchanged 
up  to  his  death,  i.e.  for  twenty-eight  years.  It  has  been  rather  hastily 
assumed  thit  in  a  certain  percentage  of  cases,  tattoo-marks  spontaneously 
21 


322  REMOVAL    OF    TATTOO-MARKS    BY    ART. 

disappear  in  the  course  of  time.  Thus  Hutin  examined  50G  cases  of  tattoo- 
in*^.  Relying  upon  the  statements  made  by  soldiers,  sailors,  convicts,  and 
others,  his  conclusion  was  that  in  47  the  marks  were  completely  obliterated 
after  a  period  of  from  twenty-eight  to  sixty  years;  in  117  the  marks  were 
partially  obliterated  after  a  period  of  from  ten  to  sixty-four  years ;  but  in 
342  the  marks  were  quite  distinct  after  a  space  of  from  four  to  sixty-five 
years.  With  the  exception  of  two  cases  of  tattooing  in  vermilion  which 
disappeared  after  thirty  years,  Tardieu  found  that  the  disappearance  of 
tattoo-marks  did  not  take  place  until  after  thirty  to  forty  years,  and  of  the 
only  two  tattooings  with  China-ink  which  were  obliterated,  one  disap- 
peared after  forty-five  and  the  other  only  after  sixty  years. 

These  and  similar  facts  show  that  in  a  few  cases  these  marks  may  fade 
or  become  less  visible,  but  this  change  requires  a  period  of  ten  years  at 
the  least.  The  fading  of  the  marks  most  probably  arises,  not  from  a  re- 
moval of  the  coloring  matter  by  the  absorbents,  but  from  the  fact  that  in 
some  cases  the  tattooing  has  been  superficially  performed  on  a  thin  skin. 
If  the  absorbents  can  remove  from  the  tattoo-marks  such  insoluble  colors 
as  carbon  and  vermilion,  it  would  scarcely  require  a  period  of  from  ten  to 
twenty-eight  years  for  their  removal,  and  on  this  theory  it  would  be  im- 
possible to  explain  why  tattoo-marks  remain  permanent  in  any  case.  The 
subject  has  been  considered  by  Horteloup.  (Ann.  d'Hyg.,  1870,  t.  2,  p. 
453,  and  1872,  t.  1,  p.  423.)  It  is  said  that  the  vermilion  has  been  seea 
in  substance  in  the  neighboring  absorbent  glands,  but  it  does  not  appear 
that  mercury  has  ever  been  detected  in  these  glands  (Casper),  the  crucial 
test  of  its  presence. 

The  nature  of  the  coloring  material  appears  to  have  some  influence  on 
the  durability  of  the  tattoo-marks.  Thus  Hutin  found  that  out  of  78 
persons  who  had  been  tattooed  with  vermilion  alone,  the  tattoo-marks 
had  disappeared  in  eleven,  and  that  out  of  104  tattooed  with  black  pig- 
ment, such  as  carbon,  China-ink,  etc.,  not  one  had  become  obliterated. 
This  permanency  of  the  black  pigment  has  also  been  noticed  by  other 
observers. 

The  general  conclusion  from  these  observations  is  that  tattoo-marks 
once  properly  made  in  the  cutift  are  practically  indelible,  but  that  when  the 
operation  is  imperfectly  performed  the  marks  may,  in  the  course  of  many 
years,  become  lighter  and  disappear.  This  is  observed  more  commonly 
with  red  coloring  matter  than  Avith  the  black  or  carbonaceous  colors.  As 
accurate  information  can  seldom  be  obtained  respecting  the  tattooing  in 
early  life,  it  may  be  inferred  in  a  contested  case  in  which  the  marks  are 
proved  to  have  disappeared,  that  the  tattooing  was  imperfectly  performed. 
This  point,  however,  admits  of  refutation  when  it  can  be  proved  that  the 
marks  are  still  visible  on  the  arm  of  another,  tattooed  at  the  same  time, 
by  the  same  person,  and  Avith  similar  materials. 

Removal  of  Tattoo-marks  by  Art. — Man}^  absurd  statements  have  been 
made  by  convicts  respecting  the  removal  of  tattoo-marks  from  their  skin. 
The  only  methods  l;)y  Avhich  such  marks  admit  of  removal  are  by  excision 
of  the  cutis,  or  the  application  of  the  actual  cautery  or  escharotics  to 
destroy  the  skin.  In  such  cases  cicatrices  remain,  Avhich,  under  a  proper 
examination,  may  lead  to  detection.  A  case  occurred  to  Tardieu  in  which 
the  fact  of  obliteration  Avas  the  main  question  for  solution.  (Ann.  d'Hyg., 
1855,  t.  1,  p.  201.)  A  man  named  Aubert  was  charged  Avith  having  com- 
mitted a  robbery  in  1843.  His  defence  Avas  that  he  Avas  at  that  date  con- 
fined in  a  certain  prison  under  the  assumed  name  of  Solignon.  On 
searching  the  pri.son-register  it  Avas  found  that  a  man  named  Solignon  was 
there  confined  at  the  date  assigned,  and  the  description  of  the  prisoner 


REMOVAL    OF    TATTOO-MARKS    BY    ART.  323 

.showed  that  he  was  tattooed  on  both  arms— on  the  left  there  were  two 
hearts,  a.  dog,  and  other  emblems;  on  the  riyht  a  man,  a  woman,  a  doy, 
and  two  hearts.  On  examining  the  prisoner  Aubert,  no  marks  of  tattoo- 
ing were  seen  upon  his  arms,  although  he  affirmed  that  he  had  been  tattooed 
by  a  friend  in  1840,  and  again  in  1846,  with  a  blue  vegetable  ink,  but  that 
he  had  some  months  previously  removed  the  marks  by  a  chemical  process. 
He  also  described  the  marks:  those  on  the  right  arm  representing  the 
bust  of  a  woman  and  the  letters  "J  S,"  and  on  the  left  a  tomb,  with 
foliage,  etc.  In  184(5,  a  hunting  scene  had  been  added,  but  this  was 
the  faintest  of  all.  By  close  examination  of  the  skin  with  a  lens  in  a 
strong  light,  Tardicu  was  able  to  detect  faint  white  marks  like  cicatrices 
representing  the  outline  of  a  tomb,  with  two  hearts;  and  the  marks  in- 
dicative of  two  letters  were  also  detected  on  the  skin  of  the  other  arm  by 
the  same  means.  By  these  observations,  the  non-identity  of  the  accused 
Aubert  with  the  former  prisoner  Solignon  was  clearly  proved.  Both 
were  tattooed,  but  the  tattoo-designs  were  quite  different,  and  under  less 
skilful  hands  than  those  of  Tardieu,  Aubert  might  have  escaped  the  pun- 
ishment which  he  merited. 

The  prisoner  Aubert  communicated  to  Tardieu  the  plan  which  he  had 
adopted  for  removing  the  tattoo-marks.  He  first  applied  an  ointment  of 
strong  acetic  acid,  then  a  weak  solution  of  potash,  and  afterwards  h3'^dro- 
chloric  acid.  The  skin  which  had  been  removed  by  these  caustics  was 
gradually  reproduced;  but,  although  the  coloring  material  was  removed, 
linear  cicatrices  were  left  in  the  skin  in  every  part  to  which  the  tattooing- 
ncedles  had  been  applied.  Tardieu  subsequently  tried  this  process  on 
some  tattoo-marks,  and  found  that  the  coloring  matter  might  be  thus  re- 
moved, but  that  traces  indicative  of  the  original  designs  were  still  left  in 
the  skin.  Simple  friction  of  the  skin  will  sometimes  suffice  to  bring  out 
obliterated  tattoo-marks.  An  escaped  convict  was  on  trial  before  a  French 
court,  and  the  question  turned  upon  his  identity  with  a  prisoner  known 
to  have  been  tattooed.  There  was  no  appearance  of  colored  marks  upon 
his  arm,  and  the  question  submitted  to  Leroy  was  whether  the  man  had 
ever  been  tattooed.  Leroy  applied  strong  friction  to  the  skin  of  the  arm. 
This  had  the  effect  of  bringing  out  cicatrices  f.s  white  lines  with  a  slight 
bluish  tint.  By  this  means  the  word  "  Sophie"'  was  plainly  legible  in 
white  marks  on  the  reddened  skin.  This  fixed  the  identity  of  the  convict. 
(Ann.  d'Hyg.,  1870,  t.  2,  p.  460.) 

As  perfect  tattooing  cannot  take  place  Avithout  deeply  Avounding  the  cutis 
and  causing  a  cicatrix,  we  must  not  trust  to  the  absence  of  color  only 
wiien  an  opinion  is  required  whether  the  person  has  or  has  not  been 
tattooed.  These  observations  equally  apply  to  the  destruction  of  the 
marks  by  fire.  Horteloup  examined  the  arm  of  a  man,  eet.  42,  who  at  the 
age  of  18  had  been  tattooed  with  China-ink.  At  the  age  of  30  a  bar  of 
iron,  at  a  white  heat,  accidentally  dropped  on  the  tattooed  portion  of  his 
arm.  Twelve  years  after  this  accident  Horteloup  found  a  white  cicatrix 
on  the  arm  which  had  obliterated  part  of  the  design  (a  ship).  .When  the 
obliterated  portion  was  minutel}^  examined  with  a  lens,  faint  white  lines 
were  seen  which  filled  up  and  completed  the  figure  of  a  ship.  (Ann. 
d'Hyg.,  1870,  t.  2,  p.  459.)  Bois  de  Loury  met  with  an  instance  which 
proves  that  it  is  very  difficult  to  eradicate  the  tattoo-marks  without  leaving 
distinct  cicatrices  of  them.  In  this  case  a  man  had  a  number  of  initials  of 
names  spread  over  the  skin  of  his  chest  and  arms,  and  in  many  parts  he 
had  obliterated  the  letters  by  a  red-hot  iron  applied  to  the  skin, — but  in 
ever}^  instance  there  was  a  well-defined  cicatrix,  and  it  was  still  possible 
to  make  out  traces  of  the  letters.     (Ann.  d'Hyg.,  1872,  t.  1,  p.  423.) 


824  TATTOO-MARKS    OX    THE    DEAD. 

Tattoo-marhs  on  the  Dead. — When  wc  are  required  to  examine  a  dead 
bod}"  for  marks  of  tattooing,  g-reat  caution  is  required  if  no  colored  marks 
are  apparent  on  the  skin.  Putrefaction,  unless  very  far  advanced,  does 
not  interfere  with  theii'  appearance.  Tardieu  states  that,  in  examining 
the  partially  decomposed  body  of  a  man  who  had  been  a  carpenter,  the 
tattoo-marks  on  his  arm  clearly  represented  the  instruments  of  his  trade. 
When  the  question  is  whether  the  marks  have  been  on  the  arm  and  sub- 
sequently removed,  there  will  be  some  difficulty.  An  examination  of  the 
skin  with  a  lens  in  a  strong  light  may  show  the  presence  of  lines  corre- 
sponding to  cicatrices  ;  but  the  evidence  derivable  from  friction  of  the  skin 
is  here  lost.  Hortelonp  recommends  the  examination  of  the  neighboring 
absorbent  glands  for  the  coloring  matrer  ;  but  if  the  marks  are  of  many 
years'  standing,  coloring  matter  is  not  likely  to  be  found  in  them.  In  this 
respect  a  case  which  occurred  to  Casper  is  eminently  instructive.  In  1849, 
the  body  of  a  man,  decapitated,  was  found  in  the  neighborhood  of  Berlin. 
It  was  supposed  to  be  that  of  one  Gottleib  Ebermann,  who  was  missing. 
It  was  stated  that  the  body  of  Ebermann  could  be  identified  by  marks  of 
cupping  on  the  wrists,  an  operation  performed  on  him  eight  or  nine  j-ears 
before  his  death,  and  also  by  tattoo-marks  of  a  heart  and  tlse  letters 
"  G  E"  on  the  left  arm.  On  an  examination  of  the  body  no  marks  of  any 
kind  could  be  perceived,  and  Ebermann's  wife,  Avho  had  been  married  to 
him  tw^o  years,  and  his  three  sisters,  affirmed  that  they  had  never  seen 
any  tattoo-marks  on  him.  The  body  was  exhumed  after  five  months,  but 
owing  to  putrefaction  no  further  evidence  could  be  obtained  from  it.  A 
man  named  Schall  had  been  in  the  mean  time  charged  Avith  the  murder, 
and  the  circumstantial  evidence  M^as  so  strong  against  him  that  nothing 
more  was  required  than  to  prove  that  the  body  found  was  that  of  Eber- 
mann. Of  two  medical  experts  who  were  called  to  give  evidence,  one  de- 
posed that  the  marks  of  cupping  could  always  be  distinguished,  and  those 
of  tattooing  were  indelible  ;  the  other  stated  that  the  marks  of  cupping 
might  spontaneously  disappear,  but  with  regard  to  the  tattooing  he  could 
give  no  opinion.  As  this  medical  evidence  failed  to  establish  the  identity 
of  the  body,  the  opinion  of  Casper  was  required  by  the  court.  In  his  re- 
port, taken  from  the  observations  made  in  a  large  asylum  for  aged  and 
invalid  soldiers,  a  class  among  whom  tattoo-marks  are  common,  he  stated 
that  out  of  36  examples,  in  three  the  tattooing  had  become  faint  Avith 
time ;  in  two  the  marks  were  partially  effaced ;  in  four  they  Avere  com- 
l>letely  obliterated ;  hence  he  came  to  the  conclusion  that  the  marks  of 
tattooing  may  disappear.  A  Avitness  came  forward  and  declared,  during 
the  investigation,  that  at  fifteen  he  had  tattooed  himself  on  the  arm  Avith 
vermilion,  and  that  the  marks  had  become  entirely  effaced.  The  conclusion 
of  the  trial  was  that  Schall  Avas  condemned.  (Med.  Times  and  Gaz.,  1852, 
ii.  p.  608;  also  Casper's  Gerichtl.  Med.,  1,  p.  116;  and  Yierteljahrsschr. 
fiir  Gerichtl.  Med.,  1852,  1,  p.  274,  and  1853,  1,  p.  338.)  The  singular 
part  of  this  case  is,  that  there  Avas  a  Avant  of  proof  that  the  deceased  liad 
reallv  Ijcen  tattooed;  for  neither  the  Avife  who  had  cohabited  Avith  the  de- 
ceased for  tAvo  years,  nor  his  three  married  sisters,  had  ever  seen  any 
tattoo-marks  on  his  skin.  Chereau  (L'Union  Med.,  Nov.  16,  1852)  justly 
observes,  respecting  Casper's  report,  that  it  is  not  one  VA^hich  should 
influence  a  judicial  decision,  for  it  is  not  stated  at  Avhat  age,  Avith  Avhat 
substances,  and  in  Avhat  manner,  the  marks  were  produced  in  the  four 
instances  Avhere  there  Avas  complete  obliteration.  Were  the  men  to  be 
trusted?  How  many  years  had  really  elapsed  before  the  marks  had  be- 
come effaced  ?  What  Avas  the  nature  of  the  coloring  matter  used  ?  Was 
it  mineral  or  vegetable  ?  and  was  it  carried  deeply  into  the  cutis,  or  only 


IDENTITY    FROM    TATTOO-MARKS.  325 

disposed  on  the  surface?  These  questions  should  have  received  satis- 
lactory  answers  before  conii)arisons  were  made,  and  important  medical 
conclusions  were  based  upon  them.  Casper's  unqualified  opinion  that  such 
marks,  assuming-  them  to  have  existed,  might  have  spontaneously  disap- 
peared, led  to  the  conviction  and  execution  of  Schall.  The  accused  con- 
iessed  his  crime  befoi'e  execution,  but  the  position  assumed  by  Casper  on 
this  occasion  is' certainly  not  a  precedent  to  be  followed  by  medical  jurists, 
In  all  cases  in  which  an  opinion  is  required  of  a  medical  man — whether 
tattoo-marks  have  been  effaced  from  the  skin  or  not — there  should  be  no 
doubt  whatever  touching  their  previous  existence. 

A  question  may  arise  in  contested  identity,  whether  any  accidental  or 
temporary  marks  made  on  the  skin  can  be  mistaken  for  tattooing-.  This 
does  not  seem  at  all  probable.  Thecolor  and  the  design  might  be  imitated 
by  water-color  pigments,  but  this  would  be  only  superficial,  i.  e.  on  the 
cuticle,  and  they  would  be  readily  removed  with  water.  Xo  professional 
man  could  be  deceived  by  such  an  attempt  at  imposture.  It  may  be  sug- 
gested that  marks  of  tattooing  said  to  have  been  seen  by  witnesses  on  the 
skin  of  a  missing  person  were  caused  by  the  application  of  colored  chalk 
or  pencil.  Such  an  objection  to  evidence  hardly  needs  serious  refutation. 
Colored  marks  could  only  be  produced  by  very  soft  chalk,  and  would  never 
have  the  depth,  intensity,  or  appearance  of  tattooing.  They  would  be  re- 
moved and  obliterated  by  the  slightest  friction.  The  most  superficial 
observer  could  not  be  deceived  by  them.  Again,  it  may  be  alleged  of  a 
missing  person,  by  one  set  of  witnesses,  that  he  was  tattooed,  and  bv 
another  set  that  they  had  had  casual  opportunities  of  seeing  his  skin  and  did 
not  observe  any  tattoo-marks.  In  such  a  case,  the  evidence  given  by  near 
relatives,  whose  opportunities  of  observation  are  much  more  frequent,  is 
more  reliable  than  that  of  persons  who  could  have  had  only  an  opportunity 
of  seeing  the  bare  skin  on  some  rare  occasions,  and  could  have  had  no 
particular  reason  at  the  time  for  observing  its  condition.  This,  of  course, 
becomes  simply  a  question  of  credibility  and  accuracy  of  observation. 

A  medical  man  may  be  consulted  about  the  removal  of  these  marks; 
and  when  he  has  tried  experiments  on  this  subject  he  will  be  able  to  appre- 
ciate the  view  generall}^  entertained  of  their  indelibility,  at  least  so  far  as 
the  carbon-marks  are  concerned.  Some  years  since  the  author  was  con- 
sulted in  the  following  case:  By  an  accidental  discharge  of  gunpowder,  a 
portion  was  blown  into  the  face  of  a  young  man.  After  recovery  from 
the  first  effects,  a  bluish-black  tint  was  left  on  the  lower  part  of  the  fore- 
head, the  nose,  and  the  upper  part  of  the  cheeks  and  eyelids.  He  had  con- 
sulted several  physicians  and  surgeons,  and,  under  their  advice,  had  em- 
ployed various  local  applications  for  the  removal  of  the  marks,  but  with- 
out result.  On  examining  the  discolored  parts  a  year  after  the  accident 
v,uth  a  magnifyiug-glass,  it  Avas  obvious  that  the  small  particles  of  carbon 
were  deepl}^  and  firmly  imbedded  in  the  cutis.  Local  applications  to  pro- 
mote absorption  were  tried,  but  it  was  cpiite  evident  that  nothing  but  the 
destruction  of  the  cutis  would  remove  the  marks.  Blistering  would  have 
no  effect,  as  this  would  only  remove  the  cuticle. 

Medico-legal  questions  connected  with  the  presence  or  absence  of  tattoo- 
marks  on  the  skin  have  been  hitherto  confined  to  proof  or  disproof  of  the 
identity  of  persons  charged  with  crime.  Probably  few  cases  in  the  present 
century  have  excited  greater  interest  among  the  public  or  given  rise  to 
greater  discussion  than  that  which  is  known  as  the  Tichborne  case,  already 
referred  to  (see  p.  317,  ante).  (Tichborne  i'.  Lushington,  C.  P.,  187 1-2  ; 
and  Reg.  v.  Castro  or  Tichborne,  Aug.  1873.)  The  question  involved 
turned  entirely  upon  personal  identity.     A  man  calling  himself  Sir  Roger 


826  THE    TICIIBORNE    CASE. 

Tichborne  claimed  certain  estates.  This  led  to  a  trial  of  ejectment  in  the 
Common  Pleas,  which  extended  over  one  hundred  and  three  days,  in 
Avhich  he  was  nonsuited,  and  subsequently  committed  for  trial  on  numerous 
charges  of  perjury.  After  a  trial  for  this  ofi'ence  of  the  unexampled  dura- 
tion of  one  hundred  and  eighty-eight  days,  the  claimant  was  found  guilty 
of  perjury  and  sentenced  to  penal  servitude. 

Roger  Charles  Tichborne  was  lost  at  sea  in  April,  1854.  No  one  who 
sailed  in  the  same  ship  has  ever  l)een  seen  or  heard  of  afterwards.  At  the 
time  of  his  departure  from  England,  in  1852,  the  real  Roger  had  upon  the 
inside  of  his  left  forearm  certain  tattoo-marks  of  a  blue  color,  representing 
a  cross,  a  heart,  and  an  anchor.  These  marlcs  had  been  distinctly  seen  up  to 
the  time  of  his  leaving  England,  over  a  period  of  six  years,  by  his  mother, 
his  tutor,  and  a  number  of  friends,  male  and  female,  to  whom  he  had  at 
intervals  purposely  shown  them.  Lord  Bellew,  a  schoolfellow  of  Roger's, 
deposed  that  in  1847-8  he  saw  the  cross,  heart,  and  anchor  on  Roger's 
arm,  and  that  he  himself  tattooed  the  letters  "R  C  T,"  in  addition  to  these 
symbols.  The  letters  were  made  with  China-ink,  and  were  half  an  inch  in 
length.  On  the  same  day  that  he  tattooed  Roger's  arm,  Roger  tattooed  his 
arm  with  the  mark  of  an  anchor.  This  was  done  at  the  same  time,  and 
with  the  same  materials.  Twenty-five  years  had  elapsed  since  they  had 
thus  tattooed  each  other,  but  the  anchor  was  still  there,  and  the  witness 
showed  his  arm  to  the  jury  in  confirmation  of  his  statement.  It  was  fur- 
ther proved  that,  as  attempts  had  been  made  to  bleed  the  real  Roger  in  the 
arms,  feet,  and  temples  before  he  left  England,  there  would  be  some  cica- 
trices indicative  of  this  fact.  When  a  boy  he  had  an  issue  in  his  arm  for 
two  years,  and  when  this  was  removed  and  the  part  healed,  it  had  left  a 
large  and  deep  cicatrix.  These  facts  Avcre  deposed  to  by  several  credible 
witnesses.  The  depression  in  the  arm,  left  by  this  issue,  Avas  seen  by  them 
as  late  as  nine  years  after  its  removal.  Such  were  the  facts  satisfactorily 
proved  with  regard  to  the  real  heir.  Twelve  years  after  the  wreck  of  the 
Bella,  in  which  Roger  Tichborne  was  lost,  the  defendant  Castro,  who  was 
residing  in  Australia,  first  set  up  a  claim  to  the  estates,  announcing  that 
he  was  Roger,  and  had  been  saved  from  shipwreck.  This,  however,  was 
proved  to  have  been  after  some  advertisements  had  appeared  in  the  Aus- 
tralian papers,  offering  a  reward  for  the  discovery  of  any  survivor  of 
the  Bella. 

A  large  amount  of  evidence  was  received  for  and  again,?t  the  defendant's 
identity.  It  is  only  necessar}^  to  consider  in  this  place  the  medical  evi- 
dence derivable  from  tattoo-marks  and  cicatrices.  There  was  no  mark  of 
tattooing  about  the  person  of  the  defendant,  nor  any  appearance  indicative 
of  his  having  been  tattooed.  Lipscombe,  his  physician,  had  examined  him 
and  found  no  tattoo-marks,  and,  to  add  to  the  force  of  this  evidence,  the 
defendant  himself  denied  that  he  had  ever  been  tattooed.  As  to  cicatrices, 
the  evidence  equally  failed.  Fergusson,  who  was  a  witness  for  him,  and 
other  surgeons  examined  his  arms,  temple,  and  feet,  but  found  no  cicatrix 
such  as  would  have  followed  bleeding.  There  were  some  scars  on  the 
feet  near  the  ankles,  but  these  had  not  l)een  produced  by  incisions  for 
bleeding  in  the  feet.  There  was  no  scar  or  depression  in  the  arm  where 
an  issue  had  been  placed  in  the  real  Roger. 

Unless  we  are  prepared  to  admit  that  a  man  can  be  tattooed  and  have 
no  knowledge  of  the  fact,  and  having  been  thus  unconscioush^  tattooed, 
that  all  the  marks  had  disa]>pearcd  before  he  saw  them,  it  is  impossible 
that  this  claimant  could  have  been  the  Roger  Charles  Tichborne,  the  heir 
to  the  estates.  The  durability  of  the  marks  Avas  clearly  proved  by  Lord 
Bellew.     So,  again,  with  regard  to  cicatrices.     There  were  none  to  render 


WOUNDS    OF    THE    HEAD,  327 

the  story  of  the  defendant  even  plausible,  and,  taken  together  with  the 
tattoo-marks,  they  were  in  flat  contradiction  to  his  assertion.  Resting- 
upon  these  medical  facts  alone,  there  was  sufficient  to  overthrow  his  claim 
and  to  prove  him  to  be  an  impostor  ;  but  there  was  an  accumulation  of  other 
evidence  ba.-^ed  upon  the  earl}'  history,  education,  travels,  and  habits  of  the 
lost  heir,  which  clearly  showed  that  this  was  a  false  claim.  That  this 
Impostor  should  for  long  a  period  have  defied  the  law  aud  deluded  a  large 
number  of  persons  is  in  itself  surprising. 

Pending  the  Tichborne  trial  a  man  named  Jean  Luie  presented  himself 
as  a  witness  for  the  defendant,  and  swore  that  he  was  on  board  the  Bella 
with  the  defendant,  and  had  escaped  with  him  from  the  wreck.  It  was, 
however,  proved  that  he  was  a  ticket-of-leave  convict  named  Lungren, 
who  had  been  repeatedly  in  gaol,  and  was  recognized  by  several  gaolers. 
Lungren,  according  to  the  gaol-books,  had  a  deformity  of  the  little  finger 
of  each  hand,  and  certain  moles  were  upon  his  back.  All  these  were 
found  on  the  pretended  Jean  Luie.  He  was  tried  and  convicted  of  thus 
endeavoring  to  defeat  justice  by  flagrant  perjury. 

Medical  Besponsibiliti/. — The  process  of  tattooing  is  not  unattended 
with  danger.  Cases  are  recorded  in  which  syphilis  has  been  thus  trans- 
mitted by  inoculation.  (Ann.  d'Hyg.,  1855,  t.  1,  p.  175.)  Berchon  col- 
lected four  cases  in  which  the  operation  proved  fatal  by  reason  of  the 
after-consequences.     (Ann.  d'Hyg.,  1870,  t.  2,  p.  464.) 


CHAPTER    XXXIII. 

■WOUNDS  OF  THE  HEAD. CONCUSSION. HOW  DISTINGUISHED  FEOM  INTOXICATION. EFFUSION 

OF  BLOOD  AS  A  RESULT  OF  VIOLENCE,   DISEASE,   OR  AIENTAL  EXCITEMENT WOUNDS  OF  THE 

FACE. DEFORMITY  AS  A  CONSEQUENCE  OF  WOUNDS  OF  THE  FACE. INJURIES  TO  THE  SPINE 

AND  SPINAL  MARROW.  —  FRACTURES  OF  THE  VERTEBRiE. 

The  danger  of  wounds,  and  their  influence  in  causing  death,  are  the 
two  principal  points  to  which  the  attention  of  a  medical  jurist  must  be 
directed. 

Wounds  of  the  Head. 

Incised  wounds  affecting  the  scalp,  unless  of  great  extent,  rarely  pro- 
duce any  serious  effects.  When  the  wound  is  contused,  or  accompanied 
by  much  laceration  of  the  skin,  it  is  highly  dangerous  in  consequence  of 
the  tendency  which  the  inflammatory  process  has  to  assume  an  erysipela- 
tous character.  The  results  of  these  wounds  are,  however,  such  as  to  set 
all  general  rules  of  prognosis  at  defiance.  Slight  punctured  wounds  will 
sometimes  terminate  fatally  in  consequence  of  inflammation,  followed  by 
extensive  suppuration  ;  Avhile,  on  the  other  hand,  a  man  may  recover  from 
a  lacerated  wound  by  which  the  greater  part  of  the  flesh  may  have  been 
stripped  from  the  bone.  There  are  two  sources  of  danger  in  wounds  of 
the  scalp :  1.  The  access  of  erysipelatous  inflammation.  2.  Inflammation 
of  the  tendinous  structures,  followed  or  not  by  a  process  of  suppuration. 
Either  of  these  secondary  efl'ects  may  be  a  consequence  of  slight  or  severe 
wounds,  and  prove  fatal.  Neither  can  be  regarded  as  an  unusual  result  of 
a  severe  wound  of  the  scalp,  but  when  one   or  the  other  follows  a  slight 


328  CONCUSSION  OF  THE  BEAIN. 

injury  there  is  reason  to  suspect  that  the  patient  maj  have  been  constitu- 
tiouaily  predisposed  to  the  attack.  Bad  treatment  may  likewise  lead  to  a 
fatal  result  from  a  wound  not  serious  in  the  first  instance,  but  the  question, 
how  far  theresponsibility  of  an  aggressor  would  be  affected  by  a  circumstance 
of  this  nature,  has  been  considered  in  another  place  (p.  298).  Wounds  of 
the  head  are  dangerous  in  proportion  as  they  atfect  the  brain  ,•  and  it  is 
rare  that  a  severe  contused  wound  is  unaccompanied  by  some  injury  to 
this  organ.  There  is,  however,  a  difficulty  which  a  practitioner  has  hereto 
contend  with — namel}^,  that  it  is  scarcely  possible  to  predict  frcm  encterval 
appearances  the  degree  of  mischief  which  has  been  produced  within. 
These  injuries,  as  it  is  well  known,  are  capricious  in  their  after-efl'ects;  the 
slightest  contusions  may  be  attended  with  fatal  consequences,  while  frac- 
tures, accompanied  by  great  depression  of  bone,  and  an  absolute  loss  of 
substance  of  the  brain,  are  sometimes  followed  by  perfect  recovery  An- 
other difficulty  in  the  w-ay  of  forming  a  correct  opinion  consists  in  the  fact 
that  a  person  may  recover  from  the  first  effects  of  an  injury,  but  after 
some  days  or  weeks  he  will  suddenly  die;  and,  on  examination  of  the 
body,  the  greater  part  of  the  brain  will  be  found  destroyed  by  suppuration, 
although  no  symptoms  of  mischief  may  have  manifested  themselves  until 
within  a  few  hours  of  death. 

Concussion. — The  common  effect  of  a  violent  blow  on  the  head  is  to 
produce  concussion  or  effusion  of  blood,  or  both.  Concussion  is  usually 
indicated  by  fainting,  insensibility,  or  sudden  death  occurring  immediately 
or  soon  after  the  application  of  external  violence.  In  concussion,  the 
symptoms  come  on  at  once,  and  the  patient  sometimes  dies  without  any 
tendency  to  reaction  manifesting  itself.  In  the  most  severe  form,  the 
person  drops  at  the  very  moment  when  struck,  and  dies  on  the  spot.  In 
other  cases,  he  may  linger  in  a  state  of  insensibility  for  several  days  or 
weeks,  and  then  die.  In  concussion,  there  is  generally  more  or  less 
vomiting.  It  is  important  to  remember  that  neither  compression  nor 
obvious  physical  injury  to  the  brain  is  necessary  to  render  concussion 
fatal.  This  may  be  entirely  dependent  on  shock  to  the  nervous  system. 
After  death,  no  particular  morbid  change  may  be  discovered  in  the  body, 
or  there  may  be  merely  the  mark  of  a  slight  bruise  on  the  head.  The 
state  of  insensibility  observed  in  concussion  may  be  only  apparent,  and  a 
slight  degree  of  consciousness  mg,y  be  retained.  A  blow  on  the  skull 
may  cause  death  by  leading  to  abscess  in  the  brain,  although  there  may 
be  no  fracture  or  other  ph3^sical  injury.  A  case  of  this  kind  proving  fatal 
in  about  a  week  is  reported.     (Lancet,  1873,  i.  p.  691.) 

Inflammation  may  follow  the  primary  shock  from  concussion,  suppura- 
tion may  take  place,  and  the  patient  die  after  the  lapse  of  several  weeks, 
or  even  months.  It  is  necessary  in  a  medico-legal  point  of  view  to  notice 
that  a  person  may  move  about  and  occupy  himself,  while  apparently  con- 
valescent, for  a  week  or  ten  days  after  recovery  from  the  first  shock,  and 
then  suddenl}^  be  seized  with  fatal  symptoms  and  die.  This  apparent 
recovery  leads  to  the  common  supposition,  that  death  must  have  been 
produced  Ijy  some  intervening  cause,  and  not  by  the  original  violence  to 
the  head — a  point  generally  urged  in  the  defence  of  such  cases.  When  the 
inflammation  that  follows  concussion  is  of  a  chronic  character,  the  person 
may  suffer  from  pain  in  the  head  and  vomiting,  and  die  after  the  lapse  of 
weeks,  months,  or  even  years.  Concussion  may  sometimes  take  place  as 
a  consequence  of  a  violent  fall  on  the  feet,  in  which  case  the  head  receives 
a  shock  through  the  medium  of  the  spinal  column.  The  skull  may  be 
thereby   extensively  fractured  at  the  base,  and  the  brain  may  be  even 


CONCUSSION    AND    INTOXICATION.  329 

shattered  by  such   a  fall,     This   was  the  cause   of  death  of  the  Duke  of 
Orleans,  the  son  of  Louis  Philippe. 

In  Allen  v.  The  Chester  Ry.  Co.  (Com.  Pleas,  Feb.  1857),  the  plaintiff 
claimed  damages  for  an  injury  caused  by  a  railway  collision.  The  evi- 
dence showed  that  the  plaintiff"  received  a  blow  on  the  head.  There  were 
no  immediate  effects;  but  in  two  days  he  suffered  from  lightness  of  the 
head  and  other  S3nnptoms,  attributed  by  his  medical  attendant  to  concus- 
sion of  the  brain,  as  a  result  of  the  accident.  Subsequently  there  were 
symptoms  of  injury  to  the  spine.  There  was  pain  in  the  course  of  the  spine, 
])artial  paralysis  of  the  bladder,  rectum,  and  legs,  with  loss  of  memory. 
The  medical  witnesses  for  the  plaintiff  attributed  these  symptoms  to  a 
blow  received  by  him  at  the  base  of  the  skull.  The  defendants  contended 
that,  if  these  were  the  results  of  concussion  of  the  brain,  the}'^  ought  to 
have  manifested  themselves  immediately  on  the  occurrence  of  the  accident  ;- 
and  this  view  was  to  some  extent  supported  by  the  evidence  of  experienced 
surgeons.  In  substance,  however,  the  medical  evidence  on  the  two  sides 
was  not  conflicting.  Concussion  of  the  brain,  as  it  is  ordinarily  known  to 
surgeons,  is  generally  attended  with  some  immediate  symptoms;  but  the 
witnesses  for  the  defence  properly  admitted  that  a  "concussion  of  the 
brain  (and  spine?),  attended  with  apparently  slight  symptoms  at  first, 
might,  under  peculiar  circumstances,  be  followed  by  serious  symptoms." 
As  no  other  cause  could  be  assigned  for  the  symptoms,  this  was  practi- 
cally admitting  that  the  plaintiff'  had  suffered  from  the  injury,  the  degree 
being  simply  a  question  for  the  jury.  They  returned  a  verdict  for  the 
plaintiff. 

Concussion  distinguished  from  Intoxication. — The  symptoms  under 
which  a  wounded  person  is  laboring  may  be  sometimes  attributed  to 
intoxication,  and  a  medical  witness  may  be  asked  what  difference  exists 
between  this  state  and  that  of  concussion.  The  history  of  the  case  will, 
in  general,  suffice  to  establish  a  distinction,  but  this  cannot  be  always 
obtained.  It  is  commonly  said  that  the  odor  of  the  breath  will  enable  a 
surgeon  to  detect  intoxication  ;  but  it  is  obvious  that  a  man  may  meet 
with  concussion  after  having  drunk  liquor  insufficient  to  cause  intoxication, 
or  concussion  may  take  place  while  he  is  intoxicated — a  combination 
which  frequently  occurs.  Under  such  circumstances  we  must  wait  for 
time  to  develop  the  real  nature  of  the  case.  Concussion  may  be  so  slight 
as  sometimes  closely  to  resemble  intoxication,  and,  from  the  absence  of  ail 
marks  of  violence  to  the  head  and  the  existence  of  a  spirituous  odor  in  the 
breath,  the  medical  examiner  might  be  easil}^  deceived.  If  there  be  no 
perceptible  odor  in  the  breath,  the  presumption  is  that  the  symptoms  are 
not  due  to  intoxication.  On  the  other  hand,  intoxication  may  be  so  great 
as  to  give  rise  to  the  apprehension  of  fatal  consequences,  and  the  coexist- 
ence of  a  mark  of  violence  on  the  head  might  lead  to  error  in  the  forma- 
tion of  an  opinion.  What  is  the  line  of  conduct  to  be  pursued  on  such 
occasions  ?  The  examiner  should  weigh  all  the  circumstances,  and  if 
there  be  one  cause  for  the  symptoms  more  probable  than  another,  he 
should  adopt  it ;  if  there  be  any  doubt,  this  should  be  stated  to  the  court. 
This  mistake  is  still  frequently  made,  and  a  person  in  a  state  of  insensi- 
bility from  violence  or  disease  has  had  his  death  accelerated  by  confine- 
ment in  a  cell  as  a  drunken  person,  when  it  subsequently  transpires  that 
he  has  not  been  drinking,  and  that  he  really  requires  medical  aid.  In  the 
metropolis  this  aid  is  now  usually  sought  by  the  police. 

There  is  nothing  in  the  state  of  the  brain  in  a  dead  body  which  will 
enable  a  practitioner  to  distinguish  whether  concussion  or  intoxication  had 
existed  and  had  been  the  cause  of  the  symptoms.     The  vessels  may  be 


330         EXTRAVASATION  OR  EFFUSION  OF  BLOOD. 

congested  in  both  cases.  The  discovery  of  an  alcoholic  liquid  in  the 
i?tomach  might  lead  to  a  presumption  that  the  deceased  had  been  intoxi- 
cated, Avhile  marks  of  violence  on  the  head  might  favor  the  view  that  he 
bad  sufiered  from  concussion.  When  both  conditions  are  found,  the  ex- 
amination of  the  body  cannot  lead  to  a  solution  of  the  question.  The 
answer  must  then  depend  on  the  special  circumstances  proved,  and,  if 
procurable,  on  the  nature  of  the  symptoms  preceding  death.  It  is  to  be 
feared  that  niedical  witnesses  are  not  sufficiently  careful  on  these  occasions 
to  determine  whether  there  are  signs  of  intoxication  about  an  injured  per- 
son. Subsequent  proceedings  may  render  this  a  material  part  of  the 
inquiry. 

The  distinction  of  apoplexy  from  drunkenness  involves  greater  difficulties. 
In  the.se  cases  we  have  to  deal  with  the  true  diagnosis  of  alcoholic  or 
narcotic  poisoning  (see  Opium,  p.  179,  ante).  Jackson  has  directed  atten- 
tion to  this  medical  question  in  a  case  reported  in  the  Med.  Times  and 
Gaz.,  1871,  i.  p.  SCO.  Some  instructive  cases,  in  reference  to  this  com- 
])lication  of  wounds,  have  been  published  by  Tardieu.  (See  Loud.  Med. 
Gaz.,  vol.  xliv.  p.  347.) 

Extravasation  or  Effusion  of  Blood. — A  blow  on  the  head  may  destroy 
life  by  causing  an  effusion  of  blood  either  on  the  surface  or  in  the  sub- 
stance of  the  brain.  In  pugilistic  combats,  when  a  person  is  thus  struck, 
he  commonly  falls,  and  death  may  take  place  in  a  ^ew  minutes.  On  in- 
spection, blood  ma}"  be  found  effused  either  at  the  base  or  in  the  ventricles 
of  the  brain,  and  the  question  will  present  itself — Did  the  injury  which 
caused  death  arise  from  a  blow  or  a  fall?  A  heavy  blow  on  the  head 
may  cause  fatal  effusion  of  blood,  but  on  these  occasions  the  effusion  com- 
monly arises  from  the  violent  concussion  which  the  injured  person  su.stains 
by  the  fall.  A  medical  witness  will  therefore  in  general  be  compelled  to 
admit  that  the  fatal  effusion  might  have  taken  place  either  from  a  blow  or 
a  fall.  If  the  fall  has  resulted  from  accident,  and  not  from  a  blow,  this 
will,  of  course,  absolve  the  accused  from  responsibility  for  the  fatal  results. 
This  subject  has  important  applications  in  legal  medicine,  for  this  is  one  of 
the  most  common  causes  of  death  from  injuries  to  the  head,  and  there  are 
many  cases  of  this  description  tried.  Effusion  may  occur  from  violence 
with  or  without  fracture,  and  it  may  take  place  without  being  accom- 
panied by  any  external  marks  of  injury. 

In  case  of  injury  to  the  head  proving  fatal  b}''  effusion  of  blood  on  the 
brain,  a  person  may  recover  from  the  first  effects  of  the  violence  and  ap- 
parently be  going  on  well,  when  he  will  suddenly  become  worse  and  die. 
Effusion  takes  place  slowly  at  first ;  it  may  be  arrested  by  the  effects  of 
stupor  from  concussion,  by  a  portion' of  the  blood  coagulating  around  the 
ruptured  orifices  of  the  vessels,  or  by  some  other  mechanical  impediment 
to  its  escape  ;  but  after  a  longer  or  shorter  period,  especiallv  if  the  person 
be  excited  or  disturbed,  the  bleeding  will  recur  and  destroy  life  by  pro- 
ducing compression  of  the  brain.  How  many  hours  or  days  are  required 
in  order  that  such  an  increased  effusion  should  take  place  after  an  accident, 
it  is  impossil)le  to  say  ;  but  in  severe  cases  it  is  generalh^  observed  to 
follow  the  injury  within  a  short  time.  Astley  Cooper  has  related  the  case 
of  a  gentleman  who  was  thrown  out  of  a  chaise  and  fell  upon  his  head 
with  such  violence  as  to  stun  him  in  the  fir.st  instance.  After  a  short  time 
he  recovered  his  senses,  and  felt  so  much  better  that  he  entered  the  chaise 
again  and  was  driven  to  his  father's  house  by  a  companion.  He  at- 
tempted to  pass  off  the  accident  as  of  a  trivial  nature,  but  he  soon  began 
to  feel  heavy  and  drowsy,  so  that  he  was  obliged  to  go  to  bed.  His  symp- 
toms became  more  alarmins:,  and  he  died  in  about  an  hour,  as  it  afterwards 


EFFUSION    OF    BLOOD    FROM    DISEASE    OR    VIOLENCE.  331 

apiK'arrd,  from  efFiision  of  blood  on  the  l)rain.  When  the  brain  has  sus- 
tained laceration  from  violence,  in  addition  to  insensibility,  convulsions 
are  frequently  observed. 

Effuaion  of  Blood  from  Disease  or  Violence. — Blood  may  be  found 
effused  in  various  situations  within  the  interior  of  the  skull,  and  the  cause 
of  the  effusion  may  be  either  disease  or  violence.  The  skill  of  a  medical 
jurist  is  often  required  to  determine  which  of  these  causes  is  the  more 
probable,  as  where,  for  instance,  a  pugilist  has  died,  after  having  received 
severe  injuries  to  the  head,  and  his  adversary  is  tried  on  a  charge  of  man- 
slaughter. On  these  .occasions  it  is  often  urged,  in  the  defence,  that  the 
bleeding  might  have  arisen  either  from  the  diseased  state  of  the  vessels  of 
the  brain,  or,  if  the  evidence  render  it  probable  that  the  blow  Avas  the 
pause,  that  the  effects  of  the  blow  were  aggravated  by  a  diseased  condition 
of  the  vessels,  or  by  the  excitement  into  which  the  deceased  was  thrown, 
either  from  the  effects  of  intoxication  or  passion.  (See  case  of  Reg.  v. 
Saxon,  p.  293,  ante.)  When  the  brain  is  not  lacerated  by  violence,  the 
blood  is  effused  either  on  the  surface  of  the  hemispheres,  between  the 
membranes,  or  at  the  base.  When  the  effusion  is  caused  by  violence,  the 
effused  blood  is  not  always  found  under  the  spot  where  the  blow  was  in- 
flicted, but  occasionally,  by  counter-stroke  on  the  surface  of  the  brain, 
directly  opposite  to  it — a  case  which  a  medical  witness  has  frequently 
been  required  to  explain  on  trials,  and  which  depends  on  the  same  cause 
as  fracture  by  counter-stroke,  i.  e.  on  a  separation  of  parts  (laceration  of 
the  brain,  effusion  of  blood,  or  even  fracture  of  the  bones)  at  the  point  of 
the  skull  directly  opposite  to  that  which  sustains  the  violence.  Thus 
fracture  of  the  base  of  the  skull  is  frequently  the  result  of  severe  violence 
applied  to  the  top  of  the  head  (vertex).  Effusions  of  blood  from  a  diseased 
state  of  the  vessels  more  commonly  take  place  in  the  substance  of  the 
brain,  but  they  sometimes  occur  on  the  surface  of  the  organ  as  a  result  of 
mere  excitement,  or  over-exertion  of  the  muscular  powers.  A  diseased 
condition  of  the  vessels,  and  probably  a  softening  of  the  substance  of  the 
brain,  will,  on  these  conditions,  be  apparent  on  inspection. 

If  the  effusion  depend  on  disease,  the  arteries  around  may  be  found 
diseased,  or  the  brain  itself  may  be  found  softened  and  disorganized.  The 
state  of  the  brain  and  its  vessels  should  be  closely  examined  in  all  cases  of 
alleged  violence,  since  hemorrhage  may  take  place  either  from  excitement 
or  heavy  blows,  wherever  this  diseased  condition  exists.  It  has  occasion- 
ally happened,  especially  in  old  people,  that  the  person  has  dropped  down 
dead  without  a  blow  being  struck,  and  that  death  has  been  wrongly  im- 
puted to  violence.  Cerebral  hemorrhage  from  disease  rarely  occurs  in  per- 
sons under  forty  years  of  age.  Frequent  intemperance  and  violent  passion 
may,  however,  easily  create  a  tendency  to  it  in  younger  persons.  As  an 
effect  of  violence  it  may  take  place  in  persons  of  all  ages,  but,  when  the 
marks  of  violence  are  slight,  a  witness  must  exercise  great  caution  before 
he  alleges  that  the  effusion  was  produced  by  a  blow,  especiall}^  when  it  is 
found  that  the  deceased  was  of  intemperate  habits. 

As  a  summary  of  these  remarks,  we  may  say  that,  in  effusions  of  blood 
from  violence,  the  blood  generally  issues  from  a  vessel  which  is  plainly 
seen  to  l)e  torn,  as  the  middle  arterv  of  the  brain,  or  the  lateral  sinus.  The 
effused  blood  is  commonly  found  on  the  surface  of  the  brain,  and  not  in  its 
substance,  unless  the  organ  is  lacerated.  When  situate  between  the  dura 
mater  (outer  membrane)  and  the  skull,  but  especially  when  immediately 
below  the  seat  of  violence  or  directly  opposite  to  it  by  counter-stroke,  this 
is  strong  evidence,  cseferis  pa,rihus,  that  it  has  proceeded  from  a  blow. 
When  there  is  a  fracture  of  the  skull,  the  presumption  of  the  extravasation 


332         EFFUSION  OF  BLOOD  FROM  EXCITEMENT. 

being  due  to  violence  is  great ;  because  this  is  not  only  a  sufficient,  but  an 
obvious  cause,  while  the  idea  of  its  having  proceeded  from  disease  only  is 
remote  and  speculative.  When,  besides  these  conditions,  there  is  no  re- 
markable congestion  of  the  brain  in  other  spots,  Avhen  the  substance  of  the 
brain  is  firm,  and  the  vessels  are  to  all  appearance  free  from  disease,  we 
have  the  strongest  reason  to  believe  that  the  effusion  must  have  been  due 
to  violence,  and  to  no  other  cause. 

The  evidence  given  on  some  trials,  when  the  main  question  has  turned 
upon  the  cause  of  an  ett'usion  of  blood  on  the  brain,  in  the  case  of  a  person 
who  has  sustained  violent  injuries  to  the  head,  has  rather  tended  to  reflect 
disgrace  on  medical  science.  It  has  been  made  to  appear  from  the  mouth 
of  the  medical  witness,  either  directlv  or  by  implication,  that  no  sort  of 
mechanical  violence  applied  to  the  head  of  a  man  in  a  state  of  drunkenness 
or  passion — of  one  whose  cerebral  vessels  were  probably  diseased — could 
have  had  any  effect  in  producing  a  fatal  extravasation  found  in  the  head 
after  death.  In  spite  of  an  individual  having  received  a  violent  blow  with 
a  bludgeon,  sufficient  to  have  killed  a  stout  and  vigorous  man,  or  of  his 
having  been  thrown  with  considerable  force  with  his  head  against  a  stone 
floor,  an  unqualified  admission  is  often  made,  that  excitement  alone,  or 
drunkenness  alone,  would  account  for  the  effusion  without  reference  to  the 
blow.  In  putting  the  most  favorable  construction  upon  these  cases,  when 
we  have  clear  evidence  of  great  violence  having  been  used  to  the  head, 
with  the  presence  of  the  usual  post-mortem  appearances,  our  opinion 
should  be  that  the  excitement  or  drunkenness  might  have  predisposed  to, 
but  was  not  the  immediate  cause  of,  the  certbi'al  hemorrhage.  A  mere 
inspection  of  the  body  does  not  always  lead  to  the  discovery  of  the  cause 
of  an  effusion  on  the  brain.  The  violence  producing  an  effusion  of  blood 
ma}^  have  been  slight,  and,  unless  attention  is  particularly  directed  to  the 
subject,  it  may  be  overlooked.  The  condition  of  the  effused  blood  should 
be  accurately  noticed,  in  order  to  determine  whether  it  presents  an}'  marks 
indicative  of  its  being  recent  or  of  old  standing. 

Spontaneous  effusions,  or  effusions  frOm  disease,  are  not  easily  distin- 
guished from  those  which  are  the  result  of  violence  to  the  head.  Wilks 
has  pointed  out  that  in  most  instances  of  severe  injury  attended  with 
effusion  of  blood,  the  structure  of  the  brain  is  found  bruised.  In  meningeal 
apoplexy  (apoplexy  of  the  membrane)  the  source  of  the  blood  is  a  vein 
of  the  pia  mater,  or  inner  membrane,  and  sometimes  a  large  arterial  trunk. 
The  difficulty  chiefly  arises  in  those  cases  in  which  efi'usion  is  found  after 
slight  violence,  and  there  is,  at  the  same  time,  disease  of  the  blood- 
vessels of  the  brain.  Wilks  gives  the  results  of  several  inspections,  in 
Avhich  effusion  was  owing  to  disease,  to  violence,  and  to  a  mixed  condi- 
tion.    (See  Guy's  Hosp   Rep.,  1859,  p.  120.) 

Effusion  of  Blond  from  Excitement. — When  engaged  in  the  investiga- 
tion of  these  cases,  it  is  always  a  fair  matter  of  inquiry  whether  the  vio- 
lence, upon  the  evidence,  was  not  of  itself  sufficiently  great  to  account  for 
the  effusion  wnthout  the  supposition  of  coexisting  disease  or  excitement. 
Admitting  that  the  rupture  of  a  bloodvessel,  and  the  extensive  effusion  of 
blood  on  the  brain,  may  take  place  from  simple  excitement  and  passion, 
yet  this  is  an  event  comparatively  rare,  at  least  in  the  young  and  henlthv, 
while  nothing  is  more  common  than  that  these  results  should  follow  violent 
injuries  to  the  head,  whatever  the  age  or  condition  of  the  person.  (See  case 
of  Reg.  V.  Saxon,  p.  293,  ante.)  A  medical  witness  should  remember  that 
on  these  occasions,  if  he  is  unable  to  say  positively  whether  the  effusion 
was  due  to  the  excitement  or  the  blows,  he  will  satisfy  the  court  if  he  only 
states  clearlj"  that  which  is,  in  his  own  mind,  the  more  probable  cause  of 


DATE    OF    EFFUSION    OF    BLOOD    ON    THE    BRAIN.  333 

death ;  and,  by  weighing  all  the  circumstances  of  the  case  beforehand,  he 
will  rarely  fail  to  (ind  that  one  cause  was  more  probable  than  the  other. 
Thus,  if  a  man,  excited  by  passion,  intoxication,  or  both,  is  struck  on  the 
head,  and  tlie  blow  is  slight — such  as  an  unaft'ccted  person  would  probably 
have  sustained  without  injury — yet  in  this  case  insensibility  and  death 
follow,  and,  on  examination,  a  quantity  of  blood  is  found  effused  in  the 
substance  of  the  brain  :  can  it  be  a  matter  of  doubt  with  the  practitioner 
that  the  effusion  was  chiefly  due  to  the  excitement  under  which  the  de- 
ceased was  laboring?  To  take  a  converse  instance — a  man  engaged  in  a 
personal  conflict  with  another  is  struck  most  violently  on  the  head,  or  falls 
with  great  force  on  this  part  of  the  body  ;  on  an  inspection  it  is  found  that 
death  has  arisen  from  effusion  of  blood  on  the  surface  of  the  brain,  and  it 
would  be  no  unexpected  consequence  of  the  violence  inflicted,  that  a  similar 
appearance  should  be  met  with  in  an  individual  calm  and  unexcited  :  can 
the  practitioner  hesitate  to  say,  under  these  circumstances,  that  the  blow 
would  satisfactorily  account  for  the  effusion,  without  reference  to  any 
coexisting  causes  of  excitement  ? 

In  these  criminal  investigations,  when  a  witness  is  examined  in  chief, 
he  asserts,  perhaps,  that  the  effusion  of  blood  was  owing  to  a  blow  in- 
flicted on  the  head.  The  counsel  who  cross-examines  him  then  puts  the 
leading  question,  whether  vessels  may  not  be  ruptured  by  excitement ; 
he  answers,  without  any  qualification,  in  the  affirmative,  and  thus  pro- 
duces an  impression  on  the  minds  of  the  jury  that  excitement  may  have 
caused  the  rupture  of  the  vessel  in  the  particular  case  on  which  he  is  being 
examined.  This  is,  of  course,  the  sort  of  answer  which  a  prisoner's  counsel 
wishes  to  extract  from  a  witness ;  and  the  effect  produced  by  it  on  the 
court  is  not  always  removed,  even  by  a  careful  re-examination.  The  counsel 
for  the  defence  is  well  aware  that,  in  a  case  of  this  description,  his  only 
chance  of  obtaining  an  acquittal  is  to  throw  a  degree  of  doubt  on  the 
medical  evidence,  and  to  render  it  probable  to  a  jury  that  the  death  of  the 
deceased  person  was  due  to  some  other  cause  than  the  blow^  inflicted  by 
the  prisoner.  As  leading  questions  are  allowed  to  be  put  to  any  extent 
in  a  cross-examination,  the  answer  in  the  monosyllable  "yes"  or  "no" 
generally  carries  with  it  much  more  than  a  medical  witness  intends.  A 
medical  witness  should  remember  that  he  is  sworn  to  state  the  ivhole  truth. 
A  qualified  answer  should  be  given  to  what  is  really  a  general  question  ; 
and,  supposing  his  opinion  to  be  already  formed  on  the  subject  on  which 
his  evidence  is  requii-ed,  he  should  not,  unless  it  be  strictly  consistent 
with  his  own  views,  allow  his  answer  to  a  general  question  to  be  made 
applicable  to  a  particular  case.  If,  then,  he  is  asked  in  cross-examination 
whether  vessels  might  not  be  ruptured  and  blood  extravasated  by  mere 
excitement,  he  should  answer  that  such  an  effect  might  undoubtedly 
follow  ;  but  that  it  was  his  opinion — and  I  am  here  supposing  that  his 
opinion  has  been  founded  upon  a  deliberate  examination  of  all  the  medical 
facts — that  excitement  was  not  the  cause  of  rupture  and  extravasation  in 
the  case  in  question.  A  M'itness  has  a  right  to  insist  that  his  evidence 
shall  pass  to  the  jury  without  having  any  designed  ambiguity  attached 
to  it. 

Date  of  Effusions. — Eecent  effusions  of  blood  are  recognized  by  their 
red  color,  and  the  consistency  and  appearance  of  the  clot,  or  coagulum. 
After  some  days  the  clots  acquire  a  chocolate  or  brown  color,  and  this 
passes  gradually  into  an  ochreous  tint,  which  may  be  met  witli  in  from 
twelve  to  twenty-five  days  after  the  violence.  (Guy's  Hosp.  Rep.,  1859, 
p.  122.)  Coagula  of  effused  blood  also  underu-o  changes  in  structure 
and  consistency  ;  when  old  they  are  firmer,  and  there  is  much  lymph, 


su 


DATE    OF    EFFUSION    OF    BLOOD    ON    THE    BRAIN. 


Fig.  48. 


which  is  sometimes  disposed  in  membranous  layers  of  a  fibrous  struc- 
ture, and  these  are  adherent  to  the  dura  mater  and  the  brain.  The  surface 
of  this  organ  sometimes  presents  a  marlc  indicative  of  pressure.  When  a 
medical  man  is  required  to  give  an  opinion  of  the  date  of  an  effusion  found 
on  the  brain,  great  caution  is  required.  He  may  not  be  able  to  fix  the 
precise  date,  but  it  may  be  in  his  power  to  say  whether  the  blood  has 
been  effused  for  a  few  days,  or  for  weeks,  or  months. 

When  a  blow  on  the  head  is  of  a  heavy,  bruising  kind,  the  whole  sub- 
stance of  the  skull  may  be  fractured  without  a  division  of  the  skin.  There 
is  one  remarkable  circumstance  connected  with  fractures  accompanied  by 
depression  of  bone,  which  here  requires  to  be  mentioned — namely,  that 
the  person  has  been  sensible  so  long  as  the  foreign  substance  which  pro- 
duced the  fracture  and  depression  remained  wedged  in  the  brain,  and 
insensibility  and  other  fatal  symptoms  began  to  manifest  themselves  only 
after  its  removal.  This  being  admitted,  it  may  be  urged  in  defence  that 
death  was  really  caused  by  medical  interference.  But  it  is  a  suflQcient 
answer  to  state  that  the  wounded  person  must  have  died  from  inflamma- 
tion of  the  brain  if  the  foreign  body  had  been  allowed  to  remain ;  and 
that  it  is  consistent  with  the  soundest  principles  of  practice  to  remove  all 
such  foreign  substances  without  delay.  In  fractures  of  the  skull  with  de- 
pression, it  may  become  a  question  whether  the  surgeon  raised  the  de- 
pressed portion  of  bone  so  soon  as  he  ought  to  have  done. 

In  the  description  of  injuries  of  the  head,  it  is  impossible  to  avoid  the 
use  of  terms  with  which  members  of  the  legal  profession  are  not  likely 

to  be  acquainted.  In  giving  evidence  upon 
the  situation  of  wounds,  of  the  effusion  of 
blood  and  the  effects  of  fractures,  medical  wit- 
nesses are  often  compelled  to  make  use  of 
anatomical  terms,  and  are  not  always  success- 
ful in  explaining  them.  With  the  view  of 
removing  this  difficulty,  and  supplying,  to 
some  extent,  the  means  of  following  the  evi- 
dence of  a  witness  in  his  description  of  injuries 
to  the  head  and  its  contents,  a  diagrammatic 
engraving,  representing  the  relative  position 
of  the  membranes  of  the  brain,  is  annexed. 
Fig.  48  represents  a  section  of  the  bones  of  the  skull,  with  the  three 
membranes  which  cover  the  brain,  (a)  Section  of  the  skull-bones,  with 
the  outer  and  inner  tables,  and  the  intermediate  cellular  structure  or  diploe, 
indicated  by  the  dark  shading  ;  the  scalp,  or  skin  of  the  skull,  which  covers 
the  outer  table,  is  not  represented.  (6)  The  dura  mater,  or  outer  mem- 
brane of  the  brain  ;  it  is  thick  and  fibrous,  closely  adherent  to  the  inside 
of  the  inner  table  of  the  skull,  but  smooth  on  the  side  towards  the  brain, 
(c)  The  arachnoid  membrane,  so  named  from  its  delicate  web-like  struc- 
ture, forms  a  closed  sac,  covering  the  dura  mater — to  the  inner  surface  of 
which  it  give  its  glistening  aspect— and  also  the  pia  mater  on  the  surface 
of  the  brain,  which  it  closely  covers,  without  dipping  into  the  convolu- 
tions, (d)  The  pia  mater — the  membrane  which  immediately  invests  the 
substance  of  the  ])rain  and  dips  into  all  the  convolutions.  It  contains  the 
bloodvessels  which  nourish  the  hemispheres  of  the  brain.  These  mem- 
branes are,  for  distinctness,  represented  as  being  separated  from  each  other, 
but  they  are  naturally  in  close  proximity,  and  the  rough  side  of  the  dura 
mater  is  closely  adherent  to  the  inside  of  the  skull  (calvarium).  The  ordi- 
nary seats  of  the  effusion  of  blood  from  violence  are  between  the  dura 


i'«wt,  a 


The  skull,  -with  its  outer  and  inner 
table,  and  the  three  coverings  of 
the  brain  (membranes),  seen  iu 
section. 


WOUNDS    OF    THE    BRAIN.  33o 

mater  and  inner  table  of  the  skull,  and   between  the  pia  mater  and  the 
surface,  or  into  the  sul).stance  of  the  brain. 

In  reference  to  persons  found  dead  with  severe  injuries  to  the  head, 
attended  with  fracture  and  effusion  of  blood  on  the  brain,  a  medical  man 
may  be  required  to  ^ay  whether  such  an  amount  of  violence  is  or  is  not 
consistent  with  the  retention  of  muscular  exertion  and  power  of  locomo- 
tion by  the  deceased.  For  instance,  a  man  may  fall  from  a  height,  and 
produce  a  severe  compound  fracture  of  the  skull.  He  may,  nevertheless, 
be  able  to  rise  and  walk  some  distance  before  he  falls  dead.  Under  these 
circumstances  there  might  be  a  strong-  disposition  to  assert  that  the  de- 
ceased must  have  been  murdered — the  injuries  being  such  that  they  could 
not  have  been  produced  by  himself,  there  being  at  the  same  time  no 
weapon  near,  and  no  elevated  spot  from  which  he  could  have  fallen.  The 
discovery,  after  death,  of  severe  injury  to  the  head,  with  great  effusion  of 
blood  on  the  brain,  must  not,  however,  lead  a  surgeon  to  suppose  that  the 
person  who  sustained  the  violence  had  been  immediately  incapacitated. 
There  are  various  cases  recorded  which  show  that  a  power  to  move  has 
been  retained  under  conditions  which  might  be  supposed  to  render  a  per- 
son incapable  of  moving  from  the  spot.  Full  allowance  must  be  made  on 
these  occasions  for  the  possible  exercise  of  locomotion  by  the  deceased. 
Although  a  large  quantity  of  blood  may  be  found  after  death  pressing  on 
the  substance  of  the  brain,  it  does  not  follow  that  this  effusion  and  pressure 
were  the  immediate  results  of  the  violence.  (See  case  of  Reg.  v.  Saxon, 
p.  293.) 

The  importance  of  these  observations  will  be  further  seen  by  the  follow- 
ing case :  A  man  was  found  dead  in  a  stable,  with  a  severe  fracture  of 
the  tem])oral  bone,  which  had  caused  a  rupture  of  the  middle  artery  of  the 
brain.  A  companion  w^as  accused  of  having  murdered  him,  but  he  alleged 
that  the  deceased  had  fallen  from  his  horse  the  day  before,  and  had  thus 
met  with  the  accident.  It  appeared,  however,  that,  after  the  fall,  the  de- 
ceased had  gone  into  a  public-house  before  he  returned  to  the  stables,  and 
had  remained  there  some  time  drinking.  The  question  respecting  the 
guilt  of  the  accused  party  rested  upon  the  fact  whether,  after  such  an  ex- 
tensive fracture  of  the  skull  with  extravasation  of  blood,  it  was  possible 
for  a  man  to  do  what  the  prisoner  had  represented  the  deceased  to  have  done. 
Wallace  very  properly  gave  a  qualified  opinion;  he  said  it  was  improba- 
ble, but  not  impossible,  that,  after  receiving  such  an  injur}',  the  deceased 
could  have  walked  into  and  drunk  at  a  public-house.  The  extravasation 
was  here  the  immediate  cause  of  death,  and  probably  this  did  not  take 
place  to  the  full  extent,  except  as  a  consequence  of  the  excitement  from 
drinking. 

Wounds  of  the  Brain. — Wounds  of  the  brain,  even  when  slight,  some- 
times prove  instantaneously  mortal,  while  in  other  cases  recoveries  take 
place  from  contused  or  punctured  wounds  of  this  organ,  contrary  to  all 
expectation.  When  a  person  survives  the  first  effects  of  the  injury,  there 
are  two  sources  of  danger  which  await  him:  1.  The  production  of  so- 
called  fungus  from  the  exposed  portion  of  the  brain.  2.  Inflammation  and 
its  consequences.  The  process  of  inflammation,  it  must  be  remembered,  is 
very  slowly  established  in  this  organ  ;  it  may  not  manifest  itself  until 
from  three  to  ten  weeks  after  the  injury.  In  one  remarkable  case,  where 
a  child  was  accidentally  shot  through  the  brain,  the  ball  having  traversed 
both  hemispheres,  no  symptoms  of  cerebral  inflammation  manifested  them- 
selves for  twenty-six  days.  The  child  died  on  the  twenty-ninth  day. 
(Lend.  Med.  Gaz.,  vol.  xxxix.  p.  41.) 


386    .  INJURIES    TO    THE    SPINE. 

Woioids  of  the  Face. — When  wounds  of  the  face  are  of  any  extent, 
they  are  usually  followed  by  great  deformity;  and  when  ihey  penetrate 
the  cavities  in  which  the  organs  of  the  senses  are  situated,  they  often 
prove  fatal,  either  by  involving  the  brain  and  its  membranes,  or  by  giving 
rise  to  inflammation  of  this  organ.  Wounds  of  the  eyebrows  are  not  of  so 
simple  a  nature  as  might  at  first  sight  be  supposed.  Besides  being  attended 
with  deformity  when  they  heal,  they  are  liable,  during  the  process  of  heal- 
ing-, to  cause  serious  disorders  of  the  neighboring  parts.  Amaurosis  and 
neuralgia  are  recorded  among  the  secondary  and  not  unusual  consequences 
of  such  wounds,  when  the  supra-orbital  nerve  has  become  implicated. 
Under  certain  conditions  of  the  body,  there  may  i)e  inflammation  of  the 
parts  within  the  orbit,  extending  to  the  membranes  of  the  l)rain,  and 
proving-  fatal  by  leading  to  the  I'ormation  of  pus  within  that  organ.  Am- 
aurosis in  the  right  eye  has  been  known  to  occur  from  a  contused  wound, 
not  of  a  violent  nature,  on  the  right  eyebrow,  ^^'ounds  api  arently  con- 
iined  to  the  external  parts  of  the  face  IVequently  conceal  deep-seated  mis- 
chief. A  sharp  instrument  penetrating  the  ej^elid,  and  passing  upwards 
with  force,  will  produce  fracture  of  tlie  orbital  plate  of  the  frontal  bone, 
which  is  very  thin,  and  even  injure  the  brain  beyond. 

Deformitij  as  a  Consequence  of  Wounds  of  the  Face. — Wounds  of  the 
face,  when  at  all  extensive,  are  always  followed,  in  healing,  by  greater  or 
less  deformity.  A  medical  witness  may,  perhaps,  find  these  questions 
put  to  him  in  relation  to  them — Is  the  wound  likely  to  be  attended  with 
deformity?  Could  such  a  wound  of  the  face  heal  without  deformity? 
or,  could  the  deformity,  if  it  exist,  have  been  produced  by  any  other 
cause  than  the  wound?  These  questions  are  of  importance.  A  person 
may  allege  that  he  was  severely  wounded  in  the  face,  when  the  medical 
witness  may  find  no  trace  of  such  a  wound  as  that  described,  Again,  a 
person  may  seek  damages  from  another  in  a  civil  action,  alleging  that  a 
particular  deformity  was  produced  by  a  wound,  when  the  medical  witness 
may  be  able  to  trace  its  origin  to  disease,  or  to  some  accidental  cause. 

Injuries  to  the  Spine. 

The  spinal  marrow  is  liable  to  concussion  from  blows,  to  compression 
from  fracture  of  the  vertebrss  or  the  effusion  of  blood,  with  all  the 
secondary  consequences  attending  such  accidents.  Concussion  of  the 
spinal  marrow  commonly  produces  paralysis,  affecting  the  bladder,  rectum, 
or  lower  limbs.  These  symptoms  may  not  appear  at  once,  but  come  on 
after  some  hours  or  days.  After  death  no  traces  of  mechanical  injury 
may  be  discovered.  Blows  on  the  spine,  unattended  with  fracture  or  dis- 
location, may  be  followed  by  inflammation  and  softening  of  the  spinal 
marrow.  A  slight  injury  has  thus  been  known  to  cause  death,  by  giving 
rise  to  inflammation  of  the  spinal  marrow.  This  organ  is  also  liable  to 
compression  from  slight  causes,  and  death  may  occur  from  paralysis  of  the 
nerves  of  respiration. 

Fractures  of  the  Vertehrse. — These  fractures  are  generally  attended 
with  displacement,  and  thus  produce  compression  of  the  spinal  marrow. 
They  are  the  more  rapidly  fatal  in  proportion  as  the  injury  is  high  up  in 
the  vertebral  column.  The  whole  of  the  body  becomes  paralyzed  below 
the  seat  of  injury,  as  a  result  of  the  compression  of  the  spinal  marrow. 
If  the  seat  of  compression  is  above  the  fourth  cervical  vertebra,  death  is 
commonly  immediate  ;  asphyxia  then  results  from  paralysis  of  the  nerves 
which  supply  the  diaphragm,  and  which  are  necessary  to  respiration.  In 
falls  on  the  summit  of  the  head  from  a  height,  it  sometimes  happens  not 


FRACTURES    OF    THE    VERTEBRAE.  337 

only  that  the  skull  is  extensivol}^  fractured,  but  that  the  dentiform  process 
of  the  second  vertebra  is  broken  off',  owing-  to  the  head  being  doubled 
under  the  body.  This  injury  to  the  second  vertebra  may  be  the  cause  of 
death.  From  a  case  related  by  Phillips,  it  would  appear  that  this  accident 
is  not  always  attended  with  fatal  compression  of  the  spinal  marrow. 
(Edin.  Med.  and  Surg-.  Jour.,  Jan.  1838,  p.  265.)  In  one  instance  the 
person  survived  fifteen  months  (ibid.,  Oct.  1845,  p.  527);  and  in  another, 
in  which  the  fracture  was  caused  by  the  patient  turning  in  bed  while  his 
head  was  pressed  on  the  pillow,  death  did  not  take  place  for  aixteen 
months.  On  several  criminal  trials,  this  injury  was  proved  to  have  been 
the  cau.se  of  death  ;  and  in  a  case  tried  in  Glasgow  (Rex  v.  Reid,  1835),  it 
became  a  material  question  how  far  such  a  fracture  might  result  from 
di.sease.  It  may  happen  that  caries  of  the  bone,  or  disease  of  the  trans- 
verse ligament,  will  cause  a  separation  of  the  dentiform  process  from  the 
second  cervical  vertebra.  The  state  of  the  bone  in  these  alleged  fatal  acci- 
dents should,  therefore,  be  closely  examined.  A  slight  cause  may  some- 
times produce  severe  and  fatal  injury  to  the  neck.  A  lunatic  in  a  private 
asylum  suddenly  threw  her  head  back  in  order  to  avoid  taking-  some  food 
that  was  offered  to  her;  and  she  fell  dead,  evidently  from  the  compression 
produced  by  a  sudden  displacement  of  the  dentiform  process  of  the  second 
vertebra.  A  woman  died  suddenly  a  month  after  her  confinement;  she  had 
lieen  suckling- her  child  at  one  o'clock  in  the  morning,  and  at  four  she  was 
found  dead.  The  viscera  of  the  abdomen,  chest,  and  head  were  carefully 
examined,  without  the  discovery  of  any  morbid  appearance  to  account  for 
death,  when,  as  the  brain  was  being  returned  into  the  skull,  one  of  the 
inspectors  noticed  a  projection  at  the  foramen  magnum.  On  further  ex- 
amination, the  dentiform  process  of  the  second  vertebra  was  found  to  have 
been  displaced,  and  this  had  so  injured  the  spinal  marrow  as  to  destroy 
life.  (Lond.  Med.  Gaz.,  vol.  iii.  p.  582.)  It  is  not  stated  whether  the 
bone  was  in  a  healthy  or  diseased  condition.  In  fractures  of  the  vertebrse, 
a  person  is  generally  so  disabled,  whatever  may  be  the  situation  of  the 
fracture,  that  he  cannot  walk  or  exert  him.self. 

Injuries  to  the  spine  and  its  contents  are  generally  the  result  of  falls 
or  blows,  either  on  the  head  or  the  lower  part  of  the  column.  The 
secondary  consequences  of  these  injuries  are  sometimes  so  insidious  as  to 
disarm  suspicion,  and  death  may  take  place  quite  unexpectedly  some  weeks 
after  the  accident.  Spicula  of  bone,  separated  by  fractures,  may  remain 
adherent  for  some  time;  and  by  a  sudden  turn  of  the  head  be  forced  off, 
and  destroy  life  by  penetrating  the  spinal  marrow,  at  a  long  period  after 
the  infliction  of  the  injury.  This  has  been  known  to  happen  in  fractures 
involving  the  margin  of  the  foramen  magnum,  and  in  such  cases  death  is 
immediate.  The  spinal  marrow  has  been  in  some  instances  wounded  in 
its  upper  part  by  sharp-pointed  instruments  introduced  between  the  ver- 
tebrte.  Death  is  an  instantaneous  result  when  the  wound  is  above  the 
third  cervical  vertebra  :  there  is  no  part  of  the  spine  where  a  weapon  can 
so  easily  penetrate  as  this,  especially  if  the  neck  be  slightly  bent  forward. 
The  external  wound  thus  made  may  be  very  small,  and  if  produced  with 
any  obliquity  by  drawing  aside  the  skin,  it  might  be  easily  overlooked,  or  it 
might  be  set  down  as  superficial. 


22 


338  WOUNDS  OF  THE  CHEST  a:s'i>  lu:sgs. 


CHAPTER   XXXIV. 

WOUNDS  OF  THE  CHEST. WOUNDS  AND  RUPTURES  OF  THE  LUNGS  AND  HEART. WOUNDS 

OF  LARGE  BLOODVESSELS. WOUNDS  AND  RUPTURES  OF  THE  DIAPHRAGM. DIRECTION 

OF  WOUNDS  OF  THE  CHEST. ^ WOUNDS  OF  THE  ABDOMEN. DEATH  FROM  BLOWS  ON  THE 

CAVITY. RUPTURES   OF   THE   LIVER,  GALL-BLADDER,  SPLEEN,  KIDNEYS,  INTESTINES, 

STOMACH,  AND  URINARY  BLADDER. WOUNDS  OF  THE  GENITAL  ORGANS. 

Wounds  of  the  Chest. — Wounds  of  the  chest  have  been  divided  into 
these  which  are  confined  to  the  walls  and  those  which  penetrate  the  cavity. 
Incised  or  punctured  wounds  of  the  walls  of  the  chest  are  rarely  followed 
by  dang-erous  consequences.  The  bleeding-  is  not  considerable,  and  is 
generally  arre.sted  without  much  difficulty.  They  heal  either  by  adhesion 
or  suppuration,  and,  unless  their  effects  are  aggravated  by  incidental  cir- 
cumstances, the  person  recovers.  Contusions  or  contused  wounds  of  the 
chest  are,  however,  far  more  dangerous,  and  the  danger  is  in  a  ratio  to  the 
degree  of  violence  u=ed.  Such  injuries,  when  severe,  are  ordinarily  accom- 
panied by  fractures  of  the  ribs  or  sternum  ;  by  a  rupture  of  the  viscera 
within  the  cavity,  including  the  diaphragm;  by  profuse  bleeding;  or,  as 
an  after-effect,  by  inflammation  of  the  lungs,  with  or  without  suppuration. 
Fractures  of  the  ribs  are  dangerous  for  several  reasons:  the  bones  may  be 
splintered  and  driven  inwards,  thereby  wounding  the  lungs  and  causing 
hemorrhage,  or  leading  to  inflammation  of  the  pleura  or  lungs.  The  inter- 
costal arteries  may  also  be  wounded.  In  fractures  of  the  upper  ribs,  the 
prognosis  is  less  favorable  than  in  those  of  the  lower,  because  commonly 
a  much  greater  degree  of  violence  is  required  to  produce  the  fracture.  A 
simple  fracture  of  the  sternum,  or  chest-bone,  without  displacement  of  the 
bone,  is  rarely  attended  with  danger,  unless  the  concussion  has  at  the  same 
time  produced  mischief  internally,  which  will  be  known  by  the  symptoms. 
When,  however,  the  bone  is  depressed  as  well  as  fractured,  the  viscera 
behind  may  be  mortally  injured.  In  a  case  of  depressed  fracture  of  the 
sternum,  the  person  died  after  the  lapse  of  thirteen  days  ;  and  on  inspection 
it  was  found  that  the  fractured  portion  of  bone  had  produced  a  transverse 
wound  of  the  heart  about  an  inch  in  length.  The  cavities  of  the  organ 
had  not  been  penetrated,  but  the  piece  of  bone  was  exactly  adapted  to  the 
depression  produced  by  it  on  the  parietes.  (Devergie,  Med.  Leg.,  t.  2, 
p.  243.)  A  Avitness  will  frequently  be  reqired  to  take  into  consideration 
the  eS'ects  of  contusion  of  the  thorax,  with  or  without  fracture,  in  cases  of 
death  from  pugilistic  combats,  which  formerly  gave  rise  to  numerous  trials 
on  charges  of  man.slaughter.  Wounds  penetrating  into  the  cavity  of  the 
chest  are  generally  dangerous,  even  when  slight,  in  consequence  of  the 
numerous  accidents  with  which  they  are  lial)le  to  Ije  complicated.  In  these 
wounds,  the  lungs  are  most  commonly  injured;  but,  according  to  the 
direction  of  the  weapon,  the  heart,  or  the  great  vessels  connected  with  it, 
as  well  as  the  gullet  or  thoracic  duct,  may  share  in  the  mischief. 

Wounds  of  the  Lungs. — The  immediate  cause  of  danger  from  wounds 
of  these  organs  is  hemorrhage,  Avhich  is  profuse  in  proportion  to  the 
depth  of  the  wound  and  the  size  of  the  vessels  wounded.  Should  the 
weapon  divide  any  of  the  trunks  of  the  pulmonary  veins,  the  individual 
may  speedily  sink.  The  degree  of  hemorrhage  cannot  be  determined  by 
the  quantit}^  of  blood  which  escapes  from  the  wound;  for  it  may  flow  in- 


WOUNDS    OF    TJIE    HEART.  339 

tei'ually  and  collect  within  the  cavity  of  the  pleura,  impeding  respiration. 
This  is  especially  to  be  feared  when  the  external  orifice  of  the  wound  is 
small  and  oblique,  and  one  of  the  intercostal  arteries  has  been  touched  by 
the  weapon.  A  wound  of  the  lung  is  generally  known,  among  other 
symptoms,  by  the  frothiness  and  florid  color  of  the  blood  which  issues 
from  the  orifice,  as  well  as  by  the  expectoration  of  blood.  The  lungs  may 
sustain  serious  injury  from  a  blow  or  fall,  and  yet  there  may  be  no 
external  marks  of  violence  or  symptoms  indicative  of  danger  for  some 
hours.  When  death  occurs  during  the  convalescence  of  a  person  who  has 
survived  the  first  effects  of  a  penetrating  wound  of  the  chest,  the  surgeon 
should  observe  whether  it  may  not  have  been  caused  either  by  impru- 
dence on  the  part  of  the  patient,  or  by  abuse  of  regimen,  or  other  mis- 
conduct ;  for  circumstances  of  this  nature  may  be  occasionally  treated  as 
mitigatory  on  the  trial  of  an  assailant.  In  all  cases  where  a  person  is 
progressing  to  recovery,  a  relaxation  of  regimen  should  be  made  with 
great  circumspection.  Too  much  nourishment,  too  Irequent  talking,  or 
any  exertion,  are  circumstances  that  may  cause  a  renewal  of  the  bleeding 
and  extravasation. 

Wounds  of  the  Heart. — Wounds  of  the  heart  are  among  the  most  fatal 
of  penetrating  wounds  of  the  chest.  It  was  formerly  considered  that  all 
wounds  of  this  organ  were  necessarily  andinstantli/  mortal.  Uudoubtedlv, 
when  either  of  the  cavities  is  laid  open  to  a  large  extent,  the  bleeding  is  so 
profuse  on  the  withdrawal  of  the  weapon  that  death  must  be  immediate. 
But  when  the  wound  is  small,  and  penetrates  into  the  cavities  of  the  heart 
obliquely,  life  may  be  prolonged  for  a  considerable  period  ;  and  cases  are 
on  record  in  which  it  is  probable  that  such  wounds  would  have  healed, 
and  the  patients  have  finally  recovei-ed,  but  for  the  supervention  of  other 
diseases  which  destroy  life. 

[Numerous  examples  of  wounds  of  the  heart  not  directlv  fatal  are  cited 
by  Beck,  voh  ii.  pp.  329-332,  and  by  Wharton  &  Stil]e,''2d  Ed.  p.  680. 
Dr.  Hartshorne,  of  Philadelphia,  cites  three  cases  where  the  victims  were 
proven  to  have  walked  several  steps  after  having  been  wounded  in  the 
heart.  Yid.,  also,  JST.  A.  Med.  and  Chir.  Review,  March,  1859,  p.  299; 
]Sr.  Y.  Med.  Times,  April,  1855  ;  case  of  Poole,  lb..  May,  1855  ;  Statistical 
Observations  on  Wounds  of  the  Heart,  with  a  table  of  forty-two  recorded 
cases  by  Dr.  Purple;  also  Am.  Jour.  Med.  Sci.,  July,  1861,  p.  292,  for  a 
case  of  bullet  in  the  wall  of  the  heart  for  twenty  years;  also  .Am.  Jour. 
Med.  Sci.,  Aug.  1829,  p.  307,  paper  on  Wounds  of  the  Heart  by  John 
Redman  Coxe,  and  M.  Jobert  de  Lamballe  on  Penetrating- Wounds  of  the 
Heart,  Archiv.  Ge:ie:\  de  MeJ.,  Sept.  1839.] 

It  was  the  opinion  of  Dupuytren  that  these  injuries  were  not  necessarilv 
fatal,  although,  with  perhaps  one  exception,  there  is  no  case  on  record  in 
which  a  person  has  recovered  from  a  penetrating  wound  of  the  cavities  of 
the  heart.  (Edin.  Med.  and  Surg.  Jour.,  Oct.  1844,  55Y ;  also  Ann. 
d'Hyg.,  1846,  t.  1,  p.  212.)  There  are  a  few,  probably,  who  will  be  in- 
clined to  consider  them  curable  ;  a  remote  possibility  of  simple  wounds 
healing,  and  of  the  patient  recovering,  may  be  admitted,  but  until  some 
clear  instances  of  recovery  from  penetrating  wounds  of  the  cavities  are 
reported,  the  majority  of  practitioners  will  continue  to  look  upon  them  as 
fatal.  From  a  series  of  cases  collected  by  Ollivier  and  Sanson,  it  appears 
that  out  of  twenty-nine  instances  of  penetrating  wounds  of  the  heart,  only 
two  proved  fatal  within  forty -eight  hours.  In  the  others  death  took  place 
at  the  varying  periods  of  from  four  to  twenty-eight  days  after  the  inflic- 
tion of  the  wound.  (Devergie,  Med.  Leg.,  t.  2,  p.  253.)  These  differences 
in  the  time  at  which  death  occurs,  as  well  as  the  fact  that  Avounds  of  the 


340  WOUNDS  OF  THE  HEART. 

heai't  do  not  instantly  destroy  life,  have  been  ascribed  to  the  peculiar  dis- 
position of  the  muscular  fibres  of  the  organ,  and  to  the  manner  in  which 
they  are  penetrated  by  a  weapon.  It  appears  from  the  observations  of 
OUivier  and  others,  that  the  right  cavities  of  the  heart  are  more  fre- 
quently wounded  than  the  left,  and  of  these  the  right  ventricle  is  most 
commonly  the  seat  of  injury.  Out  of  fifty-four  cases  of  wounds  of  this 
organ,  twenty-nine  were  situated  in  the  right  ventricle,  twelve  in  the  left 
A^entricle,  nine  in  the  two  ventricles,  three  in  the  right  auricle,  and  one  in 
the  left  auricle.  These  differences  are  readily  accounted  for  by  the  relative 
situation  of  the  cavities.  It  appears  alse  that  wounds  of  the  right  ventri- 
cle are  not  only  the  most  frequent,  but  of  all  others  they  are  the  most 
rapidly  fatal.  It  is  considered  that  the  suddenness  of  death  in  severe 
wounds  of  the  cavities  of  this  organ  is  to  be  ascribed,  not  merely  to  the 
loss  of  blood,  but  to  the  degree  of  compression  which  the  heart  experiences 
from  that  which  escapes  into  the  bag  of  the  pericardium.  In  reference  to 
the  direction  of  penetrating  wounds  of  the  chest,  it  may  be  proper  to  state 
that  the  base  of  the  heart  corresponds  to  the  upper  margin  of  the  third 
rib  on  the  left  side ;  and  the  apex  to  the  lower  margin  of  the  fifth  rib  on 
the  same  side. 

A  penetrating  wound  of  the  heart  was  formerly  considered  to  be  instan- 
taneously mortal,  and  the  usual  medical  opinion  at  coroners'  inquests  was 
that  a  person  so  wounded  must  have  dropped  down  dead  on  the  spot. 
More  accurate  observations  have,  however,  shown  that  this  is  an  erro- 
neous and,  in  medico-legal  practice,  a  highly  dangerous  doctrine.  The 
Due  de  Berri,  who  was  murdered  in  Paris  in  1820,  survived  eight  hours 
after  having  received  a  wound  of  the  left  ventricle.  Other  and  more 
remarkable  instances  of  survivorship  have  been  recorded  ;  and  it  may  be 
stated  that,  although,  in  a  surgical  view,  a  question  of  this  kind  is  of  little 
importance,  the  case  is  very  different  in  legal  medicine.  Upon  it  may 
depend  the  decision  of  questions  relative  to  suicide,  murder,  or  justifiable 
homicide.  Watson  met  with  a  case  in  which  a  man  who  had  been  stabbed 
in  the  right  ventricle  ran  eighteen  yards  after  having  received  the  wound. 
He  then  fell,  but  was  not  again  able  to  rise  ;  he  died  in  six  hours.  On 
dissection,  it  was  found  that  a  punctured  wound  had  extended  into  the 
right  ventricle  in  an  ol)liquely  transverse  direction,  dividing  in  its  course 
the  coronary  artery.  The  pericardium  was  nearly  filled  with  blood.  When 
the  cavities  of  the  heart,  especially  the  auricles,  are  extensively  laid  open, 
death  is  likely  to  be  an  immediate  result;  but  persons  who  have  sus- 
tained -wounds  of  this  organ  have  frequently  lived  sufficiently  long  to 
exercise  a  power  of  volition  and  locomotion.  In  reference  to  penetrating 
wounds  (stabs),  little  or  no  blood  probably  escapes  from  the  heart  in  the 
first  instance,  but  it  may  afterwards  ooze  gently,  or  suddenly  burst  out  in 
fatal  quantit}^  It  must  not,  therefore,  be  supposed,  when  a  person  is 
found  dead  with  a  wound  of  the  heart,  attended  with  abundant  hemor- 
rhage, either  that  the  flow  of  blood  took  place  in  an  instant,  or  that  the 
person  died  immediately  and  was  utterly  incapable  of  exercising  any 
voluntary  power.  Boileau  met. with  a  penetrating  wound  of  the  heart  in 
a  soldier,  accidentally  inflicted  with  a  knife.  The  man  did  not  think  it 
serious,  but  laughingly  ascended  fifteen  steps,  and  commenced  to  run  to 
the  hospital,  a  distance  of  two  hundred  yards;  then  fell,  and  died  in  five 
minutes.  The  pericardium,  or  bag  of  the  heart,  was  found  full  of  blood. 
The  knife  had  entered  the  front  surface  of  the  right  ventricle,  pierced  the 
septum,  and  passed  out  through  the  left  ventricle  near  the  apex.  (Lancet, 
1879,  p.  5G0.)  In  1879,  a  boy  was  admitted  into  Guy's  Hospital  with  a 
bayonet  wound  which  had  penetrated  through  the  front  wall  of  the  right 


RUPTURES  OF  THE  HEART.  341 

auricle,  which  was  transfixed.  The  bayonet  hod  then  pierced  the  septum, 
and  entered  the  left  ventricle.  It  pierced  the  mitral  valve  also,  and  entered 
the  left  auricle.  The  boy  survived  for  forty-two  hours,  but  was  mostly 
in  an  unconscious  state. 

Minute  wounds  of  the  chest  in  the  region  of  the  heart  are  sometimes 
made  with  tlie  intention  of  destroyin*?  the  lives  of  infants  or  children.  A 
woman  was  committed  for  trial  (C.  C.  C,  Jan.  187T)  under  the  following 
circumstances.  She  was  charged  with  endangering  the  life  of  her  infant, 
three  months  old,  by  thrusting  a  needle  into  its  side  between  two  ribs  and 
near  the  heart.  A  surgeon  was  called  to  the  child,  and  he  extracted  a 
long  needle  from  the  chest.  In  his  opinion  it  could  not  have  come  there 
by  any  accident,  and  force  must  have  been  used  to  push  it  in.  This 
woman  failed  in  her  attenipt  at  mui'der  by  her  ignorance  of  the  situation 
of  the  heart.  Strange  as  it  mav  appear,  a  iatal  wound  of  this  organ  by  a  . 
needle  may  be  the  result  of  accident.  The  fullowing  case,  communicated 
by  May  of  Newcastle-upon-Tyne,  occurred  under  his  observation  in  ISIfi. 
A  mother  was  clasping  to  her  bosom  her  child,  two  years  of  age,  for- 
getting that  she  had  just  placed  in  her  dress  a  needle,  two  inches  long, 
with  which  she  had  been  sewing.  The  child  screamed:  she  observed  part 
of  a  needle  with  thread  fall  to  the  ground,  and  on  removing  the  child's 
clothes  there  was  a  red  spot  near  the  nipple,  but  no  trace  of  blood.  May 
could  find  no  trace  of  the  broken  needle,  but  considered  that  about  an  inch 
and  a  half  had  been  broken  oif  and  was  imbedded  in  the  substance  of  the 
heart.  There  is  no  doubt  that  this  accidental  wound  was  the  cause  of 
death. 

Tiie  heart  is  liable  to  be  ruptured  cither  from  disease  or  accident.  In 
the  latter  case,  the  organ  generally  gives  way  towards  the  base,  and 
through  one  of  "its  cavities  on  the  right  side.  Hope  asserted  that  in 
ruptures  from  natural  causes,  it  is  the  left  side  of  the  heart,  and  particu- 
larly the  left  ventricle,  in  which  a  rupture  is  most  frequently  found.  The 
symptoms  are  sudden  pain,  collapse,  cramps,  cold  extremities,  and  rapid 
death.  According  to  the  circumstances  under  which  they  occur,  cases  of 
rupture  from  disease  may  excite  a  suspicion  of  death  from  violence. 
Sometimes  the  substance  of  the  heart  may  be  found  to  have  undergone 
fatty  degeneration.  As  a  rnedico-legal  subject,  it  is  worthy  of  note  that 
when  this  alarming  accident  proceeds  from  blows  or  falls,  it  is  not  always 
accompanied  by  marks  of  external  violence,  or  any  fracture  or  other  visible 
injury  to  the  exterior  of  the  chest.  A  girl,  ast  5,  was  knocked  down  and 
run  over  by  a  cart.  When  brought  to  the  hospital  she  was  quite  dead, 
and  there  was  no  mark  of  injury  upon  any  part  of  the  body.  On  in- 
spection, the  pericardium  was  found  to  be  full  of  blood,  which  had  issued 
from  a  transverse  rent  across  the  apex  of  the  heart.  Both  ventricles  were 
laid  open  ;  the  muscular  substance  was  torn  to  a  greater  extent  than  the 
pericardium.  The  ribs  were  not  fractured.  The  natural  causes  of  rupture 
of  the  heart  are  violent  mental  emotions,  such  as  anger,  fright,  terror, 
paroxysms  of  passion,  sudden  or  excessive  muscular  efforts,  or  violent 
physical  exertions  in  constrained  positions.  The  heart,  like  any  other 
muscle,  may  also  give  way  from  its  own  powerful  contraction.  When 
the  heart  is  in  a  diseased  condition,  any  slight  causes  of  excitement  are 
sufficient  to  produce  rupture  and  sudden  death.  The  mere  exercise  of 
walking  rapidly  or  running  may  thus  give  rise  to  fatal  consequences,  but 
death  may  take  place  quite  suddenly  while  the  person  is  at  rest.  A  man, 
set.  36,  who  had  had  no  previous  symptoms  of  illness,  died  suddenly  during 
the  night.  On  inspection,  a  rent,  half  an  inch  in  length,  was  found  in 
the  riffht  ventricle  of  his  heart.     The  Avails  of  the  ventricle  were  soft  and 


34:2  WOUNDS    OF    ARTERIES    AND    VEINS. 

thin.  Tliove  "was  a,  large  effusion  of  blood,  which  accounted  for  death. 
(Lancet,  1872,  ii.  p.  41.)  Another  case  of  sudden  death  from  rupture  of 
the  left  ventricle  is  recorded  in  the  same  journal,  (Ibid.,  p.  524.)  In 
both  cases  sickness  was  an  early  symptom. 

Wouvds  of  Arteries  and  Veins. — Wounds  of  the  large  arterial  and 
venous  trunks  around  the  heart  must  be  considered  as  mortal:  death  is 
generally  speedy  from  the  sudden  and  profuse  bleeding  which  attends 
them.  \Vith  regard  to  these  fatal  effusions  of  blood  within  the  chest,  as  well 
as  in  the  other  great  cavities,  it  may  be  mentioned  that,  irom  whatever  ves- 
sel or  vessels  the  blood  may  have  issued,  it  is  not  commonly  found  coagu- 
lated to  any  extent.  The  greater  part  of  it  generally  preserves  the  liquid 
.state,  and  it  is  rare  that  so  much  as  one-half  of  the  c[uantity  effused  is  met 
with  in  the  form  of  coagulum.  These  effusions  of  blood  in  the  chest  may 
be  sometimes  traced  to  wounds  of  the  intercostal  and  the  internal  mam- 
mary arteries,  or  of  the  vena  azygos. 

Wounds  of  the  carotid  arteries  have  been  considered  elsewhere  in  refer- 
ence to  wounds  of  the  throat  (p.  259).  Questions  relative  to  the  power  of 
locomotion  perhaps  more  frequently  occur  with  respect  to  wounds  of  the 
bloodvessels  of  the  neck  than  of  the  heart — suicide  and  murder  being  more 
commonly  perpetrated  by  the  infliction  of  such  wounds.  Wounds  of  the 
carotid  arteries  are  often  pronounced  instantaneously  mortal.  A  witness 
may  deliberately  state  that  the  person  could  not  possibly  have  survived 
an  instant.  This  is  a  very  hazardous  opinion,  for  it  occasionally  comes 
out,  on  inquir}^,  that  if  such  a  wound  had  been  instantaneously  mortal, 
then,  in  defiance  of  rational  probability,  or  of  the  strongest  presumptive 
evidence  to  the  contrary,  the  deceased  must  have  been  murdered.  A 
medical  opinion  of  this  kind  has  not  only  been  refuted  by  circumstances, 
but  by  the  evidence  of  eye-witnesses.  There  are  several'  cases  on  record 
which  show  that  wounds  involving  the  common  carotid  artery  and  its 
branches,  as  well  as  the  internal  jugular  vein,  do  not  prevent  a  person  from 
exercising  voluntary  power,  and  even  running  a  certain  distance.  There 
is  another  circumstance  which  requires  notice  in  relation  to  severe  W'ounds 
in  the  throat — namely,  that,  although  a  person  may  have  the  power  of 
locomotion,  he  may  not  be  able  to  use  his  voice  so  as  to  call  for  assistance.  • 
It  sometimes  excites  surprise  at  an  inquest,  how  a  murder  may  in  this 
way  be  quietly  committed  without  persons  in  an  adjoining  room  hearing 
any  noise;  but  the  fact  is,  that  when  the  windpipe  is  divided  the  voice 
is  lost. 

In  Reg.  V.  Gooch  (Northampton  Ass.,  Nov.  1871),  it  was  proved  that 
the  prisoner  had  attacked  the  deceased  with  a  knife,  and  had  produced  a 
severe  wound  in  the  arm.  The  medical  evidence  showed  that  it  was  a 
punctured  wound  about  five  inches  in  depth,  involving  the  brachial  artery. 
He  lost  a  large  quantity  of  blood,  but  a  medical  man  arrived  in  time  to 
tie  the  artery  and  thus  prevent  death  from  hemorrhage.  In  three  days, 
however,  gangrene  set  in,  and  the  man  died  from  this  secondary  cause. 
The  prisoner  was  held  responsible,  and  found  guilty  of  manslaughter.  He 
had,  it  seems,  aimed  at -the  arm,  thinking  the  stab  would  not  be  likely  to 
cause  death. 

In  reference  to  severe  wounds  involving  bloodvessels,  while  we  may 
allow  that  persons  may  survive  for  a  sufficient  time  to  perform  various 
acts  of  volition  and  locomotion,  yet  the  presence  of  a  mortal  wound,  espe- 
cially when  of  a  nature  to  be  accompanied  by  a  great  loss  of  blood,  must 
prevent  all  struggling  or  violent  exertion  on  the  part  of  the  wounded  per- 
son ;  such  exertion  we  must  consider  to  be  incompatible  with  his  condi- 
tion.    A   medical  jurist  may  thus  have   it  in   his  power   to   determine 


WOUNDS    AND    RUPTURES    OF    THE    DIAPHRAGxM.  343 

whether  a  mortal  wound  found  on  the  deceased  has  or  has  not  been  in- 
tlcted  for  the  purpose  of  murder.  On  wounds  of  other  bloodvessels, 
whether  arteries  or  veins,  it  is  unnecessary  to  make  any  further  remark. 
Death  is  generally  owing-  to  loss  of  Ijlood,  and  the  bleeding  from  a  com- 
paratively small  vessel  may  prove  fatal,  according  to  its  size,  situation, 
and  the  state  of  the  wounded  person. 

Death  from  the  Entrance  of  Air  into  Wounded  Veirn^. — In  wounds  of 
veins  there  is  an  occasional  cause  of  death  which  reciuires  a  remark,  namely, 
the  entrance  of  air  by  the  open  mouth  of  the  divided  vessel.  It  has  been 
long  known  that  air  injected  into  the  jugular  vein  would  destroy  life  by 
interfering  with  the  functions  of  the  heart.  According  to  some,  the  air 
rushes  into  the  cavity  of  the  vessel  owing  to  atmospheric  pressure  during 
the  expansion  of  the  heart,  while  others  believe  it  to  be  dependent  on 
aspiration  in  the  act  of  breathing;  but  in  some  alleged  cases  of  this  kind, 
death  has  been  probably  caused  by  loss  of  blood.  When  the  bleeding  is 
slight,  and  the  hissing  sound  is  heard  at  the  time  of  the  incision,  it  may 
fairly  be  ascribed  to  the  entrance  of  the  air.  This  opinion  would  be  con- 
firmed by  the  discovery  of  a  frothy  state  of  the  blood  in  the  right  cavities 
of  the  heart.  From  the  experiments  of  Tillaux,  it  appears  that  the  injec- 
tion of  air  into  the  proximal  or  distal  end  of  the  femoral  arteiy  of  dogs 
produces  complete  paralysis  of  the  hind  legs.  A  post-mortem  examina- 
tion showed  hemorrhage  and  softening  limited  to  a  single  point  in  the 
spinal  cord.  To  explain  the  production  of  this  effect  by  the  injection  of 
air  into  the  distal  end  of  the  artery,  he  supposes  that  the  air  cannot  pass 
through  the  capillaries  into  the  veins,  but  finds  its  way  by  anastomosing 
arteries  into  the  aorta,  and  thence  into  the  arteries  supplying  the  cord. 
After  an  injection  of  air  into  the  carotids,  patches  of  red  softening  are 
found  in  the  different  parts  of  the  brain,  bat  especially  in  the  medulla 
oblongata  and  pons  Varolii.  The  death  of  the  animal  is  often  very  rapid. 
(Lond.  Med.  Rec,  18T3,  p.  3T6.)  According  to  some,  death  has  arisen 
from  want  of  contractile  power  in  the  right  ventricle,  occasioned  by  its 
distention  with  air  ;  this  may,  no  doubt,  assist  in  producing  the  result,  as 
over-distention  of  either  cavity  of  the  heart  will  cause  paralysis  of  its 
walls.  But,  according  to  Pavy,  the  more  immediate  cause  is  the  fact  that 
air  will  not  circulate  through  the  capillaries  like  blood  ;  the  air,  therefore, 
entering  the  capillaries  of  the  lungs,  blocks  them  up  and  puts  an  end  to 
the  free  circulation  of  the  blood.  A  man  was  committed  on  a  charge  of 
manslaughter  to  the  Chester  Aut.  Ass.,  1885  ;  but  the  grand  jury  returned 
no  true  bill.  The  deceased  man,  Rowbotham,  and  the  accused.  Hinds, 
had  several  scuffles  and  falls  during  a  quarrel,  the  deceased  falling  upper- 
most. After  the  last  fall  the  deceased  was  suddenly  seen  to  be  in  a  fit. 
and  died  in  a  few  moments.  On  examination  there  were  a  few  external 
injuries,  one  of  which  was  a  small  wound  over  the  root  of  the  nose. 
There  was  general  emphysema  of  the  body,  and  air  had  by  some  means 
gained  access  to  the  heart  and  general  circulation.  The  point  of  entrance 
of  the  air  could  not  be  ascertained,  and  was  attributed  to  some  injury  in- 
flicted on  the  air-passages  during  the  struggle. 

Wounds  and  Ruptures  of  the  Diaphragm. — The  diaphragm,  or  mus- 
cular partition  between  the  chest  and  abdomen,  is  liable  to  be  wounded 
either  by  weapons  which  penetrate  the  cavity  of  the  chest  or  abdomen,  or 
by  the  ribs  when  fractured  through  violent  blows  or  falls;  but,  under  any 
circumstances,  wounds  of  this  muscle  are  not  likely  to  occur  without  im- 
plicating other  important  organs  that  are  in  contact  with  it.  It  is  scarcely 
possible,  therefore,  to  estimate  the  danger  of  these  injuries  abstractedly, 
as  a  medical  opinion  must  materially  depend  on  the  concomitant  mischief 


344  DIRECTION    OF    WOUNDS    IN    THE    CHEST. 

to  the  adjoining  viscera.  Slightly  penetrating  wounds- of  the  diaphragm 
may  heal  like  those  of  other  muscular  parts :  and  cases  of  this  kind  are  on 
record.  There  is,  however,  especially  when  the  wound  is  of  a  lacerated 
kind,  a  consecutive  source  of  mischief  which  no  remedial  means  can  avert, 
namely,  that  after  the  wound  has,  to  all  appearance,  healed,  the  life  of  a 
person  may  be  cut  short  by  the  strangulation  of  a  portion  of  the  stomach 
or  bowelsin  the  half-cicatrized  aperture.  In  a  case  of  this  description, 
when  death  occurs  at  a  long  period  after  the  infliction  of  a  wound,  the 
witness  may  probably  be  required  to  say  v/hether  the  wound  was  the 
cause  of  death,  or  whether  there  was  any  other  circumstance  which 
would  have  caused  or  facilitated  the  production  of  a  hernia.  The  degree 
of  responsibility  of  an  aggressor  may  materially  depend  upon  the  answers 
returned  to  these  questions.  Fhrenic  hernia,  as  this  form  of  internal  rup- 
ture is  termed,  is  not  by  any  means  an  unusual  or  unexpected  fatal  conse- 
quence of  a  wound  of  the  diaphragm  ;  and  therefore  it  would  appear  at 
first  sight  that  death,  at  whatever  period  this  event  may  occur,  should  be 
referred  to  the  original  wound.  But  the  case  may  present  some  difficul- 
ties, as  it  is  possible  that  a  slight  blow  on  the  stomach,  received  subse- 
quently to  the  wound,  or  even  any  violent  exertion  on  the  part  of  the 
deceased,  might  have  produced  the  fatal  strangulation.  A  person  may 
survive  with  a  large  phrenic  hernia  for  a  considerable  period,  and  die  from 
other  cause.  It  has  been  stated  that  a  person  is  completely  incapacitated 
and  rendered  incapable  of  exertion  or  locomotion  by  a  rupture  of  the 
diaphragm.  This  statement,  however,  has  been  based  on  limited  observa- 
tion. The  general  effect  of  such  an  injury  is  to  incapacitate  a  person,  but 
cases  are  recorded  in  which,  in  spite  of  the  rupture,  a  person  has  possessed 
the  power  of  moving  and  walking  to  a  considerable  distance. 

The  most  serious  injuries  to  the  diaphragm  are  unquestionably  those 
w^hich  are  produced  by  violent  contusions  or  falls  on  the  abdomen,  at  a 
time  when  the  stomach  and  intestines  are  distended.  In  these  cases  the 
muscular  fibres  may  be  ruptured  to  a  greater  or  less  extent ;  but  the 
bleeding  is  not  considerable,  rarely  exceeding  two,  three,  or  four  ounces. 
A  uniform  result  of  these  ruptvres,  when  extensive,  is  a  protrusion  of  the 
stomach  into  the  chest,  with  sometimes  a  rupture  of  its  coats  and  extrava- 
sation of  its  contents.  Severe  lacerations  of  the  diaphragm  are  more 
readily  produced  during  the  act  of  inspiration  than  during  expiration — the 
fibresof  the  muscle  being  then  stretched,  and  receiving,  while  in  this  state 
of  tension,  the  whole  of  the  force  of  the  blow.  According  to  Devergie, 
the  rupture  most  frequently  takes  place  in  the  central  tendinous  structure, 
where  it  is  united  with  the  left  muscular  portion  above  the  crura.  He 
has  remarked  that  it  occurs  more  commonly  on  the  left  side  than  on  the 
right.  (Op.  cit.,  t.  2,  p.  250.)  It  has  been  supposed  that  death  w^ould  be 
an  immediate  consequence  of  this  accident ;  but  this  viev\'  is  not  supported 
by  facts.  In  a  case  of  extensive  rupture  of  the  diaphragm,  related  by 
Devergie,  in  which  the  stomach  and  colon  were  found  in  the  chest,  the 
person  lived  nine  months  after  the  only  accident  which  could  have  pro- 
duced it,  and  then  died  from  another  cause.  Besides  the  stomach,  it 
sometimes  happens  that  the  liver,  spleen,  or  intestines  pass  through  the 
opening,  and,  like  it,  these  organs  are  liable  to  become  strangulated  ;  the 
lungs  are  at  the  same  time  so  compressed  that  respiration  is  stopped,  and 
asphyxia,  or  suffocation  may  be  an  immediate  result. 

Direction  of  Wounds  in  the  Chest. — In  judging  of  the  direction  taken 
by  wounds  which  traverse  the  chest  from  front  to  back,  it  is  necessary  to 
remember  the  great  difference  that  exists  in  the  level  of  the  same  rib  an- 
teriorly and  posteriorly.     This  must  be  especially  attended  to  when  we 


WOUNDS    OF    THE    ABDOMEN.  345 

are  called  upon  to  state  the  direction  of  a  traversing  wound  from  the  de- 
scripiiou  of  it  given  by  another.  Tlie  point  here  referred  to  had  an  important 
bearing  in  the  case  of  a  fatal  gunshot-wound  which  was  the  subject  of  a 
criminal  charge  many  years  ago.  (Henke's  Zeitschr,,  183G.)  It  must 
not  be  forgotten  that  a  wound  immediately  below  the  sternum,  or  chest- 
bone,  will  in  its  forepart  involve  the  viscera  of  the  abdomen,  in  the  back 
part  those  of  the  chest,  and  in  its  central  part  it  will  traverse  the  dia- 
phragm :  owing  to  the  great  obliquity  of  the  ribs,  the  upper  edge  of  the 
sixth  rib  behind  being  on  a  level  with  the  upper  edge  of  the  third  rib  in 
front,  when  standing. 

Wounds  of  the  Walls  of  the  Abdomen. — Incised  and inmctured  wounds, 
which  affect  the  parietes  or  coverings  of  the  abdomen,  without  penetrating 
the  cavity,  are  not  quite  of  so  simple  a  nature  as  might  at  first  sight  be 
imagined.  The  danger  is  immediate  if  the  epigastric  artery  be  wounded-; 
for  a  fatal  hemorrhage  will,  in  some  instances,  take  place  from  a  wound 
of  this  small  vessel.  Among  the  sources  of  danger  from  superficial 
wounds  is  inflammation,  followed  by  suppuration  beneath  the  tendinous 
membrane  which  covers  the  abdominal  muscles.  The  matter  formed  is 
very  liable  to  accumulate  within  the  sheath  of  the  muscles,  and  this  may 
prove  fatal  unless  proper  treatment  be  adopted.  The  inflammation  will 
sometimes  extend  to  the  peritoneum  and  thus  rapidly  destroy  life.  As 
improper  medical  treatment  may,  in  either  of  these  cases,  cause  a  super- 
ficial wound  of  the  abdomen  to  terminate  fatally,  so,  when  a  person  stands 
charged  with  having  inflicted  such  a  wound,  it  will  be  necessary  for  a 
medical  witness  to  consider  how  far  the  consequences  of  the  act  of  the 
prisoner  have  been  aggravated  by  wilful  neglect  or  unskilfulness.  But 
when  these  wounds  take  a  favorable  course  and  heal  there  is  an  after-effect 
to  be  dreaded,  namely,  a  protrusion  of  the  viscera  at  the  cicatrized  spot, 
constituting  ventral  hernia.  When  the  wound  has  involved  the  muscular 
fibres  transversely  to  their  course  the  cicatrix  which  follows  is  commonly 
far  less  capable  of  resisting  the  pressure  of  the  viscera  within  than  other 
parts  of  the  parietes.  A  hernia  may  take  place,  and  this,  like  other 
hernioe,  if  neglected,  is  liable  to  become  strangulated  and  lead  to  the  de- 
struction of  life.  The  walls  of  the  abdomen,  owing  to  the  protrusion  of 
this  cavity,  are  easily  penetrated  by  pointed  instruments,  and  it  requires 
but  a  slight  force  to  traverse  them  completely  and  wound  the  intestines. 
A  slight  wound  may  thus  prove  fatal  by  causing  peritoneal  inflammation. 

Contusions  on  the  cavity  of  the  abdomen  are  attended  generally  with 
far  more  serious  effects  than  on  the  chest.  This  arises  from  the  coverings 
of  the  abdomen  having  less  power  to  resist  external  shocks.  In  the  first 
place,  death  may  be  the  immediate  result  of  a  blow  in  the  upper  and  cen- 
tral portions ;  no  particular  morbid  changes  may  be  apparent  on  inspec- 
tion, and  the  violence  may  have  been  so  slight  as  not  to  have  produced 
any  ecchymosed  mark  on  the  skin.  Death  has  been  ascribed  in  these 
cases  to  a  fatal  shock  transmitted  to  the  system  through  a  violent  impres- 
sion produced  on  the  great  nerve-centre — called  the  solar  plexus.  Some 
remarks  have  already  been  made  on  sudden  death  from  blows  on  this  part 
of  the  abdomen  (p.  289).  Travers,  Alison,  "Watson,  Cooper,  and  other 
writers  on  surgical  injuries  have  referred  to  cases  of  this  kind  as  of  not 
unfrequent  occurrence.  They  are  of  considerable  importance  in  a  medico- 
legal point  of  view,  as,  in  the  absence  of  marks  of  physical  injury  on  the 
part  struck,  a  jury  might  be  led  to  doubt  whether  the  blow  could  have 
been  the  cause  of  death.  Some  surgeons  have  thought  that  these  cases 
have  not  been  accurately  observed,  and  that  in  those  which  terminated 
fatally   a    more  careful  inspection   would  probably  have  shown  visible 


346  RUPTURES    OF    THE    LIVER. 

changes  in  the  organic  structures.  The  fact,  however,  remains :  persons 
have  died  soon  after  receiving  severe  blows  on  the  upper  part  of  the  ab- 
domen, and  the  medical  men  who  have  examined  the  bodies  for  the  express 
purpose  of  detecting  physical  injuries  have  not  found  any  to  record. 
Moreover,  they  have  not  found  in  any  part  of  the  body  a  natural  cause  of 
sudden  death.      (Reg.  v.  Stone,  Durham  Wint.  Ass.,  1872.) 

Blows  ou  the  abdomen,  when  they  do  not  destroy  life  by  shock,  may 
cause  death  by  inducing  peritoneal  inflammation.  Violence  of  a  severe 
kind  applied  to  the  abdomen  is  not  always  indicated  by  ecchymosis  or 
injury  to  the  skin.  Effusions  of  blood  in  the  sheaths  and  tendinous  cov- 
erings of  the  muscles  may  or  may  not  be  indicative  of  violence.  One  fact 
must  here  be  borne  in  mind,  to  prevent  mistakes  in  examining  a  body  after 
death,  namel}^,  that  blood  may  be  found  copiously  effused  in  and  around 
the  abdominal  muscles,  quite  irrespective  of  the  application  of  violence. 
(Reid's  Physiol.  Researches,  p.  511.)  The  absence,  in  these  cases,  of 
ecchymosis  or  abrasion  of  the  skin  is  sufficient  to  show  that  such  extensive 
effusions  are  not  caused  by  violence.  Blows  adequate  to  produce  a  lacera- 
tion of  the  vessels  and  hemorrhage,  would  most  probably  be  attended  with 
ecchymosis  and  some  visible  injury  to  the  skin.  At  any  rate,  when  such 
marks  of  violence  are  not  visible,  and  there  is  no  evidence  of  a  blow  having 
been  struck,  a  witness  will  act  wisely  in  declining  to  attribute  the  mere 
effusion  of  blood  to  the  act  of  another  person.  Deeply  penetrating  wounds 
of  the  alxlomen  are  generally  fatal  by  reason  of  the  injury  done  to  the 
intestines  and  other  organs. 

Buptures  of  the  Liver. — Blows  on  the  abdomen  may  prove  fatal  by 
causing  a  rupture  of  the  liver  or  other  viscera,  with  extravasation  of 
blood;  and,  as  it  has  been  elsewhere  stated,  these  serious  injuries  may 
occur  without  being  attended  with  any  marks  of  external  violence  (p. 
289).  Of  all  the  internal  organs  the  liver  and  spleen  are  the  most  exposed 
to  rupture,  owing  to  their  compact  structure,  which  prevents  them  from 
yielding  to  a  sudden  shock,  like  the  stomach  and  intestines.  Ruptures  of 
the  liver  may  occur  from  falls  or  blows  ;  but  this  organ  may  be  ruptured 
merely  by  a  sudden  action  of  the  abdominal  muscles.  This  accident  is 
more  likely  to  occur  when  the  liver  has  undergone  fatty  degeneration,  or 
is  in  an  otherwise  diseased  state.  In  December,  1885,  a  case  was  referred 
to  the  editor  where  a  woman  (Pink)  died  of  ursemic  convulsions  after  de- 
livery. There  was  rather  extensive  hemorrhage  into  the  substance  of  the 
liver  and  beneath  its  investing  capsule,  apparently  as  the  result  of  the 
violent  muscular  contractions.  Ruptures  of  the  liver  are  generally  seen 
on  the  convex  surface  and  in  the  anterior  margin,  seldom  extending 
through  the  whole  substance  of  the  organ,  but  consisting  of  fissures  vary- 
ing from  one  to  two  inches  in  depth.  The  right  lobe,  from  its  size,  is  more 
usually  affected  than  the  left.  Their  usual  direction  is  from  before  back- 
wards, with  a  slight  obliquity  ;  they  rarely  intersect  the  liver  transversely. 
The  lacerated  edges  are  not  much  separated,  while  the  surfaces  present  a 
granular  appearance.  But  little  blood  is  met  with  in  the  laceration  ;  it  is 
commonly  found  effused  in  the  lower  part  of  the  cavity  of  the  peritoneum, 
or  in  the  hollow  of  the  pelvis,  and  is  only  in  part  coagulated.  Ruptures 
of  the  liver,  unless  they  run  far  backwards  and  involve  the  vena  cava  or 
portal  vein,  are  not  in  general  attended  with  any  considerable  eflusion  of 
blood  ;  but  the  bleeding,  should  this  vessel  be  implicated,  is  sufficient  to 
cause  the  instant  destruction  of  life.  Under  other  circumstances,  a  person 
may  survive  some  hours  or  days,  as  the  blood  sometimes  escapes  slowly, 
or  it  may  be  suddenly  effused  in  fatal  quantity  as  a  result  of  violent  exer- 
tion or  of  fresh  violence  applied  to  the  abdomen.    A  man  came  into  Guy's 


RUPTURES    OP    THE    SPLEEN    AND    KIDNEYS.  347 

Hospital  in  whom  there  were  no  immediate  or  urg-ent  symptoms.  He 
was  sent  away,  and  a  lew  hours  afterwards  he  was  found  dead  in  a  cell  at 
the  police-station.  On  inspection  the  liver  was  found  lacerated  nearly 
through  its  diameter,  and  a  basinful  of  blood  was  found  effused  in  the 
cavity  of  the  abdomen.  (Med.  Times  and  Gaz.,  18G4,  ii.  527.)  This  large 
effusion  must  have  taken  place  after  the  man  had  left  the  hospital.  Rup- 
tures of  the  liver  generally  prove  fatal  within  forty-eight  hours.  On  the. 
other  hand,  death  may  be  a  slow  result  of  this  injury.  In  one  case  a  man 
is  reported  to  have  died  from  a  rupture  of  the  liver  which  had  occurred 
from  an  accident  eight  years  before.  (Med.-Chir.  Rev.,  1886,  p.  296.)  A 
case  occurred  to  Wilks  in  which  a  patient  in  Guy's  Hospital  survived  this 
serious  accident  ten  days.  The  question  has  frequently  arisen  whether  a 
person,  having  a  rupture  of  the  liver,  can  walk  or  exercise  the  power  of 
locomotion.  A  case  above  mentioned  shows  that  this  injury  does  not  pre- 
vent locomotion.  Other  cases  illustrating  these  facts  are  recorded  in 
medico-legal  works.  In  Reg.  v.  Chatfield  (Maidstone  Wint.  Ass.,  1874), 
the  prisoner  was  proved  to  have  maltreated  his  wife  by  kicking  her  in 
the  abdomen  while  she  was  in  a  drunken  state.  There  was  evidence  that 
she  had  walked  after  the  infliction  of  this  violence.  The  liver  was  found 
ruptured,  and  there  were  extensive  bruises  over  this  part  of  the  abdomen. 
The  medical  witness  denied  that  the  deceased  could  have  walked  with  a 
ruptured  liver,  and,  therefore,  in  his  opinion  the  kicks  did  not  cause  the 
rupture.  This  was  the  main  ground  of  the  defence  ;  but  it  was  utterly 
inconsistent  with  all  the  other  facts  of  the  case,  and  the  prisoner  was  very 
properly  found  guilty  of  manslaughter. 

Wounds  and  ruptures  of  the  gall-bladder  are  necessarily  attended  with 
the  effusion  of  bile.  This  irritant  fluid  finds  its  way  into  the  cavity  of  the  ' 
abdomen,  and  the  person  dies  from  peritonitis.  In  the  Walworth  murder 
case  (see  p.  295,  a7ife)  a  minute  puncture  of  the  gall-bladder,  and  the  con- 
sequent escape  of  bile  into  the  peritoneal  cavity,  was  the  unsuspected 
cause  of  death. 

Ruptures  of  the  Spleen. — A  rupture  of  this  organ  may  be  produced  by 
bruising-  violence  directly  applied  to  that  part  of  the  abdomen  in  which  it 
is  situated  ;  and,  as  in  other  ruptures  of  the  abdominal  viscera  from  vio- 
lence, the  skin  may  not  present  any  mark  of  contusion.  In  spite  of  this 
well-known  fact,  a  case  seldom  comes  to  trial  in  which  the  defence  is  not 
made  to  rest  upon  the  absence  of  marks  of  blows  over  the  region  of  the 
ruptured  organ.  In  Reg.  u.  Chapman  (C.  C.  C,  Sept.  1877),  it  was 
proved  that  the  deceased  woman  had  sustained  violence  at  the  hands  of 
the  prisoner,  and  after  death  the  spleen  was  found  ruptured.  There  was 
no  mark  of  a  blow  corresponding  to  the  rupture;  nevertheless,  the  jury 
were  satisfied  with  the  medical  evidence  of  the  cause  of  death,  and  found 
the  prisoner  guilty  of  manslaughter. 

When  the  spleen  is  in  a  diseased  condition  from  softening  or  enlarge- 
ment, it  is  easily  ruptured  by  slight  muscular  exertion,  as  in  suddenly 
turning  the  body  to  avoid  a  fall  or  a  blow.  Several  fatal  cases  of  this 
kind  are  reported.  This  is  an  important  fact  In  a  medico-legal  view.  An 
assailant  might  be  wrongly  charged  with  manslaughter,  while  the  rupture 
might  be  due  to  muscular  pressure  on  a  diseased  spleen.  (Brit.  Med. 
Jour.  1878,  i.  p.  641,  ii.  p.  469.)  The  healthy  organ  is  only  liable  to 
ruj)ture  by  direct  violence. 

Ruptures  of  the  Kidneys. — The  kidneys  are  occasionally  ruptured  from 
violence  ;  but  this  appears  to  be  a  rare  accident.  A  rupture  of  the  kidney 
may  be  produced  without  causing  any  prominent  symptoms,  and  prove 
fatal  in  a  few  hours. 


348      RUPTURES  OF  THE  INTESTINES  AND  STOMACH. 

It  may  be  remarked  generally  that  ruyjtures  of  the  liver,  spleen,  and 
kidnevs,  unless  attended  with  immediate  and  copious  bleeding-,  are  not  in- 
consistent with  a  person  having-  the  power  to  move  and  walk.  In  a  case 
which  occurred  at  Guy's  Hospital,  a  man  retained  the  power  of  walking 
for  some  distance,  although,  on  inspection  after  death,  one  kidney  was 
found  torn  in  halves  from  an  accident. 

Ruptures  and  Wounds  of  the  Intestines. — Ruptures  of  the  intestines 
sometimes  occur  from  disease;  and,  in  a  case  of  rupture  alleged  to  have 
been  produced  by  violence,  we  must  always  take  this  possible  objection  to 
our  opinion  into  account.  The  ruptured  part  of  the  bowel  should  be  care- 
fully examined,  in  order  to  see  whether  there  are  any  signs  of  ulceration 
or  softening  about  it.  If  not,  and  there  is  clear  evidence  of  violence  hav- 
ing being  used,  it  is  impossible  to  admit  this  speculative  objection.  If 
with  the  proof  of  violence  there  should  also  be  a  diseased  condition  of  the 
bowel,  we  may  be  required  to  say  whether  this  did  not  create  a  greater 
liability  to  rupture — a  point  which  must  be  generalh'  conceded.  That  a 
rupture  of  the  intestines  is  not  incompatible  with  the  power  of  locomotion, 
is  proved  by  a  case  related  by  Ellis  of  Dublin,  where  the  caecum  was 
ruptured;  the  man  was  able  to  walk  after  the  accident,  but  he  died  in 
twenty-four  hours.  Other  instances  of  this  kind  are  reported  by  Henke. 
The  ileum  is  observed  to  be  most  liable  to  rupture  from  accident.  A  man 
was  brought  into  Guy's  Hospital.  He  was  able  to  walk  to  his  bed,  and 
he  did  not  appear  to  be  seriously  injured,  although  it  was  stated  that  a 
bale  of  wool  had  fallen  on  him.  In  the  evening  he  became  collapsed,  and 
he  died  twelve  hours  after  his  admission.  On  inspection,  about  a  pound 
of  blood  was  found  effused  in  the  abdomen,  and  a  portion  of  the  ileum  was 
found  lacerated — the  laceration  extending  into  the  mesentery  and  includ- 
ing the  bloodvessels.  The  laceration  was  about  an  inch  and  a  half  long, 
and  the  bowel  was  divided  not  quite  through.  The  intestines  were  much 
matted  together  by  lymph  and  blood,  the  result  of  peritoneal  inflammation. 
There  had  been  only  slight  extravasation  of  the  contents.  (Med.  Times 
and  Gaz.,  18G1,  ii.  p.  271 ;  also  Ann.  d'H}^":.,  1878,  t.  1,  p.  13T.)  Croker 
King  reported  two  fatal  cases  of  ruptured  jejunum — one  arising  from  a 
kick  on  the  abdomen  and  the  other  from  an  accidental  fall.  King  has  ob- 
served that  persons  who  have  sustained  this  injury  retain  for  a  time  the 
power  of  locomotion  and  muscular  exertion. 

Such  punctured  wounds  as  merely  touch  the  bowels  without  laying 
open  the  cavity,  are  liable  to  cause  death  by  peritonitis.  These  injuries  to 
the  intestines  sometimes  destroy  life  b}^  shock ;  there  is  but  little  blood 
eflfused,  and  the  wounded  person  dies  before  peritonitis  can  be  set  up. 
Severe  wounds  to  the  intestines  may,  however,  be  inflicted  almost  Avithout 
the  consciousness  of  the  individual,  and  the  wounded  person  may  be  able 
to  walk  a  considerable  distance.     (Lond.  Med.  Gaz.,  vol.  46,  p.  24.) 

Wounds  and  Ruptures  of  the  Stomach. — Wounds  and  ruptures  of  the 
stomach  may  cause  death  by  shock.  Ruptures  commonly  give  rise  to 
severe  pain, 'which  of  itself  is  sufficient  to  bring  about  rapid  dissolution. 
The  stomach  may,  however,  be  ruptured  from  spontaneous  causes,  as  in 
cases  of  ulceration  resulting  from  disease ;  but  sometimes  there  is  no 
morbid  cause  apparent.  Penetrating  wounds  of  the  stomach  generally 
prove  rapidly  mortal,  and  seldom  form  a  subject  for  medico-legal  investi- 
gation. A  singular  case  was  tried  at  the  Norwich  Assizes  in  1832,  in 
which  a  man  was  charged  with  the  murder  of  his  wife  by  throwing  at  her 
a  red-hot  poker.  The  weapon  completely  perforated  her  stomach,  and  the 
Avoman  died  in  six  hours. 


RUPTURES  OF  THE  BLADDER.  349 

Ruptures  of  the  Bladder. — This  injury,  which  has  on  many  occasions 
triveu  rise  to  medico-leyal  discussion,  is  frequently  the  result  of  blows  or 
kicks  on  the  lower  part  of  the  abdomen.  The  principal  questions  in  refer- 
ence to  the  accident  are:  Was  the  rupture  the  result  of  wilful  violence  or 
of  an  accidental  fall?  or,  Did  it  proceed  from  spontaneouij  causes,  or  from 
over-distention  ?  The  spot  in  which  the  rupture  commonly  takes  place  is 
in  the  upper  and  back  part,  where  the  bladder  is  covered  by  the  peritoneum. 
The  aperture  is  sometimes  lar^e,  at  others  small  ;  but  the  effect  is  that  the 
urine  is  effused,  and  death  takes  place  sooner  or  later  from  peritoneal  in- 
flammation. It  is  commonly  stated  that  ruptures,  when  attended  with 
extravasation  of  urine  into  the  peritoneal  cavity,  are  uniformly  fatal ;  but 
if  the  rupture  occurs  in  the  under  part  of  the  bladder,  so  that  the  urine 
linds  it  way  into  the  cellular  tissue,  the  medical  opinion  is  not  so  unfavor- 
al)le.  The  usual  period  at  which  death  occurs  from  this  accident  is  in  from 
three  to  seven  days ;  but  Ellis  met  with  a  case  in  which  the  person  did  not 
die  until  the  fifteenth  day,  A  person  may  die  suddenly  from  this  injury, 
as  a  simple  result  of  shock. 

When  ruptures  of  the  bladder  are  produced  by  blows  they  are  rarely 
accompanied  by  marks  of  ecchymosis,  or  of  injury  to  the  skin.  Thus,  then, 
there  may  be  no  means  of  distinguishing-,  by  external  examination, 
whether  a  rupture  was  really  due  to  violence  or  to  spontaneous  causes. 
Those  who  are  unacquainted  with  this  fact  might  be  disposed  to  refer  the 
rupture  to  disease,  on  the  supposition  that  violence  should  always  be  in- 
dicated by  some  visible  external  injury;  but  there  are  numerous  cases  on 
record  which  show  that  this  view  is  erroneous  (p.  289).  Rupture  of  the 
bladder  has  been  caused  by  a  fall  in  wrestling,  proving  fatal  in  four  days. 
(Reg.  V.  Warburton,  Carlise  Lent  Ass.,  1876.) 

As  an  attempt  may  be  made,  in  cases  in  which  death  has  resulted  from 
this  injury,  to  refer  rupture  of  this  organ  to  natural  causes,  it  may  be 
observed  that  this  is  a  very  unusual  occurrence;  a  rupture  is  almost  always 
the  result  of  violence  directly  applied  to  the  part  Avhile  the  organ  is  in  a 
distended  state.  A  spontaneous  rupture  may,  however,  occur:  J.  When 
there  is  paralysis,  with  want  of  power  to  expel  the  urine.  2.  When  the 
bladder  is  ulcerated  or  otherwise  diseased.  3.  When  there  is  an  obstruc- 
tion in  the  urethra  from  stricture  or  other  causes.  The  causes  of  sponta- 
neous rupture  are  easily  recognizable  by  ascertaining  the  previous  condi- 
tion of  the  deceased,  or  by  examining  the  bladder  and  urethra  after  death. 
If  a  man  were  in  good  health  prior  to  being  struck  ;  if  he  suddenly  felt 
intense  pain,  could  not  pass  his  urine  afterwards,  and  died  from  an  attack 
of  peritonitis  in  five  or  six  days ;  if,  after  death,  the  bladder  was  found 
lacerated,  but  this  organ  and  the  urethra  were  otherwise  in  a  healthy  con- 
dition :  there  can  be  no  doubt  that  the  blow  must  have  been  the  sole  cause 
of  rupture  and  death.  In  such  a  case,  to  attribute  the  rupture  to  spon- 
taneous or  natural  causes  would  be  absurd.  As  to  the  absence  of  marks 
of  violence  externally,  this  would  be  a  difficulty  only  to  those  who  had 
not  previously  made  themselves  acquainted  with  the  facts  attending  this 
and  other  accidents  affecting  the  viscera  of  the  abdomen  (p.  345). 
Nevertheless,  a  medical  witness  must  be  prepared  to  hear  the  same  line 
of  defence  continually  brought  forward,  as  it  is  always  the  object  of  a 
counsel  to  muke  the  best  of  a  case  for  the  prisoner.  With  medical  facts, 
opinions,  and  doctrines  he  does  not  concern  himself,  so  long  as  they  do 
not  serve  his  purpose.  A  diseased  state  of  the  bladder  might  probably 
diminish  the  responsibility  of  an  accused  person  for  the  consequences  ; 
therefore  the  state  of  this  organ  should  be  closely  looked  to  on  these  occa- 
sions.    A  distended  state  of  the  organ  can  be  no  mitigatory  circumstance, 


350  WOUNDS    OF    THE    GENITAL    ORGANS. 

since  it  is  only  when  the  bladder  is  in 'this  condition  that  rupture  is  liable 
to  occur.  This  can  hardl}"  be  regarded  as  an  abnormal  condition  of  the 
organ.  An  accidental  fall  forwards  over  a  hard  surface  when  the  bladder 
is  distended  with  urine  may  lead  to  rupture.  The  person  generally  ex- 
periences at  the  time  intense  pain  in  the  lower  part  of  his  abdomen,  and 
there  is  an  inability  to  pass  the  urine.  Although  a  man  is  liable  to  be 
rendered  powerless  on  sustaining  a  rupture  of  the  bladder  from  a  heavy 
blow  or  fall,  there  are  several  well-authenticated  cases  on  record  which 
prove  that  a  man  may  walk  some  distance  and  move  about  even  for  two 
or  three  hours  afterwards. 

In  punctured  and  incised  wounds  of  the  bladder  the  urine  is  at  once 
extravasated,  but  in  gunshot-wounds  the  extravasation  does  not  coni- 
monh^  take  place  until  the  sloughs  have  separated.  Thus  life  may  be 
protracted  longer  in  cases  of  gunshot,  than  under  other  wounds  of  the 
bladder.  For  the  discovery  of  extravasated  liquids  or  blood,  in  wounds 
and  other  injuries  to  the  abdominal  viscera,  we  must  look  to  the  cavity  of 
the  pelvis,  as  it  is  here  that,  for  obvious  reasons,  such  liquids  have  a  ten- 
dency to  collect. 

Wounds  of  the  Genital  Organs. — Wounds  of  these  organs  do  not 
often  require  the  attention  of  a  medical  jurist:  such  wounds,  whether 
in  the  male  or  female,  may,  however,  prove  fatal  to  life  by  excessive 
bleeding.  Self-castration  or  mutilation  is  sometimes  observed  among 
male  lunatics  and  idiots.  When  timely  assistance  is  rendered,  a  fatal 
result  may  be  averted.  Demarquay  met  with  a  case  in  which  a  man  in  a 
fit  of  intoxication  cut  off  the  \Ahole  of  his  genital  organs  with  a  razor.  He 
lost  much  blood,  from  the  effects  of  which  he  died  on  the  following  day. 
(Lancet,  1872,  ii.  p.  10.)  The  practice  of  circumcision  on  infants  is  some- 
times followed  by  fatal  results.  Schwartz  met  with  two  cases  of  boj'S, 
eight  days  old,  who  were  submitted  to  this  rite.  They  both  died  of 
phlegmonous  inflammation,  one  five  days  and  the  other  twenty-five  days 
after  the  operation.  (Lancet,  18T0,  ii.  p.  411.)  Other  fatal  cases  are 
reported. 

Incised,  lacerated,  or  even  contused  wounds  on  the  female  genitals  may 
prove  fatal  by  loss  of  blood,  not  from  the  wound  involving  any  large 
vessel,  but  from  the  numerous  small  vessels  divided.  When  deeply  in- 
cised wounds  are  inflicted  upon  the  genital  organs  of  either  sex,  the  fact 
of  their  existence  in  such  a  situation  at  once  proves  wilful  and  deliberate 
malice  on  the  part  of  the  assailant.  Accident  is  wholly  out  of  the  que.s- 
tion,  and  suicide  is  improbable,  except  in  cases  of  confirmed  idiocy,  lunacy, 
or  intoxication.  Such  wounds  require  to  be  carefully  examined;  for  the 
proof  of  the  kind  of  wound,  when  fatal,  may  be  tantamount  to  a  proof  of 
murder.  A  practitioner  may  be  sometimes  required  to  determine  Avhether 
wounds  affecting  the  female  organs  have  resulted  from  accident,  have  been 
self-inflicted,  or  inflicted  by  others  with  homicidal  intention.  Accidental 
wounds  of  the  genitals,  unless  all  the  circumstances  are  known,  may  some- 
times resemble  those  produced  by  design,  and  thus  the  distinction  of  a 
homicidal  from  an  accidental  or  a  self-inflicted  wound  on  the  female  organs 
is  sometimes  attended  with  great  difficulty.  A  girl,  set.  6,  fell  from  a  tree 
with  her  legs  apart  upon  one  of  the  sharp-pointed  shoots  below,  about  half 
an  inch  thick.  This  entered  the  vagina,  and  passing  through  its  poste- 
rior wall,  l)roke  off.  A  woman  removed  the  wood  with  some  difficulty. 
The  child  died  in  twenty-eight  hours  from  peritonitis.  (Lancet,  1811,  ii. 
p.  74.)  Had  this  child  been  found  dead  with  the  wood  in  her  bodv,  there 
n)ight  have  been  some  difficulty  in  assigning  an  accidental  origin  to  such 
an  injury.    (For  remarks  by  Toulmouche  on  the  wounds  of  the  male  gen- 


WOUNDS  OF  THE  GENITAL  ORGANS.  351 

ital  organs,  see  Ann.  d'llyg.,  1868,  t,  2,  p  110;  and  for  cases  in  which 
such  wounds  were  huuiicidally  inflicted  upon  males,  see  Ann.  d'Hyg., 
1848,  t.  1,  p.  443;  also  18G5,  t.  1,  p.  66;  and  lor  a  case  which  led  to  a 
trial  for  the  murder  of  a  woman,  see  Lond.  Med.  Gaz.,  vol.  44,  p.  813. J 
In  Reg.  V.  Green  (Derby  Wint  Ass.,  1872),  the  medical  evidence  estab- 
lished that  there  was  a  punctured  wound  of  the  genitals  in  a  female,  and 
this  had  caused  death  by  hemorrhage;  but  it  could  not  be  clearly  shown 
whether  it  was  the  result  of  accident  or  homicide;  unless  all  the  circum- 
stances are  known,  an  accidental  injury  to  the  genital  organs  may  present 
the  characters  of  homicidal  violence. 

In  another  part  of  this  work  (p.  249)  will  be  found  reported  a  case  in 
which  an  accidental  wound  on  the  genital  organs  of  a  girl  did  not  prove 
fatal,  and  an  attempt  was  made  bj^  the  parents  to  attribute  it  to  inten- 
tional violence.  Certain  persons  were  charged  with  maliciously  wound- 
ing the  girl,  but  a  surgical  examination  of  the  wound  showed  that  this 
was  a  false  charge. 

It  has  been  said  that  lunatics,  idiots,  or  intoxicated  persons  might  in- 
flict upon  themselves  wounds  unlike  those  produced  in  ordinary  attempts 
at  suicide.  A  case  was  tried  at  Glasgow  in  18*73,  in  which  a  man  was 
charged  with  the  murder  of  his  wife.  They  were  both  intoxicated  when 
they  went  to  bed.  The  prisoner  during  the  night  called  to  one  of  his 
daughters  to  come  to  her  mother,  W''ho  had  been  taken  ill.  She  found  her 
lying  on  the  floor,  and  blood  was  flowing  from  her  and  there  was  also 
some  substance  which  proved  to  be  intestine.  A  surgeon  who  was  called 
found  a  clean-cut  wound  in  the  vagina,  through  which  a  portion  of  the 
bowel,  with  clean-cut  ends,  protruded.  Seven  feet  and  seven  inches  of 
intestine  had  been  cleanly  cut  off  in  three  pieces;  they  were  not  ragged. 
The  woman  died  at  the  end  of  the  week  from  loss  of  blood  and  peritonitis. 
The  man  was  charged  with  this  act;  but  were  these  injuries  self-inflicted, 
or  were  they  the  result  of  homicide?  It  w^as  admitted  that  suicide  was 
possible,  but  not  probable.  The  woman's  hands  were  covered  with  blood, 
but  the  man's  were  not.  The  man  was  of  good  character.  There  was 
no  known  motive  for  either  suicide  or  murder  ;  they  had  been  married 
forty  years,  and  were  much  attached  to  each  other.  No  weapon  was 
found  with  which  the  wound  could  have  been  inflicted.  Two  pocket- 
knives  were  in  the  trousers  of  the  man,  but  there  was  no  mark  of  blood 
upon  them,  and  it  was  not  thought  probable  that  the  wound  had  been  in- 
flicted with  either.  The  woman  had  made  a  dying  declaration,  obviously 
false,  which  was  that  the  wound  had  been  caused  by  her  falling  over  a 
chair,  that  no  person  injured  her,  and  that  she  and  her  husband  had  always 
been  on  friendiv  terras.  The  jury  returned  a  verdict  of  "not  proven." 
(Lancet,  1873,  'i.  p.  673.) 

Contused  wounds  on  the  female  genitals  may  prove  fatal  by  the  lacera- 
tion of  parts,  leading  to  great  loss  of  blood.  Several  trials  for  man- 
slaughter have  taken  place,  in  which  this  was  proved  to  have  been  the 
cause  of  death.  In  Reg.  v.  Lewis  (Maidstone  Lent.  Ass.,  1876),  the 
prisoner  was  charged  with  having  caused  the  death  of  his  wife  by  kick- 
ing her  in  the  lower  part  of  the  abdomen.  She  died  in  a  few  days  from 
inflammation.  The  medical  witness  considered  that  violence  was  the 
cause  of  death,  although  he  would  not  positively  swear  to  it.  Lord  Cole- 
ridge thereupon  made  this  important  oliservation  to  the  jury:  "It  is  not 
because  there  may  be  the  absence  of  absolute  demonstration,  which  from 
the  nature  of  human  affairs  can  hardly  ever  be  had,  that  therefore  you 
should  not  act  on  your  conviction.     Did  the  violence  cause  death?    What 


352  FRACTURES THEIR  CAUSES. 

else  could  have  caused  it?  What  other  cause  is  suggested  that  could  have 
caused  it?"     The  prisoner  was  convicted. 

There  may  be  such  a  loss  of  blood  in  these  cases  as  to  destroy  life, 
although  no  large  bloodvessel  may  be  implicated  in  the  injury.  A  con- 
tused wound  on  the  vulva  may  occasionally  present  an  ambiguous  sp- 
pearance,  and  be  mistaken  for  an  incised  wound.  When  the  soft  parts  of 
the  body  are  struck  by  a  blow  or  kick,  if  there  is  a  bony  surface  l)eneath, 
a  longitudinal  rent  resembling  a  cut  may  appear  as  a  result  of  the  force 
being  received  by  the  bone.  A  kick  on  the  vulva  or  a  fall  on  this  part 
may  produce  a  similar  injury,  and,  unless  carefully  examined,  may  lead  to 
the  erroneous  inference  that  a  weapon  has  been  used  for  its  production. 
Some  women  are  subject  to  frequent  discharges  of  blood  from  ihe  genital 
organs  from  natural  causes.  When  the  bleeding  immediatel}'  follows  a 
blow,  and  the  v»-oman  has  not  been  subject  to  such  a  discharge,  the  fair 
presumption  is  that  violeuQC  was  the  cause  ;  but  when  the  flow  of  blood 
appears  only  alotjg  time  after  the  alleged  violence,  of  which  no  traces  can 
be  seen,  it  is  most  probably  due  to  natural  causes.  A  case  of  this  kind 
was  communicated  to  the  author  by  Procter.  There  was  no  difficulty  in 
giving  an  opinion  that  the  flow  of  blood  was  not  due  to  violence. 

It  may  be  alleged  in  defence  that  the  injuries  lound  on  the  body  were 
inflicted  after  death,  and  not  while  the  deceased  was  living.  Kicks  or 
blows  on  the  vulva,  if  they  destroy  life  at  all,  cause  death  by  copious  effu- 
sion of  blood.  Yiolence  to  this  part  after  death  would  not  produce  such 
an  effusion  as  would  account  for  death.  There  are  also  other  distinguish- 
ing characters  which  have  been  elsewhere  pointed  out. 


CHAPTER    XXXY. 

FRACTCEES. PRODUCED  BY  A  BLOW  WITH  A  WEAPON    OR  BY    A    FALL. BRITTLENESS  OF    THE 

BONES. FRACTURES  CAUSED  BY  SLIGHT  MUSCULAR  EXERTION. FRACTCEES  IN  THE  LIVING 

AND    DEAD    BODY. HAS  A    BONE    EVER    BEEN    FRACTURED  ? LOCOMOTION  DISLOCATIONS 

FROM  VIOLENCE  OR  NATURAL  CAUSES. MEDICAL  OPINIONS  ACTIONS  FOE  MALAPEASIS. 

Fractures. 

Fractures  of  the  bones  have  some  important  bearings  in  relation  to 
medical  jurisprudence.  They  may  result  from  falls,  blows,  or  the  spon- 
taneous action  of  muscles. 

Causes. — Questions  are  sometimes  put,  whether  a  particular  fracture 
was  caused  by  an  accidental  fall  or  a  blow  ;  and,  if  by  a  blow,  whether 
by  the  use  of  a  Aveapon  or  not.  It  is  obvious  that  the  answers  must  be 
regulated  by  the  circumstances  of  each  case.  In  examining  a  fracture,  it 
i.s  important  to  determine,  if  possible,  whether  a  weapon  has  or  has  not 
l)een  used  ;  and  this  may  be  sometimes  ascertained  by  the  state  of  the 
parts.  It  is  a  common  defence,  on  these  occasions,  to  attribute  the 
fracture  to  an  accidental  fall,  Fractures  more  readily  occur  from  equal 
'degrees  of  force  in  the  old  than  in  the  young,  and  in  the  young  rather  than 
in  the  adult ;  because  it  is  at  the  adult  period  of  life  that  the  bones  possess 
their  maximum  degree  of  firmness  and  solidit}'.  The  bones  of  aged  per- 
sons are  sometimes  very  brittle,  and  slight  violence  will  then  produce 
fracture.      This  has  been  re2:arded  as  an  extenuating  circumstance  when 


SPONTANEOUS  FRACTURES.  358 

the  fracture  produced  by  a  slight  blow  was  followed  by  death.  Certain 
diseases,  such  as  syphilis,  arthritis,  cancer,  scurvy,  and  rickets,  render 
bones  more  fragile ;  but  they  are  sometimes  preternaturally  brittle  in 
apparently  healthy  persons,  and  this  brittleness  (fragililas  o^siuvi) 
appears  to  be  hereditary.  In  such  eases,  a  defence  might  fairly  rest  upon 
an  abnormal  condition  of  the  bones  if  the  violence  producing  the  fracture 
was  slight.  Several  trials  have  taken  place  in  which  this  brittleness  of 
the  bones  became  a  subject  of  inquiry.  In  a  case  of  fractured  skull  lead- 
ing to  death  from  inflammation  of  the  brain,  it  was  proved  that  the  bones 
of  the  skull  were  thin  and  brittle,  and  this  led  to  a  mitigation  of  punish- 
ment. (Dub.  xMed.  Jour.,  1831),  p.  2S'J.)  The  orbital  plate  of  the  frontal 
bone  is  very  thin,  and  it  may  be  fractured  by  a  blow  on  the  eye.  Death 
may,  under  these  circumstances,  result  from  inflammation  of  the  brain. 
According  to  Mercer,  in  cases  of  general  paralysis  of  the  insane  there 
exists  simultaneously  a  condition  of  the  bones  which  renders  them  liable 
to  fracture  under  comparatively  slight  violence.  (Brit.  Med.  Jour.,  18T4, 
i.  p.  540.)  The  author  was  not  aware  of  any  facts  to  support  this  state- 
ment. Patients  in  asylums  have  been  found  dead  with  numerous  fractures 
of  the  ribs,  and  those  who  had  the  custody  of  them  have  been  convicted 
of  manslaughter.  It  is  scarcely  possible  in  such  cases  to  determine  the 
amount  of  violence  used,  but  on  a  post-mortem  inspection  it  would  not  be 
difficult  to  determine,  by  the  examination  of  a  bone,  whether  this  brittle- 
ness really  existed  or  not.  Brittleness  of  the  bones  does  not  excuse  an  act 
of  violence,  although  it  may  mitigate  the  punishment  when  it  has  been 
proved  to  exist.  At  the  same  time,  the  attendants  on  the  insane 
suifering  from  general  paralysis  should  be  careful  not  to  use  force  in. 
such  cases. 

Spontaneous  Fractures. — In  a  case  in  ^-hich  there  is  no  appearance  of 
disease,  a  fracture  may  be  ascribed  to  spontaneous  causes.  Thus  bones 
have  been  fractured  by  moderate  muscular  exertion.  The  elbow  (ole- 
cranon), heel-bone  (os  calcis),  and  knee-pan  (patella)  are  particularly  ex- 
posed to  this  accident.  The  long  bones  are  seldom  the  subject  of  an 
accident  of  this  kind;  but  the  arm  (humerus)  in  a  healthy  man  has  been 
broken  by  the  simple  muscular  exertion  of  throwing  a  cricket-ball.  (Lend. 
Med.  Gaz.,  vol.  xvi.  p.  659.)  A  young  lady  fractured  the  neck  of  the 
scapula  by  suddenly  throwing  a  necklace  round  her  neck.  (Lond.  Med. 
Gaz.,  1842,  vol.  i.  p.  50.)  In  1858,  a  gentleman,  ^t.  40,  was  in  the  act 
of  bowling  at  cricket  when,  on  delivering  the  ball,  he  and  some  bystanders 
heard  distinctly  a  sharp  crack  like  the  breaking  of  a  dry  piece  of  wood. 
He  fell  to  the  ground  as  if  he  had  been  shot.  The  thigh-bone  was  found 
to  be  fractured,  and  evidently  from  muscular  exertion  only.  No  person 
can  meet  with  an  accident  of  this  kind  without  being  generally  instantly 
conscious  of  it.  In  1889  Humphry  communicated  to  the  editor  a  case  in 
which  an  elderly  man  stepped  off  a  chair  after  turning  off  the  gas.  He 
walked  upstairs,  and  on  proceeding  to  undress,  for  the  first  time  perceived 
blood  oozing  through  his  stocking.  He  had  unknowingly  sustained  a 
compound  fracture  of  the  tibia.  It  is  probable  that  in  these  instances,  if 
there  were  an  opportunity  of  examining  the  bone,  it  would  be  found  to 
have  undergone  some  change  in  its  composition  which  had  rendered  it 
brittle.  A  case  of  spontaneous  fracture  of  the  femur  was  brought  into 
Guy's  Hospital  in  1846.  A  healthy  man,  set.  33,  of  temperate  habits,  was  in 
the  act  of  placing  one  leg  over  the  other  to  look  at  the  sole  of  his  foot,  when 
he  heard  something  give  way,  and  the  right  Iq^^  immediately  hung  down. 
On  examination,  it  was  found  that  the  right  thigh-bone  had  been  trans- 
versely fractured  at  the  junction  of  its  middle  with  the  lower  third.  Thia 
23 


354  FRACTURES    IN    THE    LIVING    AND    DEAD    BODY. 

case  is  remarkable  inasmuch  as  spontaneous  fractures  of  the  thigh-bones 
are  very  rare,  and  the  man  had  not  suffered  from  any  of  those  diseases 
which  cause  preternatural  fragility,  and  the  fracture  was  not  caused  by 
violent  muscular  exertion.  Even  the  end  of  the  heel-bone  (os  calcis)  has 
been  broken  off  by  the  powerful  action  of  the  muscles  of  the  calf  of  the 
leg  in  making  a  false  step.  (Brit.  Med.  Jour.,  1878,  vol.  i.  p.  128.)  The 
actual  condition  of  the  bone  was,  of  course,  unknown  ;  but  it  healed  readily, 
and  the  man  left  the  hospital  at  the  usual  period.  In  fractures  arising 
from  this  cause  there  would  be  no  abrasion  of  the  skin,  nor  any  appear- 
ance to  indicate  that  a  blow  has  been  struck ;  while  the  marks  of  a  blow 
would,  of  course,  remove  all  idea  of  the  fracture  having  had  a  spontaneous 
origin.  It  is  most  unusual  that  the  ribs  should  be  fractured  from  muscu- 
lar exertion ;  but  a  case  occurred  to  Groninger,  which  shov^^s  that  this 
accident  may  really  occur.  It  is  one  of  medico-legal  importance,  inasmuch 
as  the  injury  might  be  easily  ascribed  to  violence  ;  but  the  absence  of  any 
external  appearances  indicative  of  a  blow  would  render  it  probable  that  this 
was  not  the  cause. 

Fractures  of  limbs  are  not  dangerous  to  life  unless,  when  of  a  com- 
pound nature,  they  occur  in  old  persons  or  in  those  who  are  debilitated 
by  disease  or  dissipated  habits.     They  may  then  cause  death  by  inducing 
irritative  fever,  erysipelas,  gangrene,  tetanus,  pyemia,  or  delirium  tremens. 
Fractures  in  the  Living  and  Dead  Body. — It  is  not  always  easy  to  say 
whether  a  fracture  has  been  produced  before  or  after  death.     A  fracture 
produced  shortly  after  death,  while  the  body  is  warm,  and  another  pro- 
duced shortly  before  death,  will  present  similar  characters,  except  that  in 
the  former  case  there  might  be  less  blood  effused.     A  fracture  caused  ten 
or  twelve  hours  before  death  would  be  indicated  by  a  copious  effusion  of 
blood  into  the  surrounding  parts  and  between  the  fractured  edges  of  the 
bones,  as  Avell  as  by  laceration  of  the  muscles  ;  or  if  for  a  longer  period 
before  death,  there  may  be  the  marks  of  inflammation.     Fractures  caused 
several  hours  after  death  are  not  accompanied  by  an  effusion  of  blood.     A 
medical  witness  may  be  asked.  How  long  did  the  deceased  survive  after 
receiving  the  fracture  ?     This  is  a  question  which  can  be  decided  only  by 
an  examination  of  the  fractured  part.     Unless  the   person   has  survived 
eighteen  or  twenty-four  hours,  there  are  commonly  no  appreciable  changes. 
After  this  time,  lymph  is  poured  out  from  the  surrounding  structures. 
This  slowly  becomes  hard  from  the  deposition  of  phosphate  of  calcium, 
and  forms  what  is  called  a  "callus."     In  the  process  of  time,  the  callus 
acquires  all  the  hardness  of  the  original  bone.     The  death  of  a  person  may 
take  place  during  these  changes,  and  a  medical  man  may  then   have  to 
state  the  period  at  which  the  fracture  probably  happened,  in  order  to  con- 
nect the  violence  with  the  act  of  a  particular  person.     Unfortunately,  we 
have  no  satisfactory  data,  if  we  except  the  extreme  stages  of  this  process 
of  re})air,  upon  which  to  ground  an  opinion.     We  can  say  whether  a  per- 
son  lived  for  a  long  or  a  short  time  after  receiving  a  fracture,  but  to 
specify  the  exact  time  is  impossible;  since  this  process  of  restoration  in 
l)one  varies  according  to  age,  constitution,  and  many  other  circumstances. 
In  young  persons,  bones  unite  rapidly  ;  in  the  old,  slowly  ;  in  the  diseased 
and   unhealthy,  the  process  of  union  is  slow  and  sometimes  does  not  take 
place  at  all.     In  those  who  are  at  the  time  affected  with  a  mortal  disease 
there  may  be  no  attempt  at  reparation.     According  to  Villerm^,  the  callus 
assumes  a  cartilaginous  structure  in  from  sixteen  to  twenty-five  days  ;  and 
it  becomes  ossified  in  a  period  varying  from  three  weeks  to  three  months. 
It  requires,  however,  a  period  of  from  six  to  eight  months  for  the  callus  to 
acquire  all  the  hardness,  firmness,  and  power  of  resisting  shocks  possessed 


FRACTURES DISLOCATIONS.  '  355 

by  the  original  bone.  A  force  applied  to  a  recently-united  bone  will 
break  it  through  tlie  callus  or  bond  of  union,  while,  after  the  period  stated, 
the  bone  will  not  break  there  more  readily  than  through  any  other  part. 
It  is  generally  assumed  that  the  period  required  for  the  union  of  a  simple 
fracture  in  the  adult  is,  lor  the  thigh-bone,  six  weeks;  for  the  tibia  (leg), 
five  weeks;  for  the  humerus  (upper  arm),  four  weeks;  and  for  the  ulna 
and  radius  (forearm),  three  weeks;  for  the  ribs,  about  the  same  period; 
but  cases  have  been  known  in  which  the  ribs  had  not  perfectly  united  in 
two  months,  and  in  some  fractures  of  the  other  bones  it  was  found  that 
union  had  not  taken  place  in  four  months.  In  a  case  which  occurred  to 
Reid,  a  fracture  of  the  tibia — the  principal  bone  of  the  leg — healed  in  three 
weeks. 

Han  a  bone  ever  been  fractured'^ — This  question  is  sometimes  put  in 
reference  to  the  living  bod^^  It  is  well  known  that  a  bone  seldom  unites 
so  eveuh^  that  the  point  of  ossilic  union  is  not  indicated  by  a  node  or  pro- 
jection. Some  bones  are  so  exposed  as  to  be  w^ell  placed  for  this  examina- 
tion, as  the  radius,  the  clavicle,  anpl  tibia,  these  being  but  little  covered  by 
skin  ;  in  others,  the  detection  is  difficult.  It  is  impossible  to  say  when 
the  fracture  took  place ;  it  may  have  been  six  months  or  six  years  ago,  as, 
after  the  former  period,  the  bone  undergoes  no  perceptible  change.  These 
facts  are  of  im()ortance  in  relation  to  the  dead  as  well  as  to  the  living; 
since  they  will  enable  us  to  answer  questions  respecting  the  identity  of 
skeletons  found  under  suspicious  circumstances  ;  and  here  medical  evidence 
may  take  a  wider  range,  for  a  fracture  in  any  bone  may  be  discovered,  if 
not  by  external  examination,  at  least  by  sawing  the  bone  longitudinally 
through  the  suspected  broken  part,  when,  should  the  suspicion  be  correct, 
the  bony  shell  will  be  found  thicker  and  less  regular  in  the  situation  of  the 
united  fracture  than  in  the  other  parts.  So,  in  such  cases,  it  will  be  easy 
to  say  whether  a  fracture  is  recent  or  of  old  standing. 

Locomotion. — With  respect  to  the  power  of  locomotioyi  after  a  fracture, 
it  may  be  observed  that,  when  the  injury  is  in  the  arm  or  in  the  ribs — 
unless  many  of  the  ribs  are  broken  or  the  fractures  are  on  both  sides — a 
person  may  be  able  to  move  about,  although  he  is  unfitted  for  struggling 
or  making  great  exertion.  Fractures  of  the  leg  generally  incapacitate 
persons  from  moving,  except  to  short  distances.  (See  case  by  Syme, 
Edin.  Med.  and  Surg.  Jour.,  1836,  vol.  46,  p.  255  ;  also  another  in  which 
one  bone  of  the  leg  was  fractured,  and  a  power  of  walking  some  miles  was 
retained,  Amer.  Jour.  Med.  Sci.,  1845,  p.  484.)  The  reader  will  find 
additional  information  on  this  subject  in  the  Ann.  d'Hyg.,  1839,  t.  2,  p.  241 ; 
1844,  t.  2,  p.  146  ;  and  in  Friedreich's  Ueber  die  Knochen  in  forensischer, 
Beziehung,  Ansbach    1853. 

Dislocations. 

Dislocations  are  not  frequent  in  the  old  or  in  those  persons  whose  bone,s 
are  brittle.  They  rarely  form  a  subject  for  medico-legal  investigation.  A 
witness  is  liable  to  be  asked  what  degree  of  force  and  acting  in  which  di- 
rection would  produce  a  dislocation — questions  not  difficult  to  answer. 
These  injuries,  except  those  of  the  vertebrte  of  the  neck,  are  not  dangerous 
to  life  unless  of  a  compound  nature,  when  death  may  take  place  from 
secondary  causes.  A  dislof;ation  which  has  occurred  in  the  living  body 
may  be  known  after  death  by  a  laceration  of  the  soft  parts  in  the  neigh- 
borhood of  the  joint,  and  by  the  copious  effusion  and  coagulation  of  blood. 
(For  an  account  of  the  appearances  presented  by  dislocation  of  the  shoulder 
five  days  before  death,  see  LoncL  Med.  Gaz.,  vol.  xxxi.  p.  266.)     If  of  old 


356  DETECTIOX    OF    FRACTURES. 

standing  a  dislocation  would  be  identified  by  the  cicatrices  in  surrounding 
structures.  Dislocations  may  occur  from  natural  caitses,  as  from  disease 
and  destruction  of  the  ligaments  in  a  joint ;  also  from  violent  muscular  spasm 
during  an  epileptic  convulsion.  Dyniock  met  with  an  instance  of  disloca- 
tion of  the  shoulder  forwards  during  puerperal  convulsions.  (Edin.  Med. 
and  Surg.  Jour.,  1843,  vol.  59,  p.  302  ;  see  also  Lancet,  1845,  i.  p.  440.) 
A  power  of  locomotion  may  exist,  except  when  the  injury  is  in  the  lower 
limbs;  but  it  has  been  observed  that  for  some  time  after  a  dislocation  of 
the  hip-joint  considerable  power  over  the  limb  remains ;  it  is  only  after  a 
few  hours  that  the  limb  becomes  fixed  in  one  position.  Exertion  with 
the  dislocated  member  is  in  all  cases  out  of  the  question. 

Detection  of  Fractures.  Malapraxis. — There  are  certain  fractures  of 
an  obscure  kind  which  closely  resemble  dislocations.  This  has  been 
pointed  out  by  Astley  Cooper,  in  relation  to  fractures  of  the  anatomical 
neck  of  the  humerus  (upper  arm-bone).  (Guy's  Hosp.  Eep.,  1839,  p. 
272.)  This  accident  might  easily  be  mistaken  for  a  dislocation  of  the 
shoulder.  (Lond.  Med.  Gaz.,  vol.  xxxvi.  p.  38.)  In  attempting  to  reduce 
the  bone  the  head  continually  falls  back  into  the  axilla.  In  such  a  case 
an  action  for  malapraxis  might  be  brought  against  a  surgeon.  It  could 
only  be  by  a  dissection  of  the  part  after  death  that  the  real  nature  of  the 
case  would  be  ascertained.  It  is  requisite,  therefore,  that  great  caution 
should  be  used  in  giving  an  opinion.  The  same  observations  apph'  to 
fractures  of  the  neck  of  the  thigh-bone,  although  with  less  force,  because 
this  is  a  more  common  accident  in  older  persons.  It  is  well  known  that 
fractures  and  dislocations,  when  cured,  are  often  attended  with  some  slight 
deformity  of  the  liiub,  or  with  some  impairment  of  its  functions.  This 
result  is  occasionally  inevitable  under  the  best  treatment;  but  it  is  com- 
monly set  down  as  a  sign  of  unskilfulness  in  a  medical  attendant.  An 
action  for  malapraxis  is  instituted,  and,  in  spite  of  good  evidence  in  his 
favor,  the  surger^n  is  sometimes  heavily  fined  for  a  result  which  could  not 
be  avoided.  There  is  often  great  injustice  in  these  proceedings,  and  the 
present  system  of  allowing  each  party  to  select  his  own  medical  witnesses 
often  leads  to  a  conflict  of  opinion  and  evidence. 

[The  law  upon  this  subject  may  be  stated  briefly,  as  follows : — 
Malapraxis  may  be  defined  as  bad  or  unskilful  practice  in  a  physician 
or  surgeon,  whereby  the  health  of  the  patient  is  injured. 

Xeglvjent  MaApractice  embraces  those  cases  where  there  is  no  criminal 
intent  or  purpose,  but  gross  negligence  in  bestowing  that  attention  which 
the  situation  of  the  patient  requires. 

Ignorant  Jfalpractice  is  the  administration  of  medicines,  or  the  treat- 
ment of  the  disease,  fracture,  or  injury  in  a  way  calculated  to  do  injury, 
which  actually  does  harm,  and  which  a  properly-educated,  skilled,  and 
scientific  medical  man  or  surgeon  would  know,  was  not  proper  in  the  case : 
Ehvell's  Malpractice,  198  and  243;  2  Bouv.  L.  Diet.  139. 

Phv.sicians  and  surgeons,  by  holding  themselves  out  to  the  world  as 
such,  engage  that  they  possess  the  reasonable  and  ordinary  qualifications 
of  their  profession,  and  are  bound  to  exercise  reasonable  and  ordinary 
care,  .skill,  and  diligence,  but  that  is  the  extent  of  their  liability.  The 
burden  of  proof  is  upon  the  plaintiff  in  actions  for  malpractice  to  show 
that  there  was  a  want  of  due  care,  skill,  and  diligence,  and  that  the  injury 
was  the  result  of  such  want  of  care,  skill,  and  diligence:  Holtzman  v. 
Hev,  19  111.  App.  459;  Baird  v.  Morford,  29  Iowa,  531;  Tanhoover  l\ 
Berghoff,  90  Mo.  487;  Craig  v.  Chambers,  17  Ohio  St.  253;  State  v. 
Housekeeper,  70  Md.  102,  and  Leighten  v.  Sargent,  31  jS".  H.  119;  also 
as  to  last  proposition,  Getchel  f.  Hill,  21  Minn.  4G4. 


DETECTION    OF    FRACTURES.  357 

The  reasonable  and  oi'dinaiy  care,  skill,  and  dilicionee  which  the  law 
reiiuifes  of  phyriiciaus  and  surgeons  are  such  as  those  in  the  sanie  general 
line  of  pi-actice,  in  the  same  general  locality,  ordinarily  have  and  exercise 
in  like  cases  :  Hathorn  v.  Richmond,  48  Vt.  557  ;  Wilmot  v.  Howard, 
39  Vt.  447;  Utley  v.  Burns,  70  111.  1G2;  Ritchie  v.  West,  23  111.  385; 
Almond  v.  Nugent,  34  Iowa,  300  ;  Tefi't  v.  Wilcox,  6  Kan.  46  ;  Small  v. 
Howard,  128  Mass.  131;  Patten  v.  Wiggin,  51  Me.  594,  and  similar  deci- 
sions in  Missouri,  New  Hampshire,  Oregon,  and  Texas. 

A  different  rule  has  been  held  in  Pennsylvania.  In  McCandless  v.  Mc- 
Wha,  22  Pa.  St.  2G1,  the  court  held  that  such  skill  was  required  "as 
thoroughly -educated  surgeons  ordinarily  employ,"  and  a  similar  view  was 
taken  in  Haire  v.  Reese,  7  Phila.  (Pa.)  138,  but  the  weight  of  authority- 
is  as  lirst  above  stated. 

The  locality  in  which  the  physician  or  surgeon  practises  should  be  taken 
into  account.  One  in  a  small  town  or  sparsely-settled  country  district  is 
not  expected  to  exercise  the  care  and  skill  of  him  who  resides  and  has  the 
opportunities  afforded  in  a  large  city.  He  is  bound  to  exercise  the  average 
degree  of  skill  possessed  by  the  profession  generally  in  the  locality  in 
which  he  resides  and  practises:  Gramm  v.  Boener,  56  Ind.  497  ;  Kelsey 
V.  Hay,  84  Ind.  189;  Small  v.  Howard,  128  Mass.  131 ;  Gates  i;.  Pleischer, 
G7  Wis.  504  ;  Smothers  .v  Hanks,  34  Iowa,  286  ;  Haire  v.  Reese,  7  Phila. 
(Pa.)  138;  Nelson  v.  Harrington,  72  Wis.  591. 

Physicians  and  surgeons  should,  however,  keep  np  with  the  latest  ad- 
vance in  medical  science,  and  use  the  latest  and  most  improved  methotls 
and  appliances,  having  regard  to  the  general  practice  of  the  profession  in 
the  locality  Avhere  they  practise,  and  it  is  a  question  for  the  jury  to  decide 
ffom  all  the  circumstances  of  the  case  whether  the  physician  or  surgeon 
has  done  his  duty  in  that  respect:  VanHooser  v.  Berghoff,  90  Mo.  487. 

If  a  physician  or  surgeon  departs  from  generally-approved  methods  of 
practice,  and  the  patient  suffers  an  injury  thereby,  the  medical  practitioner 
Avill  be  held  liable,  no  matter  how  honest  his  intentions  or  expectations 
were  of  benefit  to  the  patient:  Carpenter  v.  Blake,  60  Barb.  (N.  Y.)  488  ; 
50  N.  Y.  606;  10  Hun  (N.  Y.),  358;  75  N.  Y.  12;  Lampher  7J.  Phipor, 
8  C.  &  P.  475  ;  Sean  v.  Prentice,  8  East,  348  ;  Slaler  v.  Baker,  2  Wils. 
359. 

Physicians  and  surgeons  are  bound  to  give  their  patients  their  best 
judgment,  but  they  are  not  liable  for  mere  error  of  judgment :  Tefft  v. 
Wilcox,  6  Kan.  46;  Patten  v.  Wig<>en,  51  Me.  594;  Carpenter  v.  Blake, 
60  Barb.  ^N.  Y.)  488;  10  Hun  (N.  Y.),  358;  Wells  v.  World  Disp.  M. 
Ass.,  45  Hun,  588  ;  and  see  also  Fisher  v.  Nichols,  2  111.  App.  484. 

If  the  error  of  judgment  is  so  great  as  to  be  incompatible  with  reason- 
able care,  skill,  and  diligence,  the  phvsician  or  surgeon  would  be  liable  : 
West  V.  Martin,  31  Mo.  375  ;  Howard  v.  Grover,  28  Me.  97. 

If  the  patient  in  any  way  contributes  to  the  injury  by  his  fault  or  neglect 
he  cannot  recover  for  malpractice  by  the  physician  or  surgeon  :  Haire 
V.  Reese,  7  Phila.  (Pa.)  138;  McCandless  v.  McWha,  22 'Pa.  St.  261; 
Reler  v.  Hewing,  115  Pa.  St.  599;  Polter  v.  Warner,  91  Pa.  St.  362; 
Am.  Rep.,  668;  Lower  v.  Franks,  115  Ind.  334;  Chamberlain  v.  Porter, 
9  Minn.  260  ;  West  v.  Martin,  376. 

And  this  doctrine  holds  where  the  physical  weakness  of  the  patient  or 
his  natural  temperament  is  the  contributory  cause  of  the  injurv:  Haire 
I'.  Reese,  7  Phila.  (Pa.)  138;  Simond  v.  Henry,  39  Me.  155  ;"' Bogle  v. 
Winslow,  5  Phila.  (Pa.)  136. 

Damages  may  be  recovered  for  pain  and  suffering  produced  by  the  neg- 


358  GUXSIIOT-WOUXDS. 

ligence  or  want  of  skill  of  the  physician  or  surgeon,  and  also  for  loss  of 
time  and  expense  incurred  on  account  of  the  improper  treatment :  Tefit 
V.  AVilcox,  (j  Kan.  46  ;  AVenger  v.  Calder,  78  111.  275  ;  Chamberlain  v. 
Porter,  9  Minn.  260  ;  Stone  v.  Evans,  32  Minn.  243.1 


CHAPTER   XXXVI. 

GUXSHOT-WOCNDS. IX  THE  LIVING  AXD    DEAD    BODY. WAS  THE  PIECE  FIEED  NEAR  OR  FROM 

A       DISTANCE  ? ACCIDENTAL,     SUICIDAL,     OR      HOlllCIDAL      WOCXDS. POSITION      OF      THE 

WOUNDED    PERSON    WHEN    SHOT. — WOUNDS     FROM    SMALL-SHOT. WOUNDS    FROM    WADDING 

AND    GUNPOWDER. 

GuNSHOT-wouxDS  are  of  the  contused  kind,  but  they  differ  from  other 
v.-ounds  in  the  fact  that  the  vitality  of  the  parts  struck  by  the  projectile  is 
destroyed,  and  this  leads  ultimately  to  a  process  of  sloughing. 

The  medico-legal  questions  which  arise  out  of  gunshot-wounds  are  sim- 
ilar to  those  which  have  been  examined  in  relation  to  other  wounds. 
They  are  dangerous  to  life,  especially  when  they  penetrate  or  traverse 
any  of  the  great  cavities  of  the  body.  Death  may  take  place  directly, 
either  from  loss  of  blood  or  from  shock  ;  although  immediate  or  copious 
bleeding  is  not  a  common  character  of  these  injuries.  Death  from  shock 
is  occasionally  witnessed.  Indirectly,  these  wounds  are  attended  with 
much  danger ;  sloughing  generally  takes  place  uniformly  throughout  the 
whole  of  the  parts  perforated,  and  inflammation  or  fatal  bleeding  may  cut 
life  short.  If  the  person  survives  the  first  efiects,  he  may  die  at  almost 
any  period  from  suppurative  fever,  erysipelas,  gangrene,  or  from  the 
results  of  operations  absolutely  required  for  his  treatment.  Gunshot- 
wounds  may  thus  destroy  life  after  long  periods  of  time.  A  medical  wit- 
ness may  be  asked  whether  the  wound  was  inflicted  t^horlly  before  or  noon 
after  death.  It  is  by  no  means  easy  to  answer  this  question,  unless  the 
bullet  has  injured  some  vessel,  when  the  effusion  of  blood  and  the  forma- 
tion of  coagula  will  indicate  that  the  person  was  living  when  it  was  re- 
ceived. If  a  gunshot-wound  has  been  produced  in  a  dead  body  no  blood 
will  be  effused  unless  the  bullet  strikes  a  large  vein. 

If  the  person  survives  the  injury,  and  the  bullet  can  be  felt  in  an  ac- 
cessible spot,  it  should,  if  possible,  be  removed.  (See  the  case  of  Keg.  v. 
Kelly,  p.  30.5.)  In  addition  to  the  use  of  Xelaton's  probe  (unglazed 
china)  for  detecting  a  bullet  which  was  used  on  that  occasion,  a  chemical 
method  has  been  suggested.  Lint  moistened  with  vinegar,  and  secured 
to  a  flexible  stem,  may  be  introduced  into  the  wound  and  allowed  to 
remain  for  a  short  time  in  contact  with  the  supposed  bullet.  ]t  is  then 
Avithdrawn  and  placed  in  contact  with  a  solution  of  iodide  of  potassium. 
If  a  leaden  bullet  was  in  the  wound,  it  would  produce  a  p'-ecipitate  of  the 
yellow  iodide  of  lead.     Desneux  employed  this  method  in  three  cases. 

It  must  be  borne  in  mind  that  death  may  occur  from  a  pistol-shot  with 
no  external  Avound.  Ogston,  jun.,  reports  a  case  in  which  the  bullet,  in  a 
case  of  suicidal  pistol-shot,  had  passed  through  the  soft  palate,  then  through 
the  basilar  process  of  the  occipital  bone,  traversed  the  medulla  oblongata 
at  the  base  of  the  brain,  and,  striking  the  internal  occipital  protuberance, 
had  passed  forwards  and   upwards   through  the  brain  till  it  reached  the 


DETECTION  OF  BULLETS.  359 

frontal  hone.  The  bullet  had  then  sunk  backwards,  and  was  found  lying 
on  the  surface  of  the  brain.  (Edin.  Med.  and  Surg.  Jour.,  vol.  29,  1884-5, 
p.  720.) 

Was  the  piece  fired  near  or  from  a  distance  ? — A  gunshot-wound  pro- 
duced by  the  muzzle  of  a  piece  being  placed  near  to  the  surface  of  the 
body  has  the  following  characters:  there  may  be  two  apertures,  the  one 
of  entrance  and  the  other  of  exit;  but  it  sometimes  happens  that  the 
bullet  lodges  and  does  not  pass  out.  The  edges  of  the  aperture  of  entrance 
ui'e  generally  torn  and  lacerated,  and  appear  blackened,  as  if  they  had  been 
burnt;  this  arises  from  the  heat  and  flame  of  the  gunpowder  at  the 
moment  of  explosion.  The  skin  is  often  ecchymosed,  and  is  much  dis- 
colored by  the  powder;  the  clothes  covering  the  body  are  blackened  by 
the  discharge,  and  sometimes  ignited  by  the  flame.  If  the  muzzle  of  the 
piece  was  not  in  immediate  contact  with  the  part  struck,  the  wound  is, 
rounded  ;  but  if  there  has  been  direct  contact,  the  skin,  besides  being  burnt, 
is  torn  and  much  lacerated.  The  bleeding  is  usually  slight,  and,  when  it 
occurs,  it  is  more  commonly  observed  from  the  orifice  of  exit  than  from 
that  of  entrance.  It  should  be  remarked  that  the  aperture  of  entrance  is 
round  only  when  the  bullet  strikes  point-blank  or  nearly  so.  If  it  should 
strike  obliquely,  the  orifice  will  have  more  or  less  of  an  oval  or  valvular 
form  ;  and  by  an  observation  of  this  kind  we  may  sometimes  determine 
the  relative  position  of  the  assailant  with  respect  to  a  wounded  person. 
Supposing  the  bullet  to  have  been  fired  from  a  moderate  distance,  but  so 
near  as  to  have  had  sufficient  momentum  to  traverse  the  body,  then  the 
appearance  of  the  wound  will  be  difTerent :  the  orifice  of  entrance  will  be 
well  defined,  round  or  oval,  according  to  the  circumstances  ;  the  skin  slightly 
depressed,  the  edges  presenting  a  faintly-bruised  appearance,  but  the 
surrounding  parts  are  neither  blackened  nor  burnt,  and  they  do  not  pre- 
sent any  marks  of  bleeding.  In  these  cases  the  orifice  of  exit  is  large, 
irregular,  the  edges  somewhat  everted,  and  the  skin  lacerated,  but  free 
from  any  appearances  of  blackness  or  burning  ;  it  is  generally  three  or  four 
times  as  lai'ge  as  the  entrance-aperture.  The  orifice  of  entrance  is,  how- 
ever, usually  large  and  irregular  when  a  bullet  strikes  near  the  extremity 
of  its  range. 

The  entrance-aperture  may  have  the  appearance  of  being  smaller  than 
the  projectile,  owing  to  the  elasticity  of  tbe  living  skin.  (Ann.  d'Hyg., 
1829,  t.  2,  p.  219)  It  is  the  same  with  the  aperture  in  the  dress  when 
this  is  formed  of  an  elastic  material.  According  to  Dupuytren,  the  hole 
in  the  dress  is  always  smaller  than  that  made  by  a  bullet  in  the  skin. 
These  points  should  be  remembered  in  fitting  projectiles  to  wounds  which 
they  are  supposed  to  have  produced. 

In  recent  times,  bullets  of  a  novel  kind  have  been  employed,  and  the 
appearances  presented  by  gunshot-wounds  have  differed  accordingly. 
Biisch  has  directed  attention  to  this  point.  He  found  that  a  Chassepot- 
buUet,  shot  from  a  short  distance  into  the  human  body,  made  a  simple 
aperture  of  entrance,  but  that  its  aperture  of  exit  w^as  larger  than  a  fist, 
and  that  there  was  very  extensive  Assuring  and  fracturing  of  bone.  Bullets 
of  soft  lead  produced  larger  apertures  of  exit  than  those  made  with  hard 
lead.  There  is  no  essential  difference  in  the  action  of  liullets  on  the  living 
or  dead  body  as  to  appearance  ond  extent.  The  wounds  are  not  more  ex- 
tensive in  the  living  than  in  the  dead.  (Med.  Times  and  Gaz.,  1874,  vol. 
i.  p.  G16.) 

The  question  whether  a  piece  was  fired  near  to,  or  at  a  distance  from, 
the  wounded  person,  may  be  of  some  importance  either  on  a  charge  of 
homicide  or  of  alleged  suicide.     Two  persons  may  quarrel,  one  having  a 


360  ENTRANCE    AND    EXIT    APERTURES. 

loaded  weapon  in  his  band,  Avhieh  he  may  allege  to  have  been  accidentally 
discharged  and  to  have  killed  the  deceased.  If  the  allegation  be  true,  we 
ought  to  find  on  the  body  the  marks  of  a  near  wound ;  if,  however,  its 
characters  are  such  that  it  has  obviously  been  produced  from  a  distance, 
and  therefore  after  the  quarrel,  medical  proof  of  the  lact  might  imply 
malice,  and  involve  the  accused  in  a  charge  of  murder.  The  following  case 
occurred  in  Ireland  in  1834.  A  tithe-collector  was  tried  for  the  murder  of 
a  man  by  shooting  him.  It  appeared  in  evidence  that  the  prisoner,  while 
on  duty,  was  attacked  by  the  deceased  and  two  of  his  sons,  and  he  drew  a 
pistol  to  intimidate  them.  He  was  dragged  off  his  horse  by  these  persons, 
and  during  the  scuffle  it  is  supposed  the  pistol  was  discharged  accident- 
ally, and  inflicted  on  the  deceased  a  wound  of  which  he  died  shortly 
afterwards.  The  sons  of  the  deceased  swore  that  the  prisoner  took  a 
deliberate  aim,  and  fired  the  pistol  at  their  father  when  at  some  distance  ; 
and  a  priest  came  forward  to  depose  that  such  was  the  dying  declaration 
of  the  deceased.  From  some  doubt  of  the  truth  of  this  story,  the  body, 
w^hich  had  been  carelessly  inspected  in  the  first  instance,  was  ordered  to 
be  disinterred.  It  Avas  again  examined  by  a  surgeon,  who  Avas  enabled  to 
swear  positively  that  the  pistol  must  have  been  fired  close  to  the  body  of 
the  deceased,  and  not  at  a  distance,  since  there  were  the  marks  of  powder 
and  burning  on  the  wrist.  Hence  it  clearly  followed  that  the  pistol  had 
not  been  discharged  at  a  distance,  but  during  the  scuffle,  either  by  accident 
or  in  self-defence.  The  prisoner  was  acquitted,  and  the  parties  who  had 
appeared  against  him  were  convicted  of  perjury. 

It  has  been  said  that,  when  a  bullet  is  fired  close  to  the  body,  it  com- 
monly traverses  it ;  and  therefore  it  has  been  rather  hastily  assumed  that, 
when  there  is  only  one  external  wound,  and  the  bullet  has  lodged  in  the 
body,  this  is  a  proof  that  the  piece  has  been  fired  from  a  distance.  This 
inference  is,  however,  erroneous.  A  bullet  may  be  fired  close  to  a  person 
and  yet  not  traverse  the  bod}^,  either  from  its  impulsive  force  not  being 
sufficiently  great,  or  from  its  meeting  with  great  resistance  in  its  course. 
Many  cases  might  be  cited  to  show  that,  in  the  near  wounds  produced  by 
suicides  and  murderers,  the  bullets  have  not  alwaj's  traversed  the  body. 
In  suicide,  when  the  piece  is  discharged  into  the  mouth,  the  projectile 
often  lodges  in  some  part  of  the  head  {ante,  p.  358).  It  is  not  in  the 
power  of  a  witness  to  say,  fro»i  the  mere  fact  of  a  bullet  lodging  or  tra- 
versing, whether  the  assassin  was  far  off"  or  near  at  the  time  that  the 
deceased  was  Avounded.  The  latter  point  may  be  sometimes  readily  de- 
termined by  the  marks  of  injury  and  burning  about  the  skin  and  dress. 
When  a  gun  or  a  pistol  is  discharged  at  a  distance  of  three  or  four  yards 
from  the  person,  it  Avill  not,  of  course,  produce  those  marks  of  blackening, 
burning,  and  bruising  on  the  skin  Avhich  are  found  when  the  muzzle  is 
Vv^ithin  a  fcAV  inches  of  the  body.  A  Avound  which  does  not  present  these 
appearances  may  remove  the  suspicion  of  suicide  and  create  a  strong  pre- 
sumption of  homicide.  Laches  found  (Ann.  d'Hyg.,  1836,  p.  368)  that, 
in  firing  a  gun  at  a  distance  of  four  feet,  the  skin  was  only  partially 
blackened.  It  Avould  be  very  important  in  a  case  of  this  kind  to  notice  the 
direction  of  the  Avound,  as  Avell  as  the  relative  position  of  the  assailant  and 
assailed,  as  stated  by  Avitnesses  or  deduced  from  circumstances.  When  a 
ball  traverses  the  body,  it  sometimes  happens  that  the  two  apertures  are 
opposite  to  each  other,  although  the  ball  may  not  have  taken  a  rectilinear 
course  betAveen  them,  but  have  been  variously  deflected  by  the  subjacent 
hard  parts.  This  deflection  of  a  ball  from  a  rectilinear  course  is  met  Avith 
in  those  cases  in  Avhich  it  happens  to  strike  ol)liquely  a  curved  surface, 
and  it  is  found  that,  Avhen  the  ball  enters  and  does  not  pass  out,  its  course 


SUICIDAL    AND    HOMICIDAL    G  UNSIIOT- W  OUNDS  .  361 

is  often  circuitous,  so  that  it  is  not  always  easy  to  surmise  in  what  part  of 
the  body  it  will  be  found. 

A  witness  may  be  asked — When  was  the  gunshot-wound  inflicted? 
and  how  long  did  the  wounded  person  survive  after  receiving  it?  A 
gunshot-wound  undergoes  no  obvious  change  for  eight  or  ten  hours  after 
its  infliction.  Our  judgment  in  reference  to  these  questions  may  be  as- 
sisted by  observing  the  parts  which  are  involved,  although  we  cannot 
always  infer,  from  the  quantity  of  blood  found  near  to  a  body,  that  the 
bleeding  was  an  immediate  consequence  of  the  wound,  or  that  the  whole 
of  the  blood  was  effused  at  once.  We  cannot,  then,  always  affirm  that 
the  deceased  could  not  have  moved  or  exerted  himself  in  son)e  degree 
after  receiving  it.  The  e.Kertion  thus  made  subsequently  to  his  being 
wounded  may  have  actually  caused  the  fatal  bleeding. 

Suicidal  and  Homicidal  GuntiJiot-ivounds.—Wh^^a  it  is  doubtful  whether  - 
the  wound  was  the  result  of  suicide  or  homicide,  the  point  may  be  some- 
times determined  by  paying  attention  to  its  situation  and  direction. 
Suicidal  gunshot-wounds  are  almost  always  directed  to  a  vital  part — to 
the  heart  or  to  the  brain  ;  they  possess  those  characters  which  belong  to 
wounds  inflicted  near  to  the  body  :  the  skin  is  discolored  or  burnt,  the 
wound  wide  and  lacerated,  the  hand  which  discharged  the  weapon  often 
blackened  and  sometimes  still  grasping  the  pistol.  The  ball  may  or  may 
not  have  traversed,  as  this  will  depend  on  the  momentum  which  it  derived 
from  the  charge  and  the  resistance  which  it  experienced. 

On  the  occasion  of  the  trial  for  the  Uxbridge  murder  CReg.  v.  Gibbons, 
C.  C.  C,  Dec.  1884),  several  important  questions  arose  as  to  the  suicidol 
or  homicidal  character  of  four  gunshot-wounds  found  by  Boulby  on  the 
body  of  the  deceased.  One  of  the  bullets  had  penetrated  the  heart.  The 
prisoner  was  convicted.     (Brit.  Med.  Jour.,  1885,  i.  p.  62.) 

Accidental  gunshot-wounds  bear  the  characters  of  near  wounds :  they 
may  touch  vital  parts,  but,  if  the  body  has  not  been  disturbed,  the 
presence  or  absence  of  design  in  the  infliction  of  a  wound  is  commonly 
made  apparent  by  the  relative  position  of  the  body  and  the  weapon. 
They  frequently  arise  from  persons  drawing  the  charges  of  guns  or 
])istols  with  the  muzzles  pointed  towards  them,  and  they  are  then  situated 
in  front;  at  other  times  they  are  produced  by  persons  pulling  towards 
them  through  hedges  or  dragging  after  them  loaded  guns.  In  the  latter 
case  the  wound  is  behind,  and  it  may  strongl}^  resemble  a  homicidal  wound, 
although  the  circumstances  under  which  the  body  is  found  generally  suffice 
to  explain  the  matter  (Ann.  d'Hyg.,  18R0,  t.  1,  p.  443.)  A  loaded  gun 
had  been  placed  on  the  top  of  a  corn-bin  in  a  stable.  A  fowl  trod  upon 
the  trigger,  and  thus  fired  the  gun.  It  seriously  wounded  an  old  man  who 
was  near.  This  shows  by  w^hat  a  stranse  coincidence  a  man  may  be  found 
shot  with  his  own  gun,  and  how  difficult  it  might  be  to  reconcile  the  dis- 
charge of  the  gun  with  any  accidental  circumstances.  In  suicide,  there  is 
commonly  strong  evidence  of  design  ;  in  accident,  all  evidence  of  design 
is  wanting.  Suicides  sometimes  make  use  of  extraordinary  weapons,  or 
use  weapons  in  an  extraordinary  manner. 

Accidental  gunshot-\vounds  sometimes  simulate  those  which  are  the 
result  of  homicide.  In  1884  a  poacher  whilst  carrying  a  double  barrelled 
muzzle-loading  gun  in  his  pocket,  hoisted  the  carcass  of  a  roe,  which  his 
party  had  shot,  on  to  his  shoulder,  when  the  sudden  movement  of  the 
body  caused  the  weapon,  a  barrel  of  which  was  loaded,  to  fall  out  of  his 
pocket,  and  the  loaded  barrel  went  off,  the  shot  lodging  in  the  abdomen, 
causing  his  death  in  a  few  minutes.  In  1887  a  man  was  killed  by  his 
brother's  gun,  which  was  fired  by  a  dog  playing  round  the  brother.     The 


362  WOUNDS    FROM    SMALL-SHOT. 

charge  lodged  in  the  left  side  and  the  man  died  in  an  hour.  In  1890,  a 
man  was  carrying  his  gun  in  his  pocket  in  two  pieces,  and  as  he  was 
taking  out  the  stock  the  barrel  also  fell  out,  and  striking  on  a  stone  went 
off.  The  charge  entered  the  man's  arm,  shattering  it,  and  he  died  of  the 
injury  thus  inflicted.  The  above  cases  were  reported  to  the  editor  by 
Mackintosh,  who  drew  attention  to  the  fact  that  poachers  for  convenience 
often  separate  the  stock  from  the  barrel  of  a  gun,  and  carry  both  in 
their  pockets  in  order  to  avoid  observation. 

On  Jan.  18,  1881,  the  body  of  a  lawyer,  named  Bernays,  was  found  in 
a  chair,  in  a  sitting  posture,  in  a  house  into  which  he  had  been  inveigled 
eleven  days  previously.  There  was  tw^o  pistol-shot  wounds — one  in  the 
right  temple,  of  a  simple  character ;  the  other,  and  fatal  wound,  was  in 
the  nape  of  the  neck.  The  latter  was  a  perfectly  clean  wound  without 
any  singeing.  The  ball  had  gone  through  the  neck  from  left  to  right, 
slightly  ascending,  and  had  perforated  the  skull.  There  were  blood- 
stains on  the  nape  of  the  neck  and  on  the  right  side  of  the  head.  The 
bleeding  from  the  fatal  wound  was  internal  and  there  was  little  blood  on 
the  clothes.  There  was  a  small  pool  of  blood  on  the  carpet;  and  on  this, 
it  is  alleged,  was  the  impress  of  a  foot.  This  must  have  been  made  after 
the  blood  had  stiffened.  It  was  endeavored  to  be  shown,  however,  by  the 
defence,  that  the  footprint  might  have  been  made  not  more  than  ten  or 
lifteen  minutes  after  the  effusion  of  blood  had  taken  place.  The  prisoner, 
I>eon  Pelzer,  was  convicted,  and  admitted  the  justice  of  the  conviction. 
When,  how^ever,  experts  differ,  as  in  his  case,  as  to  whether  a  mark  on  a 
pool  of  blood  weighing  nine  ounces  has  been  produced  by  a  boot  or  by  a 
trouser-covered  knee,  the  evidence  ought  to  be  rejected.  (See  Brit.  Med, 
Jour.  1883,  i.  p.  23.) 

Position  of  the  Wounded  Person  when  shot. — Did  the  deceased  receive 
the  shot  while  standing,  falling,  or  lying  down  ?  Was  the  piece,  W'hen 
discharged,  pointed  from  the  shoulder?  These  questions  can  only  be 
answered  by  reference  to  the  particular  circumstances  of  the  case.  'In 
general,  when  a  person  is  shot  while  standing,  and  the  piece  is  pointed 
from  the  shoulder,  the  wound  is  more  or  less  transverse ;  but  due  allow- 
ance must  be  made  for  the  deflection  of  balls  after  penetration.  Was  the 
deceased  shot  w^hile  running  away,  or  when  approaching  the  person  who 
fired?  This  question  is  answered  by  observing,  in  the  case  of  a  trav- 
ersing w'ound,  in  w^hich  alone  any  difficulty  can  arise,  whether  the  entrance- 
orifice  be  situated  in  front  or  behind. 

Wounds  fr'o^n  Small-shot. — Death  is  sometimes  occasioned  by  small- 
shot  ;  and  here  several  medico-legal  questions  present  themselves.  Small- 
shot  may  act  in  two  ways:  (1)  it  either  strikes  without  spreading,  in 
which  case  the  discharge  is  always  near  the  person  shot,  and  its  action  is 
much  more  dangerous  than  that  of  a  single  ball,  because  it  produces  ex- 
tensive lacerations ;  or  (2)  it  strikes  after  it  has  spread,  and  here  the 
discharge  must  have  been  distant,  and  comparatively  little  mischief  is 
done.  Lachese  ascertained  by  many  experiments  on  dead  bodies  that  in 
order  to  produce,  with  small-shot,  a  round  opening  somewhat  resembling 
that  produced  by  a  bullet,  the  discharge  should  take  place  point-blank  at 
the  distance  of  about  ten  or  twelve  inches  from  the  surface  of  the  body. 
When  the  distance  was  from  twelve  to  eighteen  inches,  the  opening  made 
was  irregular,  and  the  borders  were  much  lacerated;  at  thirty-six  inches, 
the  one  central  opening  was  entirely  lost,  and  the  surface  of  the  body  was 
covered  with  shot-marks.  The  effect  after  this  was  found  to  depend  on 
the  distance,  the  kind  of  gun,  and  the  strength  of  the  charge  (Ann.  d'Hyg., 
183G,  p.  38G)  ;  but  the  shot  is,  in  genera],  much  scattered  over  the  surface 


WOUNDS    FROM    WADDING    AND    GUNPOWDER.  363 

of  the  body.     From  those  results  we  may  form  an  opinion  of  the  distance 
at  which  the  piece  was  fired. 

It  is  difficult  to  conceive  that  small-shot  can,  under  any  circumstances, 
produce  a  single  entrance-wound  having  some  appearance  of  circularity 
about  it,  without  at  the  same  time  singeing  or  burning  the  skin  or  dress. 
The  difficulty  of  laying  down  any  general  rules  resjiecting  the  wounds  pro- 
duced by  small-shot  at  their  entrance  and  exit  will  be  apparent  from  the 
following  facts.  A  boy  was  shot  in  the  neck  by  the  accidental  discharge 
of  his  gun,  loaded  with  an  ounce  of  No.  8  shot.  He  died  instantly.  He 
Avas  leaning  forwards  on  the  muzzle,  so  that  it  was  nearly  in  contact  with 
the  skin  of  the  neck.  A  large  round  hole  was  produced,  one  inch  and  a 
half  in  diameter,  the  edges  of  which  were  slightly  blackened  with  powder. 
The  exit-aperture,  which  was  at  the  back  of  the  neck  a  little  to  the  left  of 
the  third  cervical  vertebra,  was  a  mere  slit  in  the  skin,  scarcely  an  inch' 
long,  with  the  long  diameter  placed  vertically.  The  smallness  of  this 
aperture  may  have  been  owing  to  the  greater  part  of  the  charge  being- 
lodged  in  the  body.  The  entrance-aperture,  although  rounded,  was  too 
large  to  be  mistaken  for  a  bullet-wound  ;  it  was  evident h^  a  near  wound, 
from  the  blackening  of  the  edges.  On  the  other  hand,  Lowe  found  that  a 
round  aperture  might  be  produced  by  a  discharge  of  small-shot  at  a  much 
greater  distance  from  the  object  than  that  assigned  by  Lachese.  Admit- 
ting such  exceptional  instances,  and  assuming  the  general  correctness  of 
the  inferences  drawn  by  Lachese  from  the  results  of  his  experiments  in 
discharging  small-shot  at  dead  bodies  placed  at  different  distances,  it  does 
not  seem  probable  that  a  wound  from  small-shot  can,  tinder  any  circum- 
stances, be  mistaken  for  one  produced  by  a  leaden  bullet.  A  discharge  of 
small-shot  in  contact  with  the  skin  or  close  to  it  will,  however,  produce, 
not  a  round  opening,  but  a  severe  lacerated  wound. 

Small-shot  is  rarely  observed  to  traverse  the  body  entirely,  unless  dis- 
charged so  near  as  to  make  a  clean  round  opening;  but  a  single  pellet 
reaching  the  body  may  destroy  life.  There  may  be  no  exit-aperture,  or  it 
may  be  smaller  than  that  of  entrance.  Such  minute  wounds  might  be 
easily  overlooked  in  the  examination  of  a  dead  body.  Small-shot,  even 
when  wounding  only  the  skin  of  the  back  superficial!}^,  has  been  known 
to  cause  death  by  tetanus. 

Wounda  from  Wadding  and  G  mi  powder. — It  matters  not  wnth  what 
the  piece  is  charged,  it  is  capable,  when  fired  near,  of  producing  a  wound 
which  may  prove  fatal.  Thus  a  gun  loaded  with  wadding,  or  even  with 
gunpowder  only,  may  cause  death.  In  these  cases, -an  impulsive  force  is 
given  by  the  explosion,  and  the  substance  becomes  a  dangerous  projectile. 
The  lighter  the  projectile,  the  shorter  the  distance  to  which  it  is  carried  ; 
but  when  discharged  near  to  the  body  it  may  produce  a  fatal  penetrating 
wound.  A  portion  of  the  dress  may  be  carried  into  the  wound  and  lead 
to  death  from  bleeding;  or,  if  the  wounded  person  recover  from  the  first 
effects,  he  may  subsequently  sink  under  an  attack  of  tetanus  or  erysipelas. 
It  is  unfortunate  that  so  much  ignorance  prevails  on  this  point;  for  fatal 
accidents  frequently  occur  from  persons  discharging  guns  at  others  in 
sport — an  act  which  they  think  they  ma}^  perform  without  danger,  because 
they  are  not  loaded  with  ball  or  shot. 

It  has  been  observed  that  persons,  in  attempting  to  commit  suicide, 
have  occasionally  forgotten  to  put  a  bullet  into  the  pistol ;  nevertheless, 
the  discharge  of  the  weapon  into  the  mouth  has  sufficed,  from  the  effect  of 
the  w^adding  only,  to  produce  a  considerable  destruction  of  parts,  and  to 
cause  a  serious  loss  of  blood.  Fatal  accidents  have  frequentlv  taken  place 
from  the  discharge  of  wadding  from  cannon  during-  reviews.     It  is  not 


SG-i  W0U:NDS    from    AVADDIXG    AXD    GUXPOVrDER. 

easy  to  say  at  ^vbat  distance  a  weapon  thus  charged  with  wadding  and 
powder  would  cease  to  produce  mischief,  since  this  must  depend  on  the 
impulsive  force  given  by  the  powder  and  on  the  size  of  the  piece. 
Lachese  ascertained  that  a  piece  charged  with  gunpowder  is  capable  of 
producing  a  penetrating  wound  somewhat  resembling  that  caused  bv 
small-shot,  when  the  piece  is  large,  strongly  charged,  and  fired  within  six 
inches  of  the  surface  of  the  body.  (Ann.  d'Hyg.,  1836,  p.  368.)  This 
arises  from  a  portion  of  the  powder  always  escaping  combustion  at  the 
time  of  discharge,  and  each  grain  then  acts  like  a  pellet  of  small-shot. 
ITnder  any  circumstances,  a  discharge  of  powder  only,  contuses  the  skin, 
producing  ecchymosis,  and  often  lacerating  it  if  the  piece  be  fired  near. 
The  dress  is  burnt  and  the  skin  scorched  from  the  globe  of  flame  formed 
by  the  combustion  of  the  powder,  and  many  particles  of  gunpowder  may 
be  actually  driven  into  the  true  skin.  All  the  substances  here  spoken  of 
are  considered  to  be  projectiles;  and  the  weapons  are  held  in  law  to  be 
loaded  arms  so  long  as  they  are  capable  of  producing  bodih"  injury  at  the 
distance  from  which  the  piece  containing  them  is  discharged.  It  may, 
therefore,  become  a  question  as  to  the  distance  at  which  these  light  pro- 
jectiles cease  to  be  harmless.  The  answer  must  be  governed  by  circum- 
stances ;  but  it  will  in  all  cases  materially  depend  on  the  strength  of  the 
charge.  Swift  performed  some  experiments  with  a  pistol  loaded  with 
gunpowder  and  wadding,  in  order  to  determine  the  effect  of  a  discharge  at 
different  distances.  At  twelve  inches'  distance  from  a  dead  bod}",  he 
found  that  the  clothes  were  lacerated  and  the  skin  abraded,  but  the  wad- 
ding did  not  penetrate ;  at  six  inches,  the  clothes  were  lacerated,  and  the 
wadding  penetrated  to  the  depth  of  half  an  inch  ;  at  two  inches,  the 
wound  produced,  which  was  two  inches  deep,  was  ragged  and  blackened  ; 
at  an  inch  and  a  half  from  the  chest,  the  wadding  passecl  into  the  cavity 
between  the  ribs,  and  in  a  second  experiment  it  carried  away  a  portion  of 
a  rib.     (Lond.  Med.  Gaz.,  vol.  xl.  p.  T34.) 

This  subject  was  investigated  by  Mackintosh,  and  he  forwarded  to  the 
author  the  results  of  his  experiments.  As  a  summary  he  found,  in  refer- 
ence to  the  wounds  produced  by  wadding,  that  the  amount  of  injury  done 
is  in  proportion  to  the  amount  of  powder  in  the  gun,  the  hardness  and  com- 
pactness of  the  wadding  or  substance  used  in  place  of  shot  or  bullet,  and  the 
distance  of  the  object  from  the  yjoint  of  firing.  A  case  occurred  in  his 
practice  which  was  the  subject  of  atrial  for  unlawful  wottnding.  (Reg-. 
V.  Isgate,  Norwich  Aut.  Ass.,  186T.)  The  prisoner  fired  at  a  boy  with  a 
gun  loaded  with  pieces  of  brown  paper  pressed  together.  He  was  then  at 
a  distance  of  two  or  three  yards  from  the  boy.  There  was  a  wound  in  the 
chest  about  the  size  of  a  shilling.  The  margin  of  the  Avound  was  jagged, 
had  a  blui^-h-black  or  mottled  appearance,  and  the  edges  of  one  of  the  ribs 
were  laid  bare.  The  pellet  took  a  course  downwards  as  a  result  of  its 
deflection  by  the  rili.  A  cjuantity  of  brown  paper  was  removed  fi-om  the 
wound,  and  the  boy  ultimately  recovered.  The  Cjuestion  which  Mackin- 
tosTi  proposed  to  consider  was  whether  paper-wadding  could  really  pro- 
duce such  a  wound  as  was  here  found  when  the  gun  was  fired  from  a  dis- 
tance of  tioo  or  three  yards.  Without  going  into  details  it  may  be  stated 
that  when  the  gun  was  charged  with  a  small  cjuantity  of  powder  and 
brown-paper  wadding,  there  was  indentation,  but  no  penetration  at  a 
distance  of  two  yards.  With  one-third  more  powder  and  a  closely-com- 
pressed brown-paper  pellet  there  was  penetration  through  the  boy's  jacket 
to  an  inch  and  a  half  beyond.  These  facts  bear  out  the  conclusion  already 
given,  and  confirmed  the  boy's  account  of  the  distance  from  which  the 
gun  was  fired  at  him  by  the  prisoner.     Swift  had  inferred  from  his  experi- 


EXAMINATION    OF    FIREARMS.  305 

meats  that  a  penetrating,-  -wound  from  waddina'  -^'as  not  produced  unless 
the  piece  was  discharged  within  a  distance  of  six  indies  ;  but  Maclcintosli's 
results  clearly  show  that  this  must  depend  on  the  quantity  of  powder 
used  and  the  loose  or  condensed  nature  of  the  substance  employed  as  a 
projectile. 

J'Jxaminafion  of  Firearms. — An  attempt  has  been  made  by  French 
medical  jurists  to  determine  for  how  long  a  period  a  gun  or  a  pistol  found 
near  a  dead  body  may  have  been  discharged  ;  but  it  is  out  of  our  power 
to  lay  down  any  precise  rules  on  such  a  subject.  All  that  we  can  say  is 
that  a  quantity  of  sulphide  of  potassium,  mixed  with  charcoal,  is  left 
adhering-  to  the  barrel  of  the  piece  when  recently  discharged  ;  and  this  is 
indicated  by  its  forming-  a  strongly  alkaline  solution  with  water,  evolving 
an  odor  of  sulphuretted  hydrogen,  and  giving  a  deep-brown  precipitate 
with  a  solution  of  acetate  of  lead.  After  some  hours  or  days,  according - 
to  the  degree  of  exposure  to  air  and  moisture,  the  saline  residue  be- 
comes converted  into  sulphate  of  potassium,  forming  a  neutral  solution 
with  water,  and  giving-  a  white  precipitate  with  acetate  of  lead.  If  a 
considerable  time  has  elapsed  since  the  piece  was  discharged  oxide  of  iron, 
with  traces  of  sulphate,  mav  be  found.  (See  Ann.  d'Hvg.,  1834,  p.  458; 
1839,  p.  197;   1842,  p.  368.) 

When  called  to  a  case  of  gunshot-wound,  either  accidental  or  criminal, 
it  is  always  proper  to  examine  the  piece,  if  found.  Has  it  or  has  it  not 
been  recently  discharged,  may  be  a  material  question.  This  is  best  deter- 
mined by  a  gunsmith.  A  trial  took  place  on  the  Western  Circuit,  March, 
1873,  in  which  the  fact  was  of  great  importance.  The  prisoner  asserted 
that  his  gun  had  not  been  used  for  a  long  time.  On  examination  of  the 
Ijarrel,  however,  it  was  found  to  have  been  quite  recently  discharged. 
This  at  once  connected  him  with  the  act  of  wounding  of  which  he  was 
accused.  In  an  agrarian  murder  in  Ireland,  in  1876,  there  was  found 
imbedded  in  the  heart  of  the  deceased  the  half  of  a  common  marble  such 
as  children  use  in  play.  A  bag  of  marbles  of  the  same  size  and  kind  was 
found  in  the  house  of  one  of  the  prisoners,  and  this  discovery  connected 
him  with  the  act. 

The  examination  of  wadding  or  paper  found  in  a  gunshot-wound,  or 
near  a  dead  body,  has  in  more  than  in  one  instance  led  to  the  detection  of 
the  person  who  had  committed  a  crime.  The  handwriting-  has  been  traced 
(ui  the  paper  used  as  wadding,  or  it  has  been  found  to  have  been  part  of  a 
printed  page,  of  which  the  remainder  has  been  discovered  in  the  posses- 
sion of  the  accused.  When  a  gun  is  discharged  near  to  the  body  a  portion 
of  the  wadding  is  generally  carried  into  the  large  irregular  wound  which 
is  produced.  This  was  part  of  the  evidence  in  the  case  of  Reg.  v.  Blagg 
(Chester  Sum.  Ass.,  1857).  The  peculiar  character  of  the  wadding  found 
in  the  body  connected  the  prisoner  with  the  act.  Whether  the  wadding- 
is  found  in  or  near  the  body  it  should  be  equally  preserved.  In  Reg.  v. 
Richardson  (Lincoln  Ass.,  Dec.  1860),  the  accused  was  convicted  of  mur- 
dering a  policeman  under  the  following  circumstances.  He  shot  at  the 
deceased,  who  was  able  before  death  to  identify  the  prisoner ;  but  as  the 
deceased  was  weak  from  loss  of  blood,  and  failing  in  consciousness  at  the 
time,  there  was  some  difficulty  in  relying  upon  the  dying  declaration, 
especially  as  no  other  person  witnessed  the  act.  Some  paper-wadding 
had  been  picked  up  on  the  spot  where  the  deceased  fell;  ancl  a  gun,  which 
had  one  barrel  loaded  and  one  empty  from  a  recent  discharge,  was  found 
in  the  prisoner's  house  within  twenty-four  hours  of  the  murder.  The 
wadding  in  the  loaded  i:)arrel  consisted  of  a  fragment  of  the  Times  news- 
paper of  March  27,  1854,  and  the  charred  and  sulphurous  pieces  of  wad- 


366  BURNS    AND    SCALDS. 

■ding-  picked  up  on  the  spot  were  proved  by  the  publisher  of  that  journal 
to  have  formed  a  portion  of  the  same  impression.  The  prisoner's  counsel, 
in  fact,  could  not  deny  that  the  act  had  been  brought  home  to  the  instru- 
ment, if  not  to  the  agent,  and,  though  the  explanation  of  the  ci'ime  re- 
mained obscure  to  the  last,  and  the  motive  unassignable,  the  aggregate 
evidence  proved  sufficient  to  convince  the  jury.  Any  projectiles  found  in 
a  gunshot-wound  should  always  be  preserved  for  evidence.  In  the  case 
of  Rush,  who  was  tried  and  convicted  of  the  murder  of  Mr.  Jermy  by  a 
remarkable  train  of  circumstantial  evidence  (Norwich  Lent  Ass.,  1849),  it 
was  proved  that  the  projectiles  removed  from  the  body  of  the  deceased 
consisted  of  irregular  pieces  of  lead  (slugs).  Similar  masses  were  taken 
from  the  body  of  the  son,  who  was  killed  at  the  same  time.  They  were 
described  by  the  medical  witness  as  being  angular,  and  quite  unlike  the 
shot  used  in  killing  game.  This  proved  that  the  two  acts  of  murder  were 
committed  by  the  same  person,  or  by  this  person  acting  in  concert  with 
others. 

The  chemical  anal3^sis  of  a  projectile  may  be  occasionally  necessary.  A 
common  bullet  is  formed  entirely  of  lead.  Cast  bullets  are  commonly 
found  to  have  a  void  space  in  the  interior,  when  cut  through  the  centre, 
owing  to  the  exterior  cooling  more  rapidly  than  the  interior,  and  to  the 
greater  bulk  of  the  metal  when  in  a  liquid  state.  In  large  bullets  this 
cavity  is  frequently  of  the  size  of  a  barleycorn.  Bullets  obtained  by  com- 
pression have  no  such  space,  and  are  of  greater  specific  gravity.  Small 
shot  is  composed  of  lead,  with  a  minute  portion  of  arsenic  (l-200th  part). 
If  the  arsenic  is  in  large  proportion,  the  shot  is  lenticular;  if  absent,  or  in 
small  proportion,  pyriform  (Ure).  In  the  case  of  Rush,  type-metal  was 
found  in  the  house.  This  consists  of  lead,  with  one-fourth  part  of  anti- 
mony. The  slugs  were  found  to  consist  chiefly  of  lead,  and  to  contain  no 
antimony.     Type-metal  was  thus  excluded. 


CHAPTER    XXXVII. 

DEATH  FROM  BURNS  AND  SCALDS. SYMPTOMS. STUPOR. CAUSE  OF  DEATH. POST- 
MORTEM APPEARANCES. BURNS  ON  THE  DEAD  BODY. ACCIDEKT,  HOMICIDE,  OR  SUI- 
CIDE.  WOUNDS    CAUSED    BY    FIRE. SCALDING. BURNS    BY    CORROSIVE    LIQUIDS. 

Burns  and  Scalds. — A  burn  is  an  injury  produced  by  the  application 
of  a  heavy  solid,  or  a  flame,  to  the  surface  of  the  body  ;  while  a  scald  re- 
sults from  the  application  of  a  liquid  at  a  high  temperature  under  the  same 
circumstances.  There  seems  to  be  no  real  distinction  between  a  burn  and 
a  scald  in  reference  to  the  effects  produced  on  the  body  ;  the  injury  result- 
ing from  boiling  mercury  or  melted  lead  might  take  either  appellation. 
Nevertheless,  as  a  matter  of  medical  evidence,  it  may  be  important  to 
state  whether  the  injury  found  on  a  body  was  caused  by  such  a  liquid  as 
boiling  water  or  by  a  heated  solid.  If  the  former,  the  injury  might  be 
ascribed  to  accident;  if  the  latter,  to  criminal  design.  A  scald  produced 
by  boiling  water  would  be  indicated  by  a  sodden  state  of  the  skin  and 
flesh,  but  there  would  be  no  destruction  of  substance.  In  a  burn  by  a 
heated  solid,  the  parts  may  be  more  or  less  destroyed,  or  even  charred; 
the  cuticle  may  be  found  blackened,  dry,  almost  of  a  horny  consistency, 
and  presenting  a  shrivelled  appearance.     This  distinction,  however  would 


CAUSE    OF    DEATH.  3<57 

only  apply  to  scalds  from  water.  A  scald  from  melted  lead  (633°  F.)  could 
not  be  disting-uisiied  from  a  burn  produced  by  a  solid  heated  to  the  same 
temperature.  Some  of  the  oils  boil  at  500°  F.,  and  they  produce,  by  con- 
tact with  the  skin,  burns  as  severe  as  those  caused  by  melted  metal.  Burns 
from  flame,  such  as  that  of  gas,  are  indicated  by  extensive  scorching  of 
the  skin,  while  burns  from  gunpowder  are  known  not  only  by  the  scorch- 
ing, but  by  the  small  particles  of  unburnt  carbon  which  are  imbedded  in 
the  skin. 

Neither  a  burn  nor  a  scald  appears  to  be  considered  as  a  ivound  in  law  ; 
but  in  the  statute  of  wounding  they  are  included  among  bodily  injuries 
dangerous  to  life.  Burns  and  scalds  may  be  regarded  as  dangerous  in 
proportion  to  the  extent  of  surface  of  skin  which  they  cover,  as  well  as 
the  depth  to  which  they  extend.  The  extent  of  skin  involved  in  a  super- 
ficial burn,  as  a  result  of  exposure  to  flame,  is  of  greater  importance  than 
the  entire  destruction  of  a  small  part  of  the  body  through  an  intensely 
heated  solid.  When  the  burn  is  extensive,  death  may  ensue  either  from 
the  severity  of  the  pain  produced,  or  from  a  sympathetic  shock  to  the 
nervous  system.  Death  takes  place  rapidly  from  burns  in  children  and 
nervous  females ;  but  in  adults  and  old  persons  there  is  a  better  chance  of 
recovery.  In  some  instances,  especially  in  children,  stupor  and  insensi- 
bility supervene;  and  these  symptoms  have  been  soon  followed  by  coma 
and  death.  If,  under  these  circumstances,  opium  has  been  given  to  the 
patient  as  a  sedative,  the  stupor  resulting  from  a  burn  may  be  attributed 
to  the  narcotic  effects  of  the  drug ;  and,  should  the  person  die,  the  prac- 
titioner may  find  himself  involved  in  a  charge  of  malapraxis  or  man- 
slaughter. It  may  be  alleged,  as  in  the  following  case,  that  the  person 
was  poisoned  with  opium.  A  medical  man  was  charged  with  the  man- 
slaughter of  a  child,  by  giving  to  it  an  overdose  of  opium  while  it  was 
laboring  under  the  effects  of  a  severe  scald.  Abernethy  stated  in  his  evi- 
dence, which  was  given  in  favor  of  the  practitioner,  that  he  thought  the 
use  of  opium  was  very  proper;  that  the  quantity  given — eight  drops  of 
tincture  of  opium  immediately  after  the  accident,  and  ten  drops  two  hours 
afterwards — was  not  an  overdose  for  a  child  (the  age  is  not  stated).  The 
circumstance  of  the  child  continuing  to  sleep  until  it  died,  after  taking  the 
opium,  was,  in  his  judgment,  no  proof  that  it  had  been  poisoned.  The 
sleep  was  nothing  more  than  the  torpor  into  which  it  had  been  plunged 
by  the  accident.  The  surgeon  was  acquitted.  Notwithstanding  the  very 
favorable  opinion  expressed  by  Abernethy  of  this  plan  of  treatment,  it 
would  be  advisable  to  avoid  the  use  of  opium  on  these  occasions  in  treat- 
ing infants  and  children.  [Dr.  C.  Mcymott  Tidy  dissents  from  Dr.  Tay- 
lor's views  regarding  giving  opium  to  burnt  children.  He  says  in  addi- 
tion, "  It  must  not  be  forgotten  that  extreme  pain  may  be  and  often 
is  fatal:"  Tidy's  Legal  Med.,  vol.  i.  p.  465,  Phil,  ed'ition.]  Life  is 
readily  destroyed  in  young  subjects  by  the  smallest  doses  of  this  drug ; 
and  there  are  no  satisfactory  means  of  distinguishing  the  comatose  symp- 
toms produced  by  a  burn  or  a  scald  from  those  produced  by  an  overdose 
of  opium  (p.  119). 

Cause  of  Death. — In  some  instances,  especially  in  children,  stupor  and 
insensibility  have  rapidly  supervened ;  and  these  symptoms  have  been 
followed  by  coma  and  death.  Of  the  cause  of  death  in  persons  exposed  to 
fire,  little  need  be  said.  In  large  conflagrations  persons  are  frequently 
simply  suffocated  from  the  want  of  a  proper  amount  of  air  or  from  breath- 
ing the  products  of  combustion — carbonic  acid  or  carbonic  oxide.  The 
former  darkens  the  blood  and  muscles;  the  latter  renders  them  lighter  in 
color.     In  other  cases,  where  a  large  volume  of  flame  suddenly  strikes  the 


obb  BURNS    ON    THE    LIVrNG    AND    DEAD    BODY. 

body  and  the  person  is  still  able  to  breathe,  thfe  fatal  effect  may  be  due  to 
shock — a  sudden  and  violent  impression  on  the  nervous  system  through 
the  skin.  A  person  ma}'^  recover  from  the  first  effects  of  severe  burns,  but 
ultimately  sink  from  exhaustion  or  from  an  attack  of  tetanus.  (Med. 
Times  and  Gaz.,  1854,  i.  p.  406  ;  see  Ann.  d'Hyg.,  1873,  t.  1,  p.  282.) 
The  annual  deaths  I'rom  burns  and  scalds  are  numerous.  According  to 
the  returns  of  the  Kegistrar-Geneial,  Irom  i!000  to  3000  deaths -per  year 
occur  from  this  cause. 

Fost-morteni  Appearances. — In  examining  the  body  of  a  person  found 
burnt,  all  n)atters  connected  with  sex  and  identity  should  be  first  duly 
observed.  GrUubaum  has  reported  a  case  in  which  he  was  required  to 
examine  certain  carbonized  remains,  in  which,  in  spite  of  the  des^truction 
of  the  sexual  organs,  he  was  able  to  determine  the  sex.  (Horn's  Viertel- 
jahrsschr.,  Oct.  1864.)  When  a  bod}^  has  been  entirely  consumed  by  fire, 
the  presence  of  a  large  quantity  of  phosphate  of  calcium  in  the  ashes  would 
indicate  animal  remains.  The  bones  arc  never  completely  destroj^ed ; 
they  become  white,  and  the  mineral  portions  of  them  retain  their  form 
even  after  the  action  of  a  most  intense  fire.  When  death  has  been  caused 
by  severe  pain,  no  changes  have  been  detected  in  the  dead  bod}^ ;  but  in 
some  fatal  cases  it  has  been  found  on  inspection  that  there  were  patches 
of  redness  on  the  bronchial  mucous  membrane,  as  well  as  in  the  stomach 
and  intestines.  The  brain  has  been  found  gorged,  and  the  ventricles  have 
contained 'an  abundance  of  serum.  The  serous  liquids  of  the  pericardium 
and  pleura  have  also  been  in  larger  quantity  than  natural.  In  short, 
besides  congestion,  there  is  generally  abundant  serous  effusion  in  one  of 
the  three  great  cavities,  especially  in  the  head.  This  arises  from  the 
sudden  reflux  of  blood  into  the  interior,  as  an  effect  of  the  local  injury. 
In  deaths  from  fires  in  houses,  the  persons  are  usually  suffocated,  and  then 
there  are  the  appearances  of  this  kind  of  death.  (See  Suffocation,  pod.) 
In  a  case  in  which  a  woman  died  on  the  thirteenth  day  from  a  superficial 
l)urn  involving  the  skin  of  the  lower  part  of  her  body,  the  stomach  was 
found  inflamed  at  its  greater  extremity  and  the  duodenum  at  its  lower 
portion,  the  mucous  folds  of  the  intestines  having  a  scarlet  color.  The 
other  intestines  as  far  as  the  c^cum  were  also  more  or  less  inflamed. 
(Amer.  Jour.  Med.  Sci.,  1861,  p.  137.)  If  the  person  survive  the  first 
effects,  he  may  die  from  inflammation,  suppuration,  gangrene,  irritation,  or 
fever,  or  he  may  be  worn  out  by  exhaustion.  Schjcrning  has  collected 
the  records  of  a  large  number  of  post-mortem  examinations  in  deaths  from 
burns  and  scalds.  (Vierteljahrsschr.  fii.-  Gerichtl.  Med.,  1884,  xli.  pp.  24, 
273.) 

Did  the  Burniiirj  o^  ihe  borhj  fake  place  before  or  after  Death  ?  Vesi- 
cation.— The  production  of  vesication  or  of  blisters  containing  serum  is 
commonly  regarded  as  an  essential  character  of  a  burn  which  has  been 
produced  during  life,  but  it  is  not  a  necessary  or  invariable  effect  of  a  bitrn 
on  the  living  body.  Vesication  is  especially  observed  in  scalds,  or  in 
those  cases  in  which  the  skin  has  been  burnt  by  flame  or  by  the  ignition 
of  the  clothes,  provided  the  cuticle  has  not  been  destroyed.  It  is  not  so 
commonly  observed  in  burns  produced  by  intensely  heated  solids.  In 
vesication  the  cuticle  is  raised  from  the  true  skin  beneath,  and  is  converted 
into  one  or  more  blisters  containing  scrum  or  a  serous  liquid,  while  the 
skin  around  is  of  a  deep-red  color.  It  is  uncertain  as  to  the  time  at 
which  it  appears  ;  it  may  be  produced  in  a  feio  minutes,  or  sometimes  not 
for  several  hours;  hence  death  may  take  place  before  vesication  occurs, 
and  the  non-discovery  of  this  condition  docs  not  warrant  the  oyiinion  that 
the  burn  could  not  have  taken  place  during  life.    If  the  cuticle  is  removed 


BURNS    OX    THE    LIVING    AND    DEAD    BODY,  3G9 

from  a  vesicated  part  of  llic  livincc  body,  the  skin  beneath  will  become  in- 
tensely reddened;  but  if  the  cuticle  is  stripped  off  a  dead  body  the  skin 
will  become  hard,  dry,  and  of  a  horny-yellow  color — it  does  not  acfjuire 
the  intense  scarlet  injection  which  is  acquired  by  the  living-  skin  when 
vesicated  and  the  surface  is  exposed. 

In  cases  in  which  persons  while  living-  have  suffered  from  g-eneral 
dropsy,  it  has  been  found,  on  the  application  of  heat  to  their  bodies  after 
death,  that  blisters  containing-  serum  or  a  serous  liquid  have  been  formed; 
hence,  in  drawing  a  conclusion  from  the  examination  of  6ii?-nson  the  body 
of  a  person  affected  with  general  dropsy,  it  is  necessary  to  be  cautious. 
In  such  cases  it  would  not  be  possible,  from  the  mere  presence  of  serous 
blisters,  to  f^ay  whether  the  burn  was  produced  before  or  after  death. 
Wrig-ht  found,  in  his  experiments  on  the  dead  body,  that  if  a  sufficient 
heat  were  closely  applied  to  the  skin  within  half  an  hour  or  longer  after 
death,  blisters  containing  scrum  were  sooner  or  later  produced.  In  short, 
as  long  as  the  body  was  warm  and  the  joints  were  flexible  the  effects  of 
the  fire  were  similar  to  those  observed  on  the  living.  Other  experimenters 
have  found  that  blisters  were  produced,  but  that  they  did  not  contain 
serum.  The  result  no  doubt  depends  on  the  time  after  death  at  which  the 
experiment  is  performed.  The  body  of  a  drowned  man,  within  a  few 
minutes  after  the  accident,  was  removed  from  the  water  and  placed  in  a 
hot  bath.  It  was  found  impossible  to  resuscitate  him,  but,  owing  to  the 
great  heat  of  the  water,  portions  of  the  cuticle  came  off  when  the  body 
was  removed.  On  inspection,  there  were  several  vesications  filled  icith 
blood II  serum  over  a  considerable  portion  of  the  skin,  especially  of  the  ex- 
tremities. There  was  no  anasarca  (dropsy)  here  to  account  for  the  pro- 
duction of  the  blisters.  In  this  case  the  man  was  pulseless,  and  to  all 
appearance  dead  when  placed  in  the  hot  bath ;  hence  the  effects  of  hot  water 
on  the  living  and  recently  dead  body,  so  far  as  the  production  of  serous 
blisters  is  concerned,  are  similar.  Chambert  has  published  the  results  of 
numerous  experiments  on  the  effect  of  burns  on  the  living  and  dead  body. 
These  have  Ijeen  made  on  the  bodies  of  persons  from  the  moment  of  death 
until  twentv  liours  after  dissolution,  and  some  were  peformcd  before  death. 
The  general  results  of  his  researches  are  that  vesications,  or  blisters,  may 
I)e  produced  by  burns  both  on  the  living  and  dead  body  ;  that  they  are 
produced  at  a  lower  temperature  in  the  living  than  in  the  dead ;  that  in 
the  living  a  burn  produces  great  capillary  congestion,  with  the  effusion  of 
serum  in  the  blisters ;  and  that  this  serum  when  heated,  or  treated  with 
nitric  acid,  sets  into  a  nearly  solid  coagulum.  The  blisters  produced  in  a 
dead  body,  even  a  few  minutes  after  death,  contain  a  thin,  watery  serum, 
which  is  only  rendered  opaline  or  milky  by  heat  and  the  action  "of  nitric 
acid.  (Ann.  d'Hyg  ,  1859,  t.  1,  p.  .342.)  When  a  body  is  cold  and  rigid, 
blisters  containing  air  or  vapor  alone  are  produced.  Bouchut  found  that 
by  the  application  of  heat  he  could  produce  vesicles  containing  a  watery 
.serum,  sometimes  bloody,  within  twelve,  eighteen,  and  twentv-four  hours 
after  death.  (Gaz.  Mkl.,  March,  1847;  and  Ann.  d'Hys".,"  1878,  i.  p. 
509.) 

In  burns,  especially  those  produced  by  red-hot  solids,  other  effects 
besides  vesication  follow.  The  edge  of  the  skin  immediately  around  the 
part  burnt  is  commonly  of  a  dead  white,  and  close  to  this  is  a  deep-red 
line,  gradually  shaded  off  into  the  surrounding  skin,  which  is  reddened. 
The  diffused  redness  is  removable  by  pressure,  and  disappears  with  life; 
the  red  line  here  referred  to,  however,  is  not  removable  by  pressure,  and 
is  persistent  after  death.  This  line  of  redness  is  not  always  met  with  in 
severe  burns,  and  when  a  person  survives  one  or  two  davs,  its  production 
24 


370  BURNS CHANGES    IN    THE    SKIN. 

appears  to  depend  upon  a  power  of  reaction  in  the  system.  Thus,  then, 
its  absence  furnishes  no  proof  of  the  burn  havinc:  been  produced  after 
death,  for  it  is  not  a  necessary  accompaniment  of  a  burn  during  life. 
Wriii:ht  considered  that  in  a  low  state  of  vitality  a  line  of  redness  might 
not  be  produced  by  a  severe  burn  on  the  living  body,  and  that  more  cer- 
tain reliance  may  be  placed  on  the  red  marks  found  beneath  the  blisters 
and  crusts  of  vital  burns.  These  latter  were  well  marked  w^en  he  found 
the  line  of  redness  itself  indistinct.  (On  Vital  and  Post-mortem  Burning, 
p.  25.)  The  researches  of  Chambert  confirm  this  view.  In  a  burn  on  a 
living  person,  if  the  skin  has  not  been  entirely  charred  and  destroyed,  the 
cutis  Avill  present  a  dotted  or  pointed  redness — these  dots  or  points  corre- 
sponding to  the  sudoriparous  (perspiratory)  and  hair  follicles.  After  com- 
plete death  a  burn  does  not  produce  any  such  effect — the  cutis  is  of  a  dead 
whiteness  on  the  surface  and  in  its  substance.  In  one  experiment  per- 
formed ten  minutes  after  death,  there  was  no  redness  of  the  skin,  either 
beneath  the  blisters  or  in  the  surrounding  parts.  (Ann.  d'Hyg.,  1859, 
t.  ],  p.  3G8.)  This  reddened  or  congested  state  of  the  bare  skin  is  more 
constant  than  any  other  appearance,  and  forms  the  best  criterion  of  the 
infliction  of  a  burn  on  the  living  body.  The  conclusions  that  we  may 
draw"  from  the  foregoing  statemeiits  are :  1.  That,  as  a  general  rule,  when 
we  discover  blisters  with  effusion  of  serum,  or  a  line  of  redness,  or  both, 
and  a  reddened  or  congested  state  of  the  skin,  about  a  burnt  part  of  the 
bodv,  we  are  justified  in  saying  that  the  burn  has  occurred  during  life. 
2.  That  from  the  absence  of  these  appearances  it  does  not  necessarily 
follow  that  the  burn  has  not  been  produced  on  the  living  bod^^ 

When  several  burns  are  found  on  a  dead  body,  it  may  be  a  question 
whether  they  were  all  produced  at  the  same  time.  This  is  a  point  which 
can  be  determined  only  by  observing  whether  any  of  them  present  signs 
of  gangrenous  separation,  of  suppuration,  granulation,  or  other  changes 
that  take  place  in  a  living  body  after  accidents  of  this  kind.  The  witness 
may  be  asked.  How  long  did  the  deceased  survive  the  burn  ?  A  person 
may  die  in  a  few  minutes  or  live  some  hours  after  receiving  a  most  exten- 
sive burn ;  and  yet  there  will  be  no  change  in  the  part  burnt  to  indicate 
when  death  actually  took  place.  There  may  have  been  no  time  for  inflam- 
mation or  its  consequences  to  become  established.  Suppuration  generally 
follows  vesication,  and  in  severe  cases  it  may  occur  on  the  second  or  third 
day  ;  but  often  not  until  a  later  period.  In  regard  to  gangrene,  this  takes 
place  when  the  vitality  of  a  burnt  part  is  destroyed.  The  time  of  its 
occurrence  is  uncertain,  but  it  sometimes  very  speedily  follows  the  acci- 
dent. 

The  subject  of  scalding  or  boiling  scarcely  requires  a  separate  notice. 
A  scald  from  boiling  water  would,  when  recent,  be  indicated  by  the  pro- 
duction of  serous  blisters,  or  a  sodden  state  of  the  skin,  which  appears 
white  and  soft.  The  living  structures  are  not  charred  or  destroyed  as  by 
the  application  of  a  red-hot  solid.  In  a  remarkable  case  of  alleged  child- 
murder  (Keg.  V.  Goodfellow,  Winchester  Wint.  Ass.,  1876),  the  body  of 
the  child  was  found  in  a  saucepan  covered  over,  and  it  was  evident  from 
its  appearance  that  it  had  been  thorouohly  boiled.  The  main  question 
was,  Had  the  child  been  put  living  or  dead  into  the  water  ?  The  prisoner 
admitted  that  the  child  had  breathed  once,  and  that  she  had  then  placed 
the  body  where  it  was  found.  According  to  one  medical  witness,  all  the 
organs  were  healthy,  but  the  action  of  boiling  water  upon  the  body  had 
so  destroyed  the  means  of  testing  the  lungs,  that  it  was  difficult  to  say 
whether  the  child  had  breathed  or  not.  He  was  of  opinion  that  the  child 
was  dead  when  put  into  the  saucepan.     Another  physician,  relying  upon 


ACCIDENT,    HOMICIDE,    OR    SUICIDE.  371 

the  presence  on  the  body  of  blisters  containing  a  yellow  serum,  believed 
that  the  child  was  alive  when  its  body  was  put  into  the  water.  The  judge 
thought  this  too  doubtful  a  point  to  rely  upon  in  the  absence  of  evidence 
from  the  lungs.  The  woman  was  acquitted  of  murder,  but  found  guilty 
of  concealment  of  birth. 

Accident,  Homicide,  or  Suicide. — It  is  rare  that  murder  is  perpetrated 
by  burning:  the  dead  body  is  either  burnt  for  the  purpose  of  entirely 
destroying  it,  or  the  clothes  are  fired  soon  after  a  person  has  been  killed, 
in  order  to  conceal  wounds  or  other  violent  means  of  death,  and  to  make 
it  appear  as  if  the  deceased  had  been  accidentally  destroyed  by  fire. 
(Reg.  V.  Lee,  Exeter  Ass.,  Jan.  1885.)  Death  by  burning  is  either  the 
result  of  accident  or  homicide,  most  commonly  the  former;  but  medical 
evidence  may  give  rise  to  a  suspicion  of  murder  under  two  conditions:  1. 
When  it  is  evident  that  several  parts  of  the  body  or  clothing  have  been 
fired  at  the  same  time,  and  the  burns  are  such  as  not  readily  to  be  ex- 
plained by  the  same  accident  or  by  the  accidental  ignition  of  the  clothes. 
2.  When  there  are  marks  of  homicidal  violence  on  the  body;  but  these 
marks,  if  we  except  fractures  of  the  bones,  may  be  easily  effaced  when  the 
burn  is  extensive. 

Time  required  for  the  Burning  of  a  Dead  Body. — It  may  be  a  medico- 
legal question  whether,  on  discovering  a  body  much  burnt,  it  could  be 
determined  from  its  appearance  how  long  a  period  it  would  require  to 
produce  the  amount  of  destruction  observed.  Such  a  question  may  arise 
Avhen  it  is  intended  to  connect  a  person  with  the  perpetration  of  an  alleged 
crime,  but  it  does  not  admit  of  a  precise  answer.  A  conjecture  onh'^  can 
be  formed  from  the  facts  proved  in  each  particular  case.  The  human  body 
contains  a  large  proportion  of  water  (72  per  cent.) ;  this  gives  to  the  soft 
structures  a  power  of  resisting  combustion.  At  the  same  time,  there  is  a 
quantity  of  fat  in  the  body,  varying  in  different  parts,  but  amounting  to 
an  average  of  about  five  per  cent.  The  fat  or  oil  tends  to  increase  its 
combustibility,  and  this  is  still  further  increased  if  the  body  is  placed  on 
any  combustible  article  which  can  imbibe  the  oil,  such  as  a  rug  or  a  deal 
floor.  The  nature  of  the  dress  will  also  make  a  difference.  Under  a 
strong  and  active  flame,  which  might  subsequently  burn  out  before  the 
discovery  of  the  body,  there  would  be  a  degree  of  destruction  in  half  an 
hour  which  a  more  slow  and  smothered  combustion  would  not  effect  in 
several  hours.  On  the  trial  of  Pel  for  the  murder  of  his  mistress,  Bohmer 
(Paris,  June,  1885),  experiments  were  made  at  the  Morgue  with  the 
view  of  ascertaining  within  what  period  a  body  could  be  cremated,  with- 
out nuisance,  in  an  ordinary  stove.  It  was  found  that  a  body  weighing 
132  pounds  could  be  satisfactoril}^  disposed  of  in  40  hours.  It  is  from  a 
Avant  of  due  consideration  of  the  facts  relating  to  the  burning  of  the  body 
that  some  of  the  older  medico-legal  writers  have  given  support  to  the 
hypothesis  of  spontaneous  comhuMion.  It  has  been  supposed  that  in  cer- 
tain cases  the  dead  human  body  has  been  destroyed  more  than  appeared 
consistent  with  the  fact  of  ordinary  combustion  from  articles  of  dress  or 
furniture  ;  but  this  opinion  has  arisen  from  a  want  of  sufficient  experience 
on  the  effects  of  heat.  Then,  as  the  means  by  which  the  dress  of  a  person 
had  become  ignited  were  generally  destroA^ed  with  the  body,  it  Avas 
thought  that  a  human  being  might,  under  certain  conditions,  be  consumed 
by  fire  spontaneously  generated  Avithin  him.  This  extravagant  hypothesis 
has,  however,  found  advocates  in  modern  times.  In  March,  1850,  a  man 
named  Stauff  Avas  tried  at  Darmstadt  for  the  murder  of  the  Countess  of 
Goerlitz.     He  had  assaulted  the  deceased  in  her  chamber,  and  then  set 


372  BURNS    BY    CORROSIVE    LIQUIDS. 

fire  to  the  furniture  with  a  view  to  conceal  his  crime.  The  body  and 
dress  were  partially  consumed.  As  the  means  by  which  the  fire  was  ap- 
plied were  not  at  once  apparent,  and  the  assassin  had  locked  the  doors  of 
the  room,  some  medical  men  took  up  the  theory  that  the  deceased  had 
died  from  spontaneous  combustion.  The  facts  of  the  case  were  referred 
to  Liebig  and  BischofF,  and  their  report  was  issued  in  jVJarch,  1S50.  at 
which  date  the  man  Stauff  was  put  on  his  trial.  They  found  no  dilficulty 
in  concluding  that  a  murder  had  been  perpetrated,  and  thie  body  wilfully 
burnt  after  death  for  the  purpose  of  concealing  the  crime.  There  was 
some  doubt  whether  the  deceased  had  died  from  strangulation,  or  from 
violence  to  the  head.  Stauff  was  convicted,  chiefly  on  circumstantial  evi- 
dence. He  subsequently  confessed  that  the  countess  had  entered  her 
room  as  he  was  in  the  act  of  committing  a  robbery.  A  struggle  took 
place;  he  seized  her  by  the  throat,  strangled  her,  and  afterwards  placed 
the  body  in  a  chair,  piling  around  it  combustible  articles  of  furniture.  He 
set  fire  to  these,  with  a  view  of  destroying  the  proofs  of  his  crime.  It 
was  observed  that  the  tongue  of  the  deceased  was  protruded,  as  it  is  in 
violent  strangulation,  and  that  in  its  charred  state  it  retained  the  position 
given  to  it  by  the  act  of  murder.  Other  instances  of  alleged  spontaneous 
combustion,  if  properly  investigated,  would  have  turned  out  to  be  cases  of 
accidental  or  homicidal  burning.  (See  Ogston's  Lect.  on  Med.  Jurisp.,  pp. 
463,  558.) 

Spontaneous  combustion  may  take  place  in  some  kinds  of  vegetable  and 
mineral  substances,  but  not  in  the  animal  body,  living  or  dead. 

Amongst  the  questions  which  arise  in  reference  to  a  body  found  dead 
from  bunts  is  this — whether  the  burns  have  been  caused  by  gas,  or  by 
inflammable  vapors  such  as  petroleum,  or  by  gunpowder.  Petroleum  is 
at  once  indicated  by  its  peculiar  and  powerful  odor,  and  the  sooty  blacken- 
ing of  the  parts  burnt.  (Reg.  v.  Lee,  Exeter  Ass.,  Jan.  1885.)  In 
Reg.  V.  Gaitzkell  (Carlisle  Spring  Ass.,  1872),  the  prisoner  was  convicted 
of  manslaughter  under  the  following  circumstances.  He  poured  a  quan- 
tity of  petroleum  over  the  clothes  of  the  deceased,  and  by  accident  the 
vapor  caught  fire,  and  the  burns  produced  caused  the  man's  death  on  the 
following  day.  Burns  from  petroleum,  paraffin,  kerosene,  or  any  form  of 
rock-oil,  are  generally  of  a  severe  kind.  The  clothes  of  a  person  readily 
imbibe  the  liquid,  and  by  their  fibrous  structure  act  as  a  wick  for  spread- 
ing the  combustion.  There  have  been  several  cases  in  which  men  have 
been  convicted  of  the  murder  of  their  wives  by  throwing  at  them  a  lamp 
in  which  petroleum  was  burning  The  ignition  of  the  dress  has  led  to 
rapid  death.  Burns  from  the  flame  of  gunpowder  are  generally  charac- 
terized by  blackening  of  the  skin,  and  the  introduction  of  some  of  the 
grains  into  the  substance  of  the  skin,  producing  the  effects  of  tattooing. 

Corrosive  Liqvida  — Among  the  cases  in  which  medical  evidence  is 
sometimes  required  are  those  of  throwing  mineral  acids,  alkalies,  or  other 
corrosive  liquids  on  the  person.  This  crime  was,  and  is,  prevalent;  and, 
until  an  alteration  was  made  in  the  criminal  law,  there  was  no  adequate 
punishment  for  it  (24  and  25  Yict.,  c.  100,  s.  29).  On  one  occasion,  an 
assailant  escaped  a  charge  of  felony  because  it  could  not  be  considered, 
in  law,  that  sulphuric  acid  was  capable  of  producing  a  iwiivd.  The 
statute  above  mentioned,  while  it  punishes  the  offence,  omits  all  reference 
to  a  definition  of  the  word  "  wound."  The  nature  of  the  liquid  thrown 
is  merely  defined  in  general  terms,  to  be  "  any  corrosive  fluid  or  any 
destructive  .substance" — a  point  which  will  require  medical  evidence  for 
its  elucidation. 


THROWING    CORROSIVE    LIQUIDS.  373 

In  common  lan,2:uaa:e,  and  according  to  the  statute,  the  injnry  thus  pro- 
duced by  a  mineral  acid,  such  as  oil  of  vitriol,  is  called  a  burn,  but  it  is 
wholly  diftereut  in  its  ori.yin  as  well  as  in  its  progress.  Such  an  injury 
has,  ])erhaps,  never  directly  destroyed  life  ;  but  great  deformity  and  actual 
blindness  have  resulted.  A  medical  man  is  sometimes  required  to  dis- 
ting:uish  these  injuries  from  burns  and  scalds  :  this  may  be  easily  done,  in 
the  first  instance,  by  the  appearance  of  the  part  injured,  as  well  as  by  the 
description  of  the  tirst  symptoms.  The  stain  is  brown  when  sulphuric 
acid  has  been  used,  and  yellow  when  nitric  or  hydrochloric  acid  has  been 
employed.  The  eschar,  or  destroyed  part,  is  soft,  and  not  dry  as  in  a  burn 
from  a  heated  solid.  The  skin  touched  by  a  concentrated  acid  is  destroyed 
and  sloughs  away  to  the  extent  of  the  part  on  which  the  corrosive  liquid 
was  applied,  leaving-  a  suppurating-  and  granulating-  surface.  There  is  no 
capillary  congestion  or  redness  of  the  skin  around  the  injury,  as  in  a  burn  ;- 
but  the  color  of  the  injured  part  may  throw  some  light  upon  the  nature  of 
the  corrosive  substance  used.  Articles  of  dress  are  also  differently  colored 
by  the  various  acids.  The  period  at  which  a  person  may  recover  from 
an  injury  of  this  kind  dep'euds  on  its  degree  and  extent,  as  well  as  on  the 
part  affected  by  the  corrosive  liquid.  Although  a  person  may  not  die 
from  the  direct  effects  of  the  acid,  yet  in  irritable  constitutions  the  inflam- 
mation which  follows  in  deep-seated  parts  may  prove  fatal.  In  infants,  or 
delicate  nervous  females,  an  extensive  injury  thus  produced  may  readily 
destroy  life.  In  one  instance,  sulphuric  acid  thrown  on  the  face  produced 
inflammation  of  the  eye,  for  which  bleeding  was  prescribed.  The  person 
died  of  phlebitis  (inflammation  of  the  vein)  as  the  result  of  this  bleeding. 

The  nature  of  the  acid  may  be  determined  by  applying  wetted  linen  to 
the  part,  when  the  injury  is  recent,  and  examining  the  liquid  thus  ab- 
sorbed. In  general,  however,  evidence  is  readily  obtained  by  examining 
the  spots  or  stains  left  on  articles  of  clothing  or  furniture.  Oil  of  vitriol 
is  most  commonly  used.  In  one  remarkable  case  (Reg.  v.  Sipski,  C.  C.  C, 
July,  1888),  the  editor  found  that  the  cotton  night-dress  of  a  woman 
whose  life  was  taken  by  pouring  a  mixture  of  sulphuric  and  nitric  acids 
down  the  throat,  as  well  as  the  deal  floor  on  which  the  acids  w^ere  spilled, 
Avere  partially  converted  into  nitro-cellulose,  which  partially  exploded 
when  ignited  in  a  closed  tube.  The  caustic  alkalies  may  be  used  under 
these  circumstances,  as  well  as  numerous  other  liquids,  on  which  the  only 
medical  opinion  required  would  be,  whether  the  article  employed  should 
or  should  not  be  considered  as  a  "  corrosive"  liquid  or  a  "destructive" 
substance.  To  constitute  a  felony,  it  is  not  now  necessary  that  the  person 
should  have  sustained  any  bodily  injury  from  the  act  of  throw^ing  the  cor- 
rosive liquid.  IJnless  vital  reaction  has  taken  place,  there  are  no  means 
of  distinguishing  the  effects  of  a  corrosive  liquid  on  the  living  from  those 
produced  on  the  dead  body.     (Ann.  d'Hyg.,  1859,  t.  1,  p.  396.) 

The  mineral  acids  are  sometimes  used  in  other  ways  for  the  destruction 
of  life.  A  man  poured  a  quantity  of  strong-  nitric  acid  into  the  ear  of  his 
wife  while  she  was  lying  asleep.  She  awoke  suddenly  with  a  violent  pain 
in  the  ear,  which  continued  for  three  days,  whereupon  she  became  weak 
and  exhausted.  Soon  after vards  there  was  copious  bleeding,  and  a  portion 
of  membrane  escaped.  She  lost  the  use  of  her  right  arm,  and  became 
completely  deaf.  Suppuration  took  place  from  the  ear,  and  blood  escaped 
daily.  She  gradually  sank,  and  died  six  weeks  after  the  injury,  the  right 
half  of  the  body  being  convulsed  before  death.  On  inspection,  a  portion 
of  the  external  ear  was  wanting,  and  the  ear-passage  was  much  wider  than 
natural.     The  brain,  near  the  petrous  portion  of  the  temporal  bone,  was 


374  THROWING    CORROSIVE    LIQUIDS, 

softened,  and  the  bone  itself  diseased  (carious).  The  injury  had  led  to 
death  indirectlj^  by  producing  disease  of  the  brain.  (Lond.  Med.  Gaz., 
vol.  xvii.  p.  897.)  In  a  case  tried  at  Aberdeen,  the  evidence  proved  that 
a  woman  had  poured  oil  of  vitriol  down  the  throat  of  her  husband  while 
he  was  lying-  asleep  with  his  mouth  open.  She  was  convicted  of  the 
murder.  In  another  case,  a  woman  killed  her  husband  by  pouring  a  solu- 
tion of  corrosive  sublimate  down  his  throat  while  he  was  sleeping.  These, 
however,  were  treated  as  cases  of  poisoning,  as  death  did  not  depend 
on  the  local  or  external  mischief  produced  by  the  corrosive  agent 
employed. 


ASPHYXIA DROWNING.  375 


ASPHYXIA. 


DROWNING. 


CHAPTER    XXXVIII. 

CAUSE    OF    DEATH. SECONDARY    CAUSES. POST-JIORTEJI    APPEARANCES. MEDICAL     PROOFS 

OF    DEATH    FROM    DROWNING. SPECIFIC    GRAVITY    OF    THE    BODY.  —  COINCIDENTAL  CAUSES 

OF    DEATH. — MARKS  OF  VIOLENCE. ACCIDENTAL    FRACTURES. HOMICIDAL    AND  SUICIDAL 

DROWNING. 

Under  the  term  Asphyxia  are  included  those  forms  of  violent  death  in 
Avhich  the  act  of  respiration  is  primaril}^  arrested  (p.  64).  This  comprises 
death  from  drowning,  haug-ing-,  strangulation,  and  suffocation,  and  in  this 
section  the  fatal  effects  of  lightning,  cold,  and  starvation  will  be  considered. 
Apnoea  is  a  term  sometimes  improperly  applied  for  asphyxia. 

The  subject  of  asphyxia  and  the  appearances  presented  by  the  body  in 
this  mode  of  death  have  been  fully  considered  at  p.  G4. 

Drowning.  Cause  of  Death.  Aaphyxia. — In  drowning,  asphyxia  is 
produced  by  a  physical  impediment  to  the  introduction  of  air  into  the 
lungs.  The  medium  in  which  the  person  is  immersed  acts  mechanically, 
and  even  more  effectually  than  a  rope  or  ligature  round  the  neck;  for, 
although  air  escapes  from  the  lungs,  and  water  penetrates  into  the  minute 
air-tubes,  jet  no  air  can  enter  to  supply  the  place  of  that  which  has  already 
expended  its  oxygen  on  the  blood.  Hence  this  fluid  must  circulate,  in  the 
first  few  minutes  after  submersion,  in  a  state  unfitted  for  the  support  of 
life  (unaerated)  ;  but  the  person  lives,  and  is  susceptible  of  recovery  within 
a  short  interval.  After  the  entire  suspension  of  respiration  the  action  of  the 
heart  gradually  slackens  and  finally  stops.  It  is  at  this  period  of  the  arrest 
of  circulation  that  asphyxia  passes  into  death.  Asphyxia  is  determined  by 
the  period  at  which  respiration  is  completely  arrested;  but  the  point  of 
tune  at  which  death  from  drowning  occurs  is  fixed  by  the  moment  at  which 
the  action  of  the  heart  ceases.  This  varies  considerably,  according  to  age, 
sex,  state  of  health,  and  other  circumstances. 

AVhen  a  person  falls  into  water,  and  retains  his  consciousness,  violent 
attempts  are  made  to  breathe  ;  at  each  time  that  he  rises  to  the  surface  a 
portion  of  air  is  received  into  the  lungs,  but,  owing  to  the  mouth  being 
on  a  level  with  the  liquid,  water  also  enters  and  passes  into  the  throat. 
A  quantity  of  water  thus  usually  enters  the  mouth,  which  the  drowning 
person  is  irresistibly  compelled  to  swallow.  •  In  his  efforts  to  breathe 
while  his  head  is  below  water  a  portion  of  this  liquid  is  drawn  into  the 
air-tubes  and  cells  of  the  lungs.  The  struggle  for  life  may  continue  for  a 
longer  or  shorter  period,  according  to  the  age,  sex,  and  strength  of  the 
person  ;  but  the  result  is  that  the  blood  in  the  lungs  is  imperfectly  aerated, 


376  DEATH    FROM    DROWNING. 

the  person  becomes  exhausted,  and  insensibility  follows.  The  mouth  then 
sinks  altogether  below  the  level  of  the  water — air  can  no  longer  enter  into 
the  lungs;  a  portion  of  that  which  they  contain  is  expelled,  and  rises  in 
bubbles  to  the  surface;  an  indescribable  feeling  of  delirium,  with  a  ring- 
ing sensation  in  the  ears,  supervenes ;  the  person  loses  all  consciousness, 
and  sinks  asphyxiated.  In  the  state  of  asphyxia,  while  the  dark-colored 
blood  is  circulated,  convulsive  movements  of  the  body  take  place,  and  the 
contents  of  the  stomach  arc  sometimes  ejected  by  vomiting.  There  does 
not  appear  to  be  any  sensation  of  pain,  and,  as  in  other  cases  of  asphyxia, 
if  the  person  recovers,  there  is  a  total  unconsciousness  of  suffering  during 
the  period  when  the  access  of  air  was  cut  off"  from  the  lungs.  The  sensa- 
tions of  the  drowned  are  stated  to  be  by  no  means  so  acute  as  has  com- 
monly been  supposed.  A  child  thrown  into  the  water  by  a  nurse  stated 
that  she  was  conscious  of  sinking  through  the  water  till  she  felt  her  feet 
touch  the  bottom,  and  that  she  then  fell  asleep  till  she  found  herself 
rescued.  (Case  of  Reg.  v.  Redstone,  C.  C.  C,  Feb,  1885;  Brit.  Med. 
Jour.  1885,  i.  p.  341.)  One  of  the  editor's  colleagues  at  Guy's  Hospital, 
who  was  drowned  to  the  stage  of  insensibility,  describes  his  sensations  as 
having  been  by  no  means  so  fearful  as  might  have  been  expected. 

Ths  successive  phenomena  of  drowning  have  been  divided  into  three 
stages  by  Bergeron  and  Montano.  (Ann.  d'Hyg.,  1817,  t.  48,  p.  332.) 
These  authorities  also  state  that  the  presence  of  a  froth  in  the  pharynx, 
larynx,  and  bronchial  tubes  is  an  invariable  concomitant  of  death  from 
drowning ;  that  there  is  always  a  certain  amount  of  congestion  of  the 
lungs,  and  sometimes  this  is  accompanied  by  sub-pleural  ecchymosis ;  and 
that  the  extent  of  the  congestion  and  of  the  ecchymosis  is  always  pro- 
portional to  the  efforts  made  at  self-preservation. 

Some  persons  who  fall  into  water  are  observed  to  sink  at  once,  without 
making  any  attempt  to  extricate  themselves.  This  may  arise  either  from 
sudden  syncope  or  from  the  stunning  produced  by  the  fall.  Should  the 
person  be  intoxicated,  or  otherwise  incapacitated,  as  by  striking  his  head 
in  falling,  he  may  not  again  rise.  These  different  conditions  under  which 
death  may  take  place  will  sufficiently  account  for  the  difference  in  the  ap- 
pearances met  with  in  the  bodies  of  those  who  have  died  in  water.  A 
fatal  result  may  be  accelerated  by  the  impression  suddenly  produced  upon 
the  skin,  from  the  difference  of  temperature  between  the  body  and  the 
water.  To  those  who  are  not  accustomed  to  water,  a  sudden  immersion 
produces  a  great  and  rapid  cooling  of  the  surface  and  forces  the  blood  into 
the  internal  organs.  There  is  difficulty  of  breathing,  or  severe  spasmodic 
respiration,  with  giddiness  and  other  symptoms,  which  may  render  a  pei'- 
son  powerless  to  extricate  himself  The  effect  of  cold  on  the  skin  is  seen 
in  the  contracted  state  of  the  cutis  in  the  bodies  of  those  who  have  been 
drowned  during  the  winter.  It  is  calculated  that  in  25  per  cent,  of  all 
who  are  drowned  the  cause  of  death  is  pure  asphyxia,  and  that  in  the 
remainder  syncope  and  cerebral  congestion,  amounting  to  apoplexy,  may 
have  a  share  in  causing  death. 

In  regard  to  the  time  required  for  death  to  take  place  by  drowning,  it 
may  be  observed  that,  when  the  mouth  is  so  covered  by  water  that  air  can- 
not enter,  asphyxia  coines  on  in  the  course  of  one  or  two  minutes  at  the 
furthest,  and  the  time  at  which  this  occurs  does  not  appear  to  vary  ma- 
terially. Complete  insensibility  has  supervened  after  one  minute's  sub- 
mersion, and  it  is  probable  that  in  most  cases  a  few  seconds  Avould  suffice 
for  the  commencement  of  asphyxia.  In  this  state  a  person  can  make  no 
efforts  to  save  himself,  and  death  commonly  ensues  in  from  two  to  Jive 
mimdes.     The  power  of  restoring  life  depends,  not  merely  on  the  time 


EFFECTS    OF    SUBMERSION.  377 

that  the  body  may  have  been  submerged,  but  on  the  condition  of  the  lungs 
at  the  time  of  its  removal  from  the  water.  Experiments  performed  by  a 
Committee  of  the  Medico-Chirurgical  Society  have  clearly  proved  that,  as 
a  form  of  asphyxia,  drowning  is  not  only  more  speedily  fatal  to  life  than 
ordinary  suffocation,  but,  from  the  physical  changes  produced  in  the  lungs 
by  water  the  chances  of  recovery  are  lessened.  The  committee  found  that 
the  difference  in  the  results  was  not  owing  to  exhaustion  from  struggling, 
from  the  violent  efforts  made  to  breathe,  nor  from  the  effects  of  cold  in 
immersing  the  whole  of  the  body,  but  to  the  introduction  of  water  by 
aspiration  into  the  minute  air-tuljes  and  cells  of  the  lungs.  This  conclu- 
sion was  derived  from  the  following  experiments:  Two  dogs  of  the  same 
size  were  submerged  at  the  same  moment,  but  one  had  his  windpipe 
plugged  so  that  no  air  or  water  could  enter,  while  the  other  had  not. 
After  tioo  minutes  they  were  taken  out  together :  the  one  with  the  wind-" 
pipe  plugged  recovered  at  once,  the  other  died.  In  three  experiments 
dogs  with  their  windpipes  plugged  were  kept  below  water  for  fuar 
minutes:  the  animals  recovered  perfectly  when  removed  from  the  water. 
(Med.-Chir.  Trans.,  1862,  p.  449)  An  inspection  of  the  bodies  at  once 
revealed  the  difference.  In  animals  simply  deprived  of  air  by  plugging 
the  windpipe,  tlie  lungs  were  merely  congested;  but  in  those  which  were 
submerged  in  their  ordinary  condition,  the  lungs,  besides  being  more  con- 
gested and  showing  ecchymosed  points  on  the  surface  and  in  the  substance, 
contained  in  their  bronchial  tubas  a  bloody  mucous  froth  fornied  of  water, 
blood,  and  mucus,  which  completely  filled  the  small  air-tubes.  The  violent 
respiratory  efforts  made  by  the  animal  before  death  had  caused  the  pro- 
duction of  this  froth,  which  formed  a  mechanical  impediment  to  the  en- 
trance of  air  by  the  movements  of  the  chest,  as  in  respiration.  This 
mucous  froth  or  foam  issued  from  the  lungs  on  section,  and  appeared  to 
penetrate  their  entire  substance,  which  was  saturated  with  water  tinged 
with  blood.  The  lungs  were  sodden  with  water,  heavy,  soft,  doughy, 
retained  an  impression  produced  by  the  finger,  and  were  incapable  of 
collapsing.  In  the  lungs  of  animals  which  recovered  after  a  short  sub- 
mersion, little  or  none  of  this  raucous  froth  was  fbundin  the  air-cells.  In 
the  fatal  cases,  the  quantity  was  great  in  proportion  to  the  time  of  sub- 
mersion. There  is  no  doubt  that  this  froth  is  produced  by  the  violent 
efforts  to  breathe  which  are  made  within  a  minute  after  submersion. 

It  may  be  inferred  from  these  results  that  the  power  of  recovery  in 
human  beings  has  a  direct  relation  to  the  quantity  of  mucous  froth  in 
the  air  tubes,  and  to  the  penetration  of  the  substance  of  the  lungs  with 
water.  The  larger  the  amount  of  froth  produced  and  the  greater  the  pene- 
tration, the  less  the  hope  of  recovery  ;  for  when  the  lungs  have  undergone 
these  changes  they  are  physically  unfitted  either  to  receive  or  expel  air  by 
respiration,  and  are  incapable  of  collapsing.  These  circumsttinces  will 
account  for  the  fact  that  persons  have  been  resuscitated  in  drowning  under 
various  and  even  opposite  modes  of  treatment,  and  even  under  no  treat- 
ment at  all.  It  is  right  that  every  reasonable  effort  should  be  made  to 
restore  life,  but  if  the  lungs  are  sodden  with  water  their  functions  cannot 
be  restored  by  any  mode  of  treatment.  The  committee  found  that  a  com- 
plete submersion  of  four  minutes  effectuall}^  killed  dogs,  although,  aftef 
removal  from  water,  the  heart  continued  to  beat  from  four  to  five  minutes. 
The  continuance  of  the  heart's  action  furnishes,  therefore,  no  criterion  of 
the  power  of  recovery.  A  human  being,  as  a  rule,  dies  if  submerged  fora 
period  of  from  four  to  five  minutes.  In  a  few  exceptional  cases,  persons 
have  been  resuscitated  after  this  period  ;  but  it  is  most  probable  that  in  them 
the  lungs  had  sustained  no  physical  damage.     When  the  submersion  has 


378  DROWNING EXTERNAL  APPEARANCES. 

been  short,  the  respiratory  struggle  below  water  slight,  and  the  person 
has  been  treated  immediately  on  removal,  recovery  is  probable  ;  but  under 
opposite  conditions  it  is,  wilh  rare  exceptions,  hopeless. 

Death  from  Secondary  Causes. — Drowning  may  operate  indirectly  as 
the  cause  of  death.  Thus  it  has  been  repeatedly  remarked  that  persons 
who  have  been  rescued  from  water  in  a  living  state,  and  who  have  ap- 
parently recovered  from  the  effects  of  submersion,  have  died,  in  spite  of 
treatment,  after  the  lapse  of  some  minutes  or  hours  ;  others  have  lingered 
for  one  or  two  days,  and  then  have  sunk,  apparently  from  exhaustion. 
In  those  who  perish  soon  after  removal  from  water,  death  may  arise  either 
from  exhaustion  or  from  the  obstruction  of  respiration  by  the  penetration 
of  water  into  the  air-cells  of  the  lungs.  The  case  of  Colonel  Mackenzie, 
in  1873,  furnishes  an  instance  of  rapid  death  from  secondary  causes.  The 
colonel  and  a  companion  while  crossing  a  river  were  carried  away  by  the 
current.  After  much  struggling  they  both  reached  the  bank  in  an  ex- 
hausted state.  The  companion  left  the  colonel  apparently  well,  to  procure 
assistance.  On  his  return,  soon  afterwards,  the  colonel  was  found  dead. 
Death  was  attributed  to  apoplexy,  but  it  was  more  probably  due  to  ex- 
haustion from  over-exertion.  A  child,  a3t.  2|-  years,  was  found  floating 
on  water.  It  was  insensible,  with  gasping  breathing,  fluttering  heart, 
no  pulse  at  the  wrists,  tongue  protruded,  and  cold  water  draining  from 
the  mouth  and  nose.  Artificial  respiration  restored  breathing,  but  not 
sensibility.  Convulsions  followed,  lasting  for  two  hours.  These  passed 
off.  The  breathing  was  natural  and  the  Ijody  warm  ;  temperature,  101.2°  F. 
In  this  state  the  child  continued  seven  hours,  when  difficultj^  of  breathing 
suddenly  came  on,  and  the  child  died  eighteen  or  twenty  hours  after 
removal  from  the  water.  Marcet  states  that  spasm  of  the  glottis  has 
been  among  the  severe  secondary  symptoms  in  persons  who  have  been 
removed  from  water  apparently  drowned.  A  severe  spasm  of  this  kind 
manifested  itself  in  one  case  while  placing  the  patient  in  a  warm  bath. 
(Med.  Times  and  Gaz.,  1857,  i.  p.  148.)  When  death  takes  place  at  a 
remote  period,  it  maybe  caused  by  disease;  and  a  question  may  then  arise 
whether  the  disease  was  produced  by  the  immersion  in  water  or  not. 
Such  eases,  occasionally- present  themselves  before  our  courts  of  assize. 

PoHt-mortem  Appearances. — The  external  and  internal  appearances  pro- 
duced by  drowning  var}^  according  to  the  length  of  time  during  which 
the  body  has  remained  in  water,  and  the  period  that  has  elapsed  after  its 
removal  and  before  it  is  examined.  Thus,  in  reference  to  the  bodies 
of  two  persons  drowned  by  a  common  accident,  if  one  is  removed  and  ex- 
amined immediately,  and  the  other  is  not  removed  from  the  water  until 
after  the  lapse  of  several  days  and  is  then  inspected,  the  appearances  will 
1)6  different.  So,  if  the  two  bodies  are  removed  at  the  same  time,  and  one 
is  immediately  examined,  while  the  other  is  not  inspected  until  a  month 
after  removal,  the  proofs  of  drowning  which  may  be  discoverable  in  the 
former  will  probably  have  disappeared  in  the  latter.  A  protract-ed  ex- 
posure of  the  drowned  body  either  to  water  or  air,  especially  if  the  tem- 
perature is  high,  may  render  an  inspection  useless  for  the  purpose  of  evi- 
dence. 

External  Appearances. — Supposing  that  the  body  has  remained  in  the 
water  only  a  few  hours  after  death,  and  the  inspection  has  taken  place 
immediately  on  its  removal,  the  skin  will  be  found  cold  and  pallid — some- 
times contracted,  under  the  form  of  "  cutis  anserina.  "  This  contracted 
state  of  the  skin,  when  found,  furnishes  strong  evidence  of  the  body  having 
gone  into  the  water  living.  The  skin  is  often  covered  to  a  greater  or  less 
extent  by  livid  discolorations ;  the  face  is  pale  and  calm,  with  a  placid  ex- 


DROWNING — EXTERNAL  APPEARANCES.  370 

presslon  ;  the  eyes  are  half  open,  the  eyelids  livid,  and  the  pupils  dilated; 
the  mouth  closed  or  half  open  ;  the  tongue  swollen  and  congested — fre- 
((uently  pushed  forwards  to  the  inner  surface  of  the  lips,  sometimes  in- 
dented or  even  lacerated  by  the  teeth  ;  and  the  lips,  together  with  the 
nostrils,  are  covered  with  a  mucous  froth  which  issues  from  them.  Kanz- 
ler  has  noticed  in  the  male  subject  a  remarkable  retraction  of  the  penis. 
In  men  who  have  gone  living  into  the  water  and  been  drowned,  this  ap- 
l)earance  has  been  repeatedly  observed  by  Casper  and  Kanzler ;  and  the 
former  states  that  he  has  not  met  with  this  condition  of  the  male  organ 
after  any  other  form  of  death.  In  strong  and  robust  men  it  has  been 
found  short,  and  strongly  retracted  into  the  skin.  (Ger.  Leich.-Oeffn.,  ii. 
109.)  The  body  and  limbs  of  a  person  recently  drowned  are  usually 
found  relaxed;  but  cadaveric  rigidity  appears  to  come  on  quickly  in  cases 
of  drowning,  and  the  body  is  often  stiffened  in  the  convulsed  or  distorted, 
attitude  which  it  may  have  had  at  the  time  of  death.  In  a  case  observed 
l>v  Beardsley,  the  body  of  a  man  who  was  drowned  under  ice  was  found 
with  the  arms  stiifened  in  the  attitude  in  which  he  was  endeavoring  to 
support  himself  on  the  iee. 

Among  the  casual  external  appearances  it  has  been  noticed  that  the 
fingers  and  surface  of  the  body  occasionally  present  abrasions.  Gravel, 
sand,  mud,  weeds,  or  other  substances  may  be  found  locked  within  the 
hands  or  nails  of  drowned  persons;  for,  in  the  act  of  drowning,  as  com- 
mon experience  testifies,  a  person  will  grasp  at  any  object  within  his  reach, 
and  in  his  efforts  to  extricate  himself  he  may  excoriate  or  wound  his 
lingers.  Substances  floating  in  the  water  are  also  sometimes  found  in 
the  nose,  mouth,  and  ears.  There  are,  however,  many  cases  of  drowning 
in  which  such  appearances  do  not  exist.  There  may  be  no  substance  for 
the  drowning  person  to  grasp  ;  this  will  depend  in  a  great  degree  upon 
the  fact  of  the  water  being  deep  or  shallow,  of  its  being  confined  within  a 
narrow  channel  or  not,  and  many  other  contingencies.  In  all  cases,  when 
the  person  is  unconscious  before  he  falls  into  the  water,  or  when  his  death 
is  occasioned  by  syncope,  he  will  be  incapable  of  making  those  exertions 
which  are  necessary  to  the  production  of  this  appearance,  and  it  is  proba- 
ble that  this  frequently  occurs  among  women  who  are  accidentally  drowned. 
When  the  body  has  remained  several  days  in  water,  the  skin  of  the  palms 
of  the  hands  and  soles  of  the  feet  is  found  thickened,  white  and  sodden,  as 
a  result  of  imbibition.  This  coupled  with  the  lividity  appearing  through 
the  sodden  skin,  gives  rise  to  the  appearance  known  as  the  "  cholera  hand," 
met  with,  also,  as  the  name  implies,  in  epidemic  cholera.  Casper  asserts 
that  this  conditioa  may  be  produced  by  macerating  a  dead  hand,  if  livid, 
in  water. 

Ogston,  Jr.,  summarizes  the  external  signs  of  drowning  thus  :  General 
pallor  of  the  surface  of  the  body,  with  bright  rosy-red  patches  on  the  face 
and  front  of  the  neck  chiefly,  sometimes  on  other  situations.  Cutis  an- 
serina  on  the  outer  aspect  of  the  thighs  and  arms,  and  about  the  top  of 
the  sternum.  A  blanched  and  corrugated  condition  of  the  skin  of  the 
hands,  wrists,  feet,  and  ankles,  and  not  infrequently  of  the  front  of  the 
knees  and  back  of  the  elbows.  This  state  of  the  hands  may  be  accompa- 
nied by  what  has  been  termed  the  "  cholera  hand."  where  venous  conges- 
tion shining  through  the  bleached  cuticle  gives  the  hand  a  bluish  appear- 
ance, like  that  observed  in  persons  suffering  from  cholera.  A  white  watery 
froth,  like  the  lather  of  soap,  at  the  mouth  and  nostrils,  generally  found 
when  the  body  is  seen  in  a  fresh  state,  and  soon  after  its  removal  from  the 
water;  or  a  red  bloody  froth  at  these  parts  when  tbe  body  is  decomposed. 
Water,  sometimes  mixed  with  froth,  flows  from  the  mouth  in  quantity 


380  IKTERXAL    APPEARANCES. 

when  the  bodj  is  turned  face  do^vn^vard^;.  The  tongue  may  be  protruded 
beyond,  or  pressed  against,  and  marlied  by,  the  teetli.  The  penis  may  be 
erect,  semi-erect,  or  retracted,  and  the  scrotum  shrunk  and  wrinkled.  Sand 
or  weeds  may  be  found  under  the  nails,  or  grasped  in  the  clenched  hands. 
Excoriations  are  not  infrequently  observed  about  the  knuckles,  or  erosions 
on  the  bands,  face,  cars,  etc.,  caused  by  fish  or  other  animals  in  the  water 
after  death.  Injuries  of  various  kinds,  cuts,  bruises,  evidently  inflicted 
before  death,  which  mav  complicate  the  diagnosis,  may  not  infrequently 
be  found.     (Edin.  Med."  and  Surg.  Jour.,  1882,  p.  865.) 

Internal  Appearances. — In  a  recently-drowned  body  the  lungs  and 
heart  present  the  appearances  usually  indicative  of  asphyxia  (p.  64,  ante). 
The  venous  system  is  generally  gorged  with  dark-colored  liquid  blood.  If 
death  has  not  taken  place  from  asphyxia,  or  if  the  bod}'  has  remained  a 
long  time  in  vrater  before  an  inspection  is  made,  the  lungs  and  heart  will 
not  present  the  characters  about  to  be  described.  Some  physiologists 
have  a.sserted  that  the  blood  remains  fluid  in  the  bodies  of  the  drowned  ; 
but  more  importance  has  been  attached  to  this  appearance  than  it  really 
merits.  Some  observers  have  found  the  blood  coagulated  in  the  drowned. 
If  the  blood  is  found  generally  liquid  this -may  be  due  to  the  imbibition 
of  water  or  to  putrefactive  changes.  Riedell  found  the  blood  in  the 
heart  and  large  vessels  to  contain  coagula  in  inspections  made  from  two 
hours  to  five  days  after  death.  (Lond.  Med.  Gaz.,  vol.  xlvi.  p.  478.) 
Hence  it  follows  that  the  blood  may  be  found  either  coagulated  or  un- 
coagulated  in  those  who  go  into  the  water  living  and  die  by  drowning. 
Ogston,  Jr.,  gives  the  following  as  the  internal  signs  of  drowning  :  Water 
in  the  air  passages,  lungs,  gullet,  stomach  ;  and  watery  fluid  in  the  pleural 
and  peritoneal  cavities.  White  wateiw  froth  in  the  mouth,  throat,  air- 
])assages,  and  lungs,  perhaps  also  in  the  stomach.  Sand,  etc.,  in  these 
situations.  Bulkiness  or  protrusion  of  the  lungs,  and  over-distention  or 
rupture  of  their  superficial  air-cells.  Fluidity  of  the  blood  in  the  heart. 
Redness  of  the  windpipe  and  gullet.  In  conjunction  with  these  the  usual 
signs  of  asphyxia,  namely,  more  blood  in  ttie  right  than  in  the  left  cavi- 
ties of  the  heart;  congestion  of  the  lunjfs,  liver,  spleen,  and  kidneys;  per- 
haps also  congestion  of  the  brain  and  the  bloodvessels  Avithin  the  skull. 
(Edin.  Med.  a"nd  Surg.  Jour.,  1882,  p.  866.) 

The  lu77gs  are  sometimes  congested  and  more  generallv  distended  than 
collapsed.  Casper  and  Kanzler  found  them,  as  a  rule,  much  increased  in 
volume,  and  completely  filling  the  cavit}'  of  the  chest,  so  that  when  the 
chest  was  opened  they  protruded  out  of  it,  but  this  did  not  depend  on 
mere  fulness  of  blood.  The  most  accurate  observations  show,  in  recent 
cases  of  drowning,  that  the  lungs  are  generally  distended  and  in  a  flabby 
condition.  Owing  to  the  penetration  of  their  substance  by  water  they 
have  lost  their  usual  elasticity,  so  that  an  impression  made  upon  them  by 
a  finger  is  preserved  as  in  a  dropsical  iimb.  Riedell  has  pointed  out  this 
flabby  and  dilated  condition  of  the  lungs  as  a  special  characteristic  of 
drowning;  although  they  floated,  he  found  that  they  were  three  or  four 
times  as  heavy  as  in  their  natural  state",  owing  to  the  water  in  their  sub- 
.stance.  (Lond.  Med.  Gaz.,  vol.  xlvi.  p.  478.)  On  making  a  section  of 
anv  part  of  the  lungs  a  blood\^  frothy  liquid  escapes — air  and  water  being 
mi.xed  together  in  the  air-cells.  The.~e  appearances  are  only  likely  to  be 
observed  in  a  well-marked  form  when  the  body  is  examined  soon  after 
death.  The  windpipe,  bronchi,  and  minute  air-tubes  of  the  lungs,  in  a 
recently-drowned  body,  arc  filled  more  or  less  with  a  mucous  froth  tinged 
with  blood,  as  a  resxilt  of  thp  last  violent  efforts  at  respiration  when  the 
mouth  has  sunk  below  the  level  of  the  water.     This  appearance  is  not 


STATE    OF    THE    LUNGS    AND    HEART.  381 

always  met  with.  Thus  it  has  not  been  found  in  the  bodies  of  those  who 
have  sunk  at  once  below  the  surface  and  have  not  an:ain  risen  to  breathe. 
But  from  experiments  on  animals,  made  by  the  Committee  of  the  Medico- 
Chirurgical  Society,  its  presence  in  tiie  air-passa^res  docs  not  depend  on 
the  fact  of  a  person  rising  to  the  surface,  although  this  may  increase  the 
quantity,  bat  rather  upon  the  violent  spasmodic  efforts  made  to  breathe, 
under  circumstances  in  which  water  alone  can  enter  the  lungs.  (Med. 
Chir.  Trans.,  1862,  p.  449.)  These  facts  show  that  a  mucous  froth  is 
produced  in  the  air-passages  even  in  two  minutes  M'hen  there  is  entire 
submersion  of  the  head  ;  and  its  quantity  appears  to  be  in  proportion  to 
the  length  of  submersion  and  the  violence  of  the  efforts  made  to   breathe. 

The  presence  in  the  air-passages  of  a  white,  watery  froth,  frequently, 
tinged  with  blood,  may  be  regarded  as  a  special  character  of  asphyxia  by 
drowning.  When  discovered  in  the  lungs,  associated  with  a  watery  con- 
dition of  these  organs,  it  furnishes  a  satisfactory  proof  of  this  mode  of 
death.  As  its  presence  depends  on  the  retention  of  air  in  thin  vesicles 
diffused  through  the  air-tubes  it  is  obvious  that,  except  in  recent  inspec- 
tions, i.  e.  within  a  few  hours  of  death,  it  may  have  wholly  or  partly  dis- 
appeared.    Water  passing  in  and  out   by  the  windpipe  may  destroy  it 

also  the  exposure  of  the  body  to  a  high  temperature.  This  may  account 
for  the  fact  that  it  is  not  always  observed  in  the  inspection  of  the  bodies 
of  the  drowned  when  removed  from  water.  Violent  efforts  at  breathing 
may,  however,  produce  it — especially  if,  owing  to  the  loss  of  ])ower  of 
swallowing,  any  liquid  should  tind  its  way  into  the  windpipe.  Indepen- 
dently of  the  presence  of  ivater  (sometimes  mixed  with  mud,  sand,  or 
weeds)  in  the  larger  air-tubes  a  portion  of  this  liquid  is  generally  drawn 
into  the  lungs  by  convulsive  efforts  at  respiration.  It  fdls  the  cells  and 
penetrates  the  substance  of  the  organs,  giving  to  them  the  flabby  and 
doughy  consistency  already  described.  In  some  cases  the  contents  of  the 
stomach  may  be  found  in  the  windpipe  and  lungs:  this  occurs  when  a 
])erson  has  been  drowned  with  a  full  stomach.  Vomiting  takes  place,  and 
the  vomited  matters  are  drawn  into  the  lungs  by  the  attempt  to  breathe. 
According  to  Tardieu,  the  state  o^J:he  lungs  is  different  from  that  observed 
in  death  from  suffocation.  He  found  great  congestion  of  the  lungs,  but  no 
sub-pleural  ecchymoses.  If  these  were  present  it  would,  in  his  opinion, 
indicate  that  the  deceased  had  been  suffocated  before  being  thrown  into 
the  water.  (Ann.  d'Hyg,,  1855,  t.  2,  p.  307;  also  1878,  t.  2,  p.  174.) 
According  to  Bergeron,  ecchymoses  (not  punctiform)  are  sometimes 
present  in  cases  of  drowning-,  and  the  intensity  of  congestion  and  their 
extent  are  always  in  proportion  to  the  struggles  of  the  animal. 

The  state  of  the  heart  in  the  drowned  has  given  rise  to  some  discussion. 
In  death  from  asphyxia  the  right  cavities  generally  contain  blood,  while 
the  left  cavities  are  either  empty,  or  they  contain  much  less  than  the  right. 
Out  of  fifty-three  inspections  made  by  Ogston  the  right  cavities  were 
found  empty  in  only  two  cases,  and  the  left  cavities  empty  in  fourteen. 
(Lond.  Med.  Gaz.,  vol.  xlviii.  p.  291.)  In  a  case  of  drowning  which  was 
examined  by  Bishop  the  right  side  of  the  heart  contained  scarcely  any 
blood  ;  and  in  another  case  the  only  medical  difficulty  regarding  death  by 
drowning  presented  itself  in  an  emptiness  or  non-di.stention  of  the  right 
cavities  of  this  organ.  The  facts  and  observations  accumulated  by 
Che  vers  show  that  a  full  condition  of  the  heart,  although  a  common,  is 
not  an  invariable  concomitant  of  asphyxia,  either  from  drowning  or  any 
other  cause.  (Med.  Jurispr.  for  India,  p.  441.)  It  has  been  elsewhere 
remarked  that  the  action  of  the  heart  continues  after  the  stoppage  of  re- 
spiration, and  that  the  period  at  which  this  organ  ceases  to  contract  is 


382  STATE    OF    THE    BRAIN    AND    INTESTINES. 

variable.  Hence  in  some  cases  there  may  be  sufficient  power  in  the  right 
cavities  to  contract  upon  their  contents,  and  to  expel,  more  or  less  com- 
pletely, the  last  traces  of  blood  received  from  the  body.  Emptiness  of  the 
ri.irht  cavities  of  the  heart  must  not,  therefore,  be  regarded  as  inconsistent 
with  death  from  drowning ;  at  the  same  time  it  cannot  be  taken  as  a  proof 
that  the  person  has  died  not  from  drowning.  Riedell  states  that  in  half 
the  number  of  instances  which  had  fallen  under  his  observation  the  two 
sides  of  the  heart  contained  equal  quantities  of  blood;  in  the  other  half, 
the  right  side  contained  the  larger  proportion.  In  only  one  case  the 
emptiness  of  the  left  side  contrasted  strongly  with  the  fulness  of  the  right. 

A  greater  or  less  fulness  of  the  vessels  of  the  brain  is  described  as  one 
of  the  appearances  met  with  in  drowning;  but  this,  when  it  exists,  is 
probabh^  a  consequence  of  a  congested  state  of  the  lungs.  Some  remarks 
have  been  already  made  on  this  subject,  and  from  these  it  is  evident  that 
the  state  of  the  cerebral  vessels  can  afford  no  presumption  that  death  has 
taken  place  from  drowning.  In  regard  to  the  cases  which  we  have  had  an 
opportunity  of  examining,  the  quantity  of  blood  contained  within  the 
cerebral  vessels  has  rarely  been  so  great  as  to  call  for  particular  notice. 

In  examining  the  abdomen,  it  will  commonly  be  found  that  the  stomach 
contains  water,  which  appears  to  enter  into  this  organ  by  the  act  of  swal- 
lowing during  Ihe  struggle  for  life.  This  may  be  salt  or  fresh,  according 
to  the  medium  in  which  the  drowning  has  taken  place.  The  quantity  is 
subject  to  great  variation  :  sometimes  it  is  large,  at  other  times  small,  and 
in  some  instances  no  water  whatever  is  to  be  met  with.  The  absence  of 
water  may  probaljly  indicate  a  rapid  death,  as  there  could  have  been  no 
power  to  swallow.  Orfila  has  remarked  that  the  mucous  membrane  of  the 
stomach  and  bowels  is  occasionally  much  discolored  in  drowned  subjects. 
He  observed  also  that,  when  drowning  took  place  while  the  process  of 
digestion  was  going  on,  the  mucous  membrane  of  the  stomach  often  had  a 
pinkish  or  violet  tint.  When  the  dead  body  had  remained  a  long  time  in 
water,  this  membrane  was  observed  to  acquire  a  deep  violet  or  brown 
color.  A  knowledge  of  this  fact  may  be  of  some  importance  in  those  cases 
in  which  a  person  is  suspected  to  have  been  poisoned  previously  to  sub- 
mersion. It  has  been  said  that  the  diaphragm  is  generally  much  raised 
towards  the  chest;  but  this  may  have  depended  on  gaseous  putrefaction, 
and  the  increase  in  the  size  of  the  abdomen  by  the  formation  of  gas  in  the 
intestines.  The  urinary  bladder  in  some  cases  contains  urine,  in  others  it 
is  perfectly  empty.  Casper  found  it  empty  in  one-half  of  the  cases  which 
he  examined.  It  is  obvious  that  the  state  in  Avhich  the  bladder  is  found 
must  depend  on  its  condition  at  the  time  at  which  the  drowning  occurred. 
(See,  in  reference  to  the  appearances  in  the  drowned,  a  paper  by  Ogston, 
Lond.  Med.  Gaz.,  vol.  xlvii.  pp.  7G3,  854,  et  seq.  ;  Riedell,  Lond.  Med. 
Gaz.,  vol.  xlvi.  p.  478;  Casper,  Ger.  Leich.-Oeff'n.,  vol.  1,  p.  87;  2,  p. 
106;  Klin.  Novellen,  18G3,  p.  523;  and  Ogston,  Jun.,  Edin.  Med.  and 
Surg.  Jour.,  April,  1882,  p.  8(;5.) 

Bergei^on  and  Montano  conclude,  from  their  post-mortem  examinations 
of  drowned  bodies  brought  to  the  Morgue  in  Paris,  that  the  constant  and 
certain  sign  of  death  by  drowning  is  the  presence  of  mucous  froth,  not 
only  in  the  mouth,  but  in  the  larynx  and  bronchial  tubes.  There  was 
always  some  degree  of  congestion,  and  occasionally  of  ecchymosis  under 
the  pleura,  but  this  membrane  never  presented  the  dotted  appearance  seen 
after  death  from  suffocation.  The  intensity  of  this  congestion  in  animals 
drowned  for  experiment  was  in  proportion  to  the  struggles  made  by  the 
animal     (Ann.  d'Hyg.,  1877,  t.  2,  p.  332.) 

Was  Death  Caused  by  Droiomnri  ? — For  a  correct  solution  of  this 
question  it  will  be  necessary  to  consider  the  appearances  met  with  in  the 


SUBSTANCES  GRASPED  IN  THE  HANDS.  383 

drowned,  and  to  determine  how  far  they  are  characteristic  of  this  form  of 
death.  Among-  the  external  signs  of  drowning,  when  the  body  is  seen 
soon  after  death,  are  paleness  of  tlie  surface,  a  contracted  state  of  the  skin 
(cutis  anserina),  and  tlie  presence  of  a  mucous  froth  about  the  nostrils 
and  lips.  The  absence  of  these  appearances,  however,  would  not  prove 
that  the  person  had  not  been  drowned;  for  if  the  body  had  remained  some 
time  in  water,  or  if  it  had  been  long  exposed  to  air  before  it  was  seen  by 
a  medical  man,  the  skin  would  undergo  various  changes  in  its  condition 
and  color,  and  mucous  froth  would  no  longer  be  found  adhering  to  the 
lips  and  nostrils. 

Ogston,  Jun.,  thus  summarizes  the  post-mortem  appearances  in  the 
drowned:  When  an  external  examination  of  the  body  only  is  allowed,  if 
abundance  of  water  pours  from  the  mouth  on  turning  the  corpse  face 
downwards,  and  if  white  watery  froth  is  found  at  the  mouth  and  nostrils, 
or  if  it  be  made  to  issue  from  them  on  compressing  the  chest,  we  may  be 
justified  in  giving  an  opinion  as  to  the  probability  of  drowning,  especially 
when  the  accessory  signs,  viz.,  rosy  redness  of  the  face  and  front  of  the 
chest,  goose-skin,  and  bleaching  and  corrugation  of  the  hands  are  well 
marked,  presuming  always  that  no  lethal  injuries  are  seen  on  the  body 
which  would  appear  to  have  been  inflicted  before  death,  and  no  traces  of 
corrosive  action,  etc.,  from  poisons  be  observable  about  the  lips,  hands, 
clothes,  etc.  ;  but  that  to  justify  us  in  giving  a  more  positive  opinion  we 
ought  to  have  furnished  to  us  a  detailed  account  of  the  locality  in  which, 
and  the  circumstances  under  which  the  body  was  observed  before  its  re- 
moval to  the  place  where  it  lie's  for  examination.  That  where  a  complete 
inspection  of  the  body  is  permitted,  we  may  give  a  more  positive  opinion 
when,  in  addition  to  the  external  appearances,  water  in  marked  quantity, 
mixed  with  white  watery  froth,  is  found  in  the  lungs  and  stomach,  and 
also,  perhaps,  when  a  larger  quantity  of  watery  fluid  is  seen  in  the  pleural 
cavities;  when  sand,  seaweed,  etc.,  are  found  in  the  bronchi,  or  even  in 
the  windpipe;  when  the  lungs  are  bulky  or  protrude  on  the  removal  of 
the  sternum  ;  and  when  the  blood  within  the  heart  is  whollv  fiuid — espe- 
cially when  with  these  signs  we  find  marked  appearances  of  asphj^xia  in 
the  heart,  lungs,  liver,  etc.     (Edin.  Med.  and  Surg.  Jour.,  1882,  p.  873.) 

State  of  the  Skin.—'Vhe.  goose-skin,  or  cutis  anserina,  which  is  frequently 
observed  in  the  drowned,  shows  that  the  skin  possessed  the  living  power 
of  contractility  at  the  time  of  immersion.  Wagner  suggests  that  the 
appearance  might  be  produced  in  a  dead  body  if  thrown  into  cold  water 
immediately  after  death,  i.  e.  while  the  skin  is  warm.  As  none  but 
assassins  would  be  likely  to  resort  to  this  proceeding,  the  objection  would, 
if  admitted,  merely  leave  the  fact  of  drowning  still  to  be  made  out  by  an 
internal  inspection.  This  contracted  state  of  the  skin  could  hardly  be 
mistaken  for  a  naturally  rough  or  horny  skin,  as  suggested  by  Casper. 
(Ger.  Leich.-Oeft'a.,  vol.  i.  p.  89.)  As  this  condition  of  the  skin  is  not 
invariably  present,  even  in  the  recently  drowned,  its  absence  must  not  be 
taken  to  negative  the  hypothesis  of  drowning. 

ISubstances  grafiped  in  the  Hands. — Foreign  substances,  such  as  gravel, 
dirt,  grass,  or  weeds,  are  sometimes  found  locked  within  the  hands  or 
lodged  under  the  nails  of  drowned  suVijects.  This  fact  may  occasionally 
afford  strong  circumstantial  evidence  of  the  manner  in  which  a  person  has 
died.  If  materials  are  found  grasped  within  the  hands  of  the  deceased 
which  have  evidently  been  torn  from  the  banks  of  a  canal  or  river,  or 
from  the  bottom  of  the  water  in  which  the  body  is  found,  we  have  strong 
presumptive  evidence  that  the  person  died  within  the  water.  For  although 
it  is  possible  to  imagine  that  the  deceased  may  have  struggled  on  the 


38-i  DROWNING  —  WATER    IN    THE    STOMACH. 

bank,  and  have  bepn  kiHed  prior  to  submersion,  yet  in  the  value  attached 
to  this  sign  we  are  assuming  that  there  are  no  marks  of  violence  on  the 
person,  nor  any  other  appearances  about  the  body  sufficiently  striking-  to 
lead  the  examiner  to  suspect  that  death  had  occurred  in  any  other  way 
than  by  drowning.  If  the  substance  locked  within  the  fingers  or  finger- 
nails is  sand  of  the  same  character  as  that  existing  at  the  bottom  of  the 
river  or  pond,  it  is  difficult  to  conceive  any  stronger  fact  to  establish  death 
from  submer.sion.  The  abrasion  of  the  fingers  is  a  circumstance  of  minor 
importance ;  no  value  could  be  attached  to  this  state  of  the  fingers  as  an 
indication  of  a  person  having  perished  by  drowning,  unless  it  were  in 
conjunction  with  the  appearances  above  described.  A  witness  would  be 
constrained  to  admit,  in  many  cases,  that  the  fingers  might  become  abraded 
or  excoriated  after  death,  or  even  before  submersion  ;  while  in  no  case 
could  he  be  called  upon  to  make,  in  regard  to  substances  found  grasped 
within  the  hands,  an  admission  which  would  invalidate  the  evidence  de- 
ducible  from  this  condition.  This  must,  then,  be  regarded  as  a  satisfactory 
proof  of  a  person  having  been  alive  after  his  body  was  in  the  water.  It 
is  well  known  that,  when  two  or  three  are  drowned  by  the  same  accident, 
they  are  not  unfrequently  found  clasped  within  each  other's  arms — a  fact 
which  at  once  proves  that  they  must  have  been  living  when  submerged: 
so  if  a  dead  bod}'  is  discovered  still  holding  to  a  rope,  cable,  or  oar,  no 
further  evidence  is  recjuired  to  show  that  the  deceased  must  have  died  from 
drowning.  In  1877,  the  body  of  a  gentleman  was  taken  out  of  a  pond  on 
his  own  estate  in  Cornwall.  His  e3'e-glass  was  open  and  firmly  grasped 
in  his  hand.  There  is  reason  to  believe  that  he  had  fallen  into  the  pond 
while  looking  at  the  fish. 

The  internal  appearances  upon  which  medical  jurists  chiefly  rely  as 
proofs  qf  this  kind  of  death,  are — first,  water  in  the  stomach  ;  and,  second, 
water  with  a  mucous  froth  in  the  air-passages  and  lungs. 

1.  Water  in  the  /S7o?}?ac/?.— Riedell  found  that,  in  the  majority  of  cases 
of  drowning,  water  passed  into  the  stomach.  In  animals  previously 
killed,  and  placed  for  twenty-four  hours  in  water  with  the  mouth  wide 
open,  no  fluid  peneti'ated  to  the  stomach.  (Lond.  Med.  Gaz.,  vol.  xlvi.  p. 
478.)  Water  commonly  passes  into  the  stomach  of  a  living  animal  while 
drowning  by  the  act  of  swallowing.  It  has  been  observed  that,  when  an 
animal  is  stunned  prior  to  sulimersion,  water  does  not  pass  into  the  gullet ; 
and  when  syncope  occurs  none  may  be  found  there.  As  a  proof  that  its 
entrance  into  this  organ  depends  on  the  act  of  swallowing,  it  may  be 
stated  that  the  quantity  in  the  stomach  is  greater  when  an  animal  is 
allowed  to  come  frequently  to  the  surface  and  respire,  than  when  it  is 
maintained  altogether  below  the  surface.  The  power  of  swallowing  is 
immediately  suspended  on  the  occurrence  of  asphyxia,  and  in  this  way  we 
may  satisfactorily  account  for  the  difference  observed  in  the  two  cases. 
The  water  thus  found  is  in  variable  quantity  ;  and  there  are  some  cases 
of  drowning  in  which  water  is  vot  present  in  the  stomach.  Water  does 
not  readily  penetrate  into  the  .stomach  of  a  body  which  has  been  thrown 
in  after  death  ;  the  sides  of  the  gullet  applying  themselves  too  closely  to 
each  other  to  allow  of  the  passage  of  fluid.  If  putrefaction  has  advanced 
to  a  great  extent,  some  water  may  enter;  but  a  medical  man  will  easily 
judge,  from  the  general  state  of  the  body,  how  far  this  process  may  have 
been  concerned  in  the  admission  of  fluid  into  the  stomach  and  intestines, 
Orfila  has  suggested  Ihat  water  may  be  found  in  the  stomach  of  a  person 
apparentl}'  drowned,  in  consequence  of  this  liquid  having  been  drunk  by 
the  deceased,  or  artificially  injected  by  another  into  the  stomnch  after 
death.     It  is  difficult  to  conceive  under  what  circumstances  the  latter  ob- 


WATER    AND    FROTH    IN    THE    LUNGS.  385 

jectioa  could  be  made,  or  what  purpose  it  would  answer ;  but  in  rel3'ing 
upon  the  presence  of  water  in  the  stomach,  it  may  be  admitted  that  the 
deceased  may  have  drunk  water  before  his  body  v/as  submerged.  The 
mere  discovery  of  water  in  the  stomach,  except  under  circumstances  to  be 
presently  mentioned,  is  not,  therefore,  a  necessary  proof  that  it  has  been 
swallowed  during  the  act  of  drowning. 

It  is,  of  course,  presumed  that  the  liquid  contained  within  the  stomach 
is  of  the  same  nature  as  that  in  which  the  body  is  immersed;  for  it  is 
possible  that  fresh  water  may  be  found  in  the  stomach  of  a  person  drowned 
in  salt  water,  and  in  such  a  case  it  would  be  obviously  improper  for  a 
medical  witness  to  affirm,  from  the  mere  presence  of  water,  that  the  person 
had  died  where  his  body  was  discovered.  If  the  water  contained  mud, 
straw,  duckweed,  moss,  seaweed,  diatoms  or  other  aquatic  organisms,  or 
any  substance  like  those  existing  in  the  pond,  river,  or  other  water  where 
the  drowning  occurred,  this  is  a  proof,  when  the  inpection  is  recent,  of  its 
having  been  swallowed  by  a  living  person.  The  absence  of  water  from 
the  stomach  cannot,  however,  lead  to  the  inference  that  the  person  has  not 
died  from  drowning,  because  in  some  instances  it  is  not  swallowed,  and  in 
others  it  may  drain  away  and  be  lost  after  death  before  an  inspection  is 
made. 

2.  Water  loith  White  Watery  Froth  in  the  Air-passages  and  Lungs. — 
If  the  body  is  carefully  removed  from  the  water,  and  is  examined  soon 
after  removal,  these  appearances,  which  furnish  satisfactory  evidence  of 
death  from  drowning,  will  be  found.  Riedell  regards  the  presence  of  a 
fi'oth  as  a  constant  sign  of  this  kind  of  death.  In  all  his  experiments  and 
observations  he  states  that  he  found  a  frothy  fluid  in  the  windpipe,  bronchi, 
and  lungs.  After  death  it  gradually  disappeared  from  the  air-tubes  by 
exosmosis,  but  not  from  the  lungs.  The  fluidity  of  this  froth  is,  he  con- 
tends, a  distinctive  character  of  death  from  drowning,  and  is  not  met  with 
in  any  other  case.  (Lond.  Med.  Gaz.,  vol.  xlvi.  p.  478.)  These  observa- 
tions, made  long  since  by  Riedell,  have  been  lately  confirmed  by  others 
made  at  the  Morgue  by  Bergeron  and  Montano.  The  existence  of  a  froth 
in  the  fauces,  larynx,  and  bronchi  is,  according  to  them,  the  only  constant 
sign  of  death  by  submersion,  whether  syncope  or  asphyxia  preceded 
death.  They  found  it  in  animals  narcotized  previously  to  being  thrown 
into  water.  The  presence  of  a  frothy  fluid  would  undoubtedly  show  that 
liquid,  from  some  cause,  had  penetrated  into  the  air-passages ;  and  when 
taken  in  conjunction  with  the  presence  of  water  in  the  substance  of  the 
lungs,  it  may  be  considered  to  furnish  conclusive  evidence  of  death  from 
drowning.  On  the  other  hand,  its  absence  does  not  necessarily  prove 
that  a  person  has  not  died  from  this  cause.  There  may  have  been  no  con- 
vulsive efforts  at  breathing  prior  to  death.  A  froth  may  ijot  be  found  when 
the  body  has  remained  for  a  long  period  in  the  water  after  death,  since  by 
the  free  passage  of  this  fluid  into  and  out  of  the  air-tubes  the  froth, 
although  formed  in  the  first  instance,  may  have  disappeared.  If,  after 
removal  from  the  water,  the  body  is  exposed  to  the  air  for  several  days 
before  it  is  examined,  it  is  rare  that  this  appearance  is  seen.  The  froth 
may  have  been  formed  in  the  air-passages,  but  it  may  have  entirely 
disappeared. 

3.  Water  and  Foreign  Substances  in  the  Lungs. — It  has  been  elsewhere 
stated  that,  in  the  act  of  drowning,  water  is  drawn  with  considerable 
force  into  the  lungs,  by  violent  attempts  at  inspiration.  The  aspiratory 
force  thus  exerted  by  the  lungs  is  considerable.  It  has  been  found  that, 
when  the  heads  of  animals  were  plunged  below  mercury,  some  of  this 
fluid,  in  spite  of  its  great  density,  was  actually  drawn  into  the  lungs,  and 

25 


386  DROWNING SUMMARY    OF    APPEARANCES. 

p:lobules  of  it  have  been  found  in  the  air-cells.  A  fortiori,  this  takes  place 
in  a  greater  deg-ree  with  water  which  is  forcibl}'  drawn  into  and  per- 
meates the  spongy  texture  of  the  lungs,  rendering  recovery  more  difficult,- 
and  death  more  rapid,  than  in  other  forms  of  asphyxia.  This  aspiratory 
force  of  the  lungs  has  been  measured,  and  is  found  in  small  animals  to 
be  equal  to  raising  a  column  of  mercury  four  inches  in  height.  Not  only 
is  water  thus  drawn  in,  but  sand,  mud,  weeds,  or  other  substances  floating 
in  it  are  also  carried  into  the  air-tubes  and  cells  of  the  lungs.  When  the 
water  is  mixed  with  weeds  or  mud  and  water  presenting  the  same  admix- 
ture is  found  in  the  throat  and  stomach,  this  is  strong  evidence  that  the 
body  has  been  plunged  into  the  medium  when  the  power  of  breathing 
and  swallowing  still  existed,  and  hence  that  the  deceased  has  been 
drowned.  An  attention  to  the  condition  of  the  stomach  and  lungs 
together  Avill,  therefore,  be  of  importance  in  cases  of  alleged  child-murder 
by  drowning,  since  it  may  aid  in  proving  or  disproving  the  charge. 

When  a  dead  body  is  thrown  into  water,  and  has  remained  there  some 
time,  water  with  fine  particles  of  sand,  mud,  or  weeds,  may  pass  through 
the  windpipe  into  the  lungs,  and  be  there  deposited.  Water  under  these 
circumstances,  however,  does  not  penetrate  into  the  substance  of  the  lungs 
as  by  aspiration  daring  life,  and  the  amount  which  passes  through  the 
chink  of  the  glottis  is  small.  If  simply  an  after-death  effect,  the  water  is 
found  in  the  larger  air-tubes  unaccompanied  by  mucous  froth.  In  most 
cases,  however,  the  effect  of  aspiration  as  a  result  of  living  power  is  so 
manifest  that  the  examiner  can  have  no  difficulty  in  forming  an  opinion; 

A  medical  man  may  be  occasionally  required  to  express  an  opinion  on 
the  length  of  time  that  may  have  elapsed  since  the  act  of  drowning-,  when 
the  dead  body  of  a  person  has  been  discovered  in  water.  The  rules  which 
have  been  suggested  for  the  guidance  of  a  medical  witness  on  these  occa- 
sions are  open  to  so  many  exceptions,  owing  to  the  different  degrees  in 
which  putrefaction  takes  place  in  bodies  exposed  under  similar  circum- 
stances, that  they  are  of  but  little  service  as  a  basis  for  medical  evidence. 
From  these  observations  it  will  be  perceived  that  the  only  characters  on 
which  reliance  can  be  placed,  as  medical  proofs  of  death  from  drowning, 
are — first,  the  presence  of  a  mucous  froth  in  the  windpipe  and  air-tubes ; 
second,  of  water  in  the  air-tubes  and  air-cells  of  the  lungs;  and  third,  of 
water  in  the  stomach.  An  early  inspection  of  the  body  may  thus  enable 
a  medical  man  to  come  to  a  satisfactory  conclusion  that  death  was  or  was 
not  caused  by  drowning.  The  longer  this  inspection  is  delayed,  the  more 
ambiguous  the  evidence  becomes,  since  the  froth  slowly  disappears  from 
the  air-tubes,  while  water  may  penetrate  into  the  lungs  and  stomach.  The 
great  cause  of  failure  in  obtaining  medical  proofs  of  drowning  is  generally 
the  unavoidable  delay  before  an  inspection  is  made. 

If,  in  examinilig  a  body  taken  from  the  water,  we  find  upon  it  marks  of 
violence,  or  severe  internal  injuries  sufficient  to  destroy  life,  there  is  strong- 
ground  for  suspicion.  AVhy  the  body  of  a  person  who  has  really  died 
from  natural  causes  should  be  afterwards  thrown  into  \vater  it  would  not 
be  easy  to  explain  upon  any  hypothesis  of  innocence,  but  we  can  readilv 
appreciate  the  motive  when  murderous  violence  has  been  used.  (See 
p.  o90,7?os<.)  After  the  lapse  of  five  or  six  weeks,  especially  if  the  body 
lias  been  removed  from  the  water  for  the  greater  part  of  this  period,  none 
of  the  usual  appearances  of  drowning  will  be  met  with  ;  and  in  the 
present  day,  no  practitioner  would  think  of  seeking  for  evidence  under 
such  circumstances. 

In  consequence  of  the  uncertainty  attendant  on  the  appearances  of 
drowning,  legal  ingenuity  is  often  strained  to  the  utmost  to  show  that 


SPECIFIC    GRAVITY    OF    THE    BODY.  387 

there  is  no  certain  sign  of  drowning,  and  therefore  that  the  deceased  must 
have  died  from  some  other  cause.  The  general  impression  among  non- 
medical persons  appears  to  be  that,  whether  in  drowning  or  suffocation, 
there  ought  to  be  some  particular  visible  change  in  some  part  of  the  body 
to  indicate  at  once  the  kind  of  death  ;  but  it  need  hardly  be  said  that  this 
notion  is  founded  on  false  views.  A  medical  inference  of  drowning  is 
founded  upon  a  certain  series  of  facts,  to  each  of  which,  individually,  it 
may  be  easy  to  oppose  plausible  objections;  but  taken  together  they  fur- 
nish cumulative  evidence  as  strong  as  is  commonly  required  for  proof  of 
any  kind  of  death. 

In  death  from  drowning,  a  question  respecting  the  specific  gravity  of 
the  human  body  may  incidentally  arise.  In  the  healthy  living  body  this 
is  made  up  of  the  combined  specific  gravities  of  its  different  parts  ;  so  that, 
as  in  all  heterogeneous  solids,  it  is  a  complex  quantity.  The  only  part  of 
the  body  which  is  lighter  than  water  is  fat.  The  specific  gravity  of  this 
is  0.92,  and  it  is  calculated  that  the  proportion  of  fat  in  an  adult  is  about 
five  per  cent,  of  the  weight  of  the  body,  or  one-twentieth  part.  The 
specific  gravity  of  muscle  is  1.085,  of  brain  1.04,  of  the  soft  organs  gen- 
erally 1.05,  of  the  lungs  containing  air  0.94,  and  of  bone,  the  heaviest  part 
of  the  body,  2.01.  The  lightness  of  the  fatty  portions  is  more  than  coun- 
terbalanced by  the  weight  of  the  skeleton  (about  ten  and  a  half  pounds  in 
the  male,  and  nine  pounds  in  the  female),  so  that  the  naked  human  body, 
placed  on  water,  has  a  slight  tendency  to  sink.  This  tendency  diminishes 
just  in  proportion  to  the  quantity  of  the  body  immersed  ;  because  all  those 
parts  which  are  out  of  water,  not  being  supported  by  w^ater,  become  so 
much  additional  weight  to  the  portion  immersed.  Hence  the  frequent 
cause  of  death  by  drowning.  An  inexperienced  person  exhausts  himself 
by  exertion,  raises  his  arms  continually  out  of  the  water,  and  as  often 
sinks,  owing  to  their  weight  having  just  so  much  effect  on  his  body  as  if 
a  leaden  weight  had  been  suddenly  applied  to  his  feet  to  sink  him.  When 
the  lohole  of  the  living  body  is  immersed,  the  specific  gravity,  owing  to 
the  expansion  of  the  chest,  diflfers  so  little  from  that  of  water,  that  a  very 
slight  motion  of  the  hands  or  feet  will  suffice  to  keep  a  person  on  the  sur- 
face. The  head,  owing  to  the  weight  of  the  bones  of  the  skull,  has  alwavs 
a  tendency  to  sink  below  the  level  of  water,  and  muscular  force  is  re- 
ciuired  to  keep  it  above  the  surface.  Neil  Arnott  calculated,  from  the 
weight  of  water  displaced,  that  the  bulk  of  the  adult  body  is  equal  to  two 
and  a  half  cubic  feet  (about  two  and  a  quarter  cubic  feet. — Ed.).  This  is 
the  quantity  displaced  by  total  immersion,  and  its  weight  is  about  156 
pounds.  There  are  two  circumstances  which  cause  the  specific  gravity  of 
the  body  to  vary.  If  the  quantity  o^  fat  is  proportionably  large,  it  will 
be  diminished;  and  such  a  person  will  float  more  readily  than  another  in 
an  opposite  condition.  On  the  other  hand,  a  large  proportion  o^  hone  ren- 
ders a  person  heavier  than  his  bulk  of  water  ;  and  his  body  will  sink  more 
rapidly  than  that  of  another.  These  two  modifying  causes  of  buoyancv 
are  liable  te  constant  variation  ;  hence  the  different  accounts  given  by  ex- 
perimentalists relative  to  the  specific  gravity  of  the  human  body.  "  The 
bodies  of  women  are,  cseteris  paribus,  of  less  specific  gravity  than  those 
of  men  ;  the  skeleton  is  smaller,  and  there  is  a  greater  proportion  of  fat ; 
hence  they  more  readily  float.  The  bodies  of  infants  and  young  children 
float  with  the  greatest  ease  ;  the  quantity  of  fat  is  usually  in  large  pro- 
portion, and  the  bones  are  light— the  earth}^  matter  being  not  yet  fully 
deposited.  Thus,  in  infanticide  by  drowning,  the  body  of  a  child  that  has 
fully  respired  rises  very  speedily  to  the  surface — if,  indeed,  it  does  not  re- 
main  altogether  upon  it. 


388  MARKS    OF    VIOLENCE    ON    THE    DROWNED. 

If  the  lungs  are  emptied  while  the  face  is  under  water,  and  the  person 
cannot  inhale  again,  the  body  remains  specifically  heavier  than  water,  and 
will  sink.  Hence  it  follows  that,  cseteris  paribus,  a  person  with  a  large 
and  capacious  chest  floats  more  easily  than  one  whose  chest  is  small  and 
contracted.  Hence,  also,  in  a  living  person  the  body  has  a  tendency  to 
rise  out  of  water  during  inspiration,  and  to  sink  during  expiration — the 
quantity  of  water  displaced  under  these  two  opposite  conditions  of  the 
respiratory  organs  being  very  different.  The  entrance  into  water  with 
the  chest  nearly  emptied  as  the  result  of  a  loud  scream  or  shriek  is  very 
unfavorable  to  the  buoyancy  of  the  body.  The  fact  of  clothes  being  on 
the  person  may  also  make  a  difference — either  from  their  nature,  in  serv- 
ing to  buoy  up  the  body,  or  from  their  weight  to  sink  it  more  deeplv. 
Women  are  sometimes  saved  from  drowning  by  reason  of  their  clothes 
floating,  and  thus  presenting  a  large  surface  to  the  water ;  it  is  partly 
owing  to  this  circumstance  that  the  bodies  of  drowned  women  often  re- 
main floating  on  the  water  immediately  after  death. 

It  may  be  laid  down  as  a  general  rule,  that  the  recently  dead  body  un- 
clothed is,  when  left  to  itself,  heavier  than  water,  and  sinks  when  im- 
mersed. The  expulsion  of  air  from  the  lungs  and  their  penetration  by 
water,  combined  with  the  fact  that  the  bones  and  all  the  soft  parts,  ex- 
cepting the  fat,  are  of  greater  specific  gravity  than  water,  offer  a  sufficient 
explanation  of  the  sinking.  After  a  variable  period,  generally  not  more 
than  a  few  days,  the  body  will  rise  again  to  the  surface,  and  float.  The 
period  of  its  rising  will  depend — first,  on  the  specific  gravity  of  the  body  ; 
second,  on  the  nature  of  the  water,  whether  salt  or  fresh  ;  third,  on  the 
access  of  heat  and  air  in  facilitating  putrefaction.  If  the  gases  generated 
find  an  escape,  the  body  will  sink;  more  gases  may  form,  and  then  it  will 
again  rise,  so  that  the  sinking  and  rising  may  become  alternate  phenom- 
ena. A  small  quantity  of  air  collected  in  the  abdomen,  as  a  result  of 
putrefaction,  will  suffice  for  the  floating  of  the  body.  Thus,  taking  the 
specific  gravity  of  the  dead  body  at  1.08  to  1.1,  it  would  require  but  little 
air  to  keep  it  at  or  near  the  surface  of  the  water.  But  a  dead  body, 
whether  death  has  been  caused  by  drowning  or  not,  may  not  sink  at  all, 
owing  to  some  one  of  the  counteracting  causes  above  mentioned.  Several 
cases  are  reported  in  which  the  bodies  of  persons  recently  drowned  have 
floated. 

Marks  of  Violence  on  the  Drowned. — The  chief  inquiry  with  regard  to 
marks  of  violence  on  the  bodies  of  the  drowned  is,  whether  they  have  re- 
sulted from  accident  or  design.  In  forming  an  opinion  a  witness  must 
give  due  value  to  the  accidents  to  which  a  body  floating  loosely  in  water 
may  be  exposed.  Bruises  or  ecchymoses  of  considerable  extent  are  some- 
times seen  on  the  drowned  when  the  bodies  have  been  carried  by  a  cur- 
rent against  mechanical  obstacles  in  a  navigable  river  or  canal.  If  the 
deceased  fell  from  a  considerable  height  into  water  his  body  in  falling  may 
have  struck  against  a  rock  or  projection,  which  may  have  produced  ex- 
tensive marks  of  violence.  Dead  bodies  taken  out  of  wells  often  present 
considerable  marks  of  violence  inflicted  during  life  when  the  deceased  per- 
sons have  fallen  in  accidentally  or  have  thrown  themselves  in  intention- 
ally. The  presence  of  these  marks  must  not  create  a  hasty  suspicion  of 
murder.  It  is  manifestly  impossible  to  lay  down  any  specific  rules  for 
forming  a  decision  in  cases  of  this  kind,  since,  probably,  no  two  instances 
will  be" met  with  which  will  be  perfectly  similar  in  the  details.  In  clear- 
ing up  these  doubtful  points  everything  must  depend  on  the  tact  and 
experience  of  the  practitioner  who  is  called  upon  to  conduct  an  investiga- 
tion.    There  may  be  a  severe  cut  in  the  throat  arising  from  a  previous 


MARKS    OF    VIOLENCE    ON    TUB    DROWNED.  389 

attempt  at  suicide,  as  in  the  case  of  Sands  (July,  1818),  who  destroyed  his 
three  children  by  cutting-  their  throats,  and  then  cut  his  own  throat ;  but 
as  the  wound  involved  only  the  branches  of  the  external  carotid  artery  he 
was  able  to  walk  to  a  pond  about  thirty  yards  away  in  which  his  dead 
body  was  subsequently  found.  The  first  question  which  a  medical  jurist  has 
to  determine  is  whether  the  wounds  or  injuries  on  the  body  were  produced 
before  or  after  death.  (See  Wounds,  ante,  p.  241  )  If  after  death,  then  they 
ou^trht  to  be  obviously  of  accidental  origin.  If  the  injuries  show  inten- 
tional violence,  it  will  be  proper  to  consider  whether  they  are  such  as  to 
be  consistent  with  a  suicidal  attempt,  or  whether  they  indicate  homicide. 
(See  Wounds,  ante,  p.  257.)  Men  have  been  known  to  produce  very 
severe  wounds  on  the  throat,  resembling  homicidal  wounds,  and  still  to 
have  retained  the  power  of  throwing  themselves  into  a  pond  or  canal.  A 
case  of  this  kind  was  the  subject  of  an  inquest  in  1817.  In  1878  the  dead 
body  of  a  man  was  found  in  the  Serpentine  with  a  bullet-wound  travers- 
ing- the  chest  in  the  region  of  the  heart,  likely  to  have  caused  immediate 
death.  It  was  proved  that  the  deceased  had  been  seen  on  the  parapet  of 
the  bridge  with  a  revolver,  and  that  immediately  after  the  report  of  a 
pistol  his  body  had  been  seen  to  fall  over  into  the  water.  Thus  were  the 
facts  readily  explained.  Care  must  be  taken  not  to  mistake  the  ravages 
of  carnivorous  animals,  as  rats,  etc.,  on  the  dead  body.  The  injuries  thus 
produced  have  been  mistaken  for  the  results  of  acts  of  violence  inflicted 
during  life. 

Accidental  violence  may  sometimes  be  of  so  serious  a  nature  that  a 
practitioner  might  well  doubt  whether  it  did  not  indicate  that  the  deceased 
had  been  violently  treated  prior  to  submersion.  If  a  dead  body  were 
taken  out  of  water  with  one  or  more  limbs  dislocated,  or  the  vertebrae  of 
the  neck  fractured  and  a  surgeon  was  asked  whether  such  injuries  could 
be  accidental  and  coincident  with  or  consequent  on  drowning,  the  answer 
would  probably  be  in  the  negative.  But  an  instance  has  occurred  in 
which  both  arms  of  a  man  were  accidentally  dislocated  at  the  shoulders 
in  the  act  of  drowning,  as  the  result  of  a  fall  into  the  water  from  a  great 
height.  The  great  point  with  regard  to  all  marks  of  violence  on  the 
drowned  is  to  throw  light  upon  the  questions — first,  whether  drowning' 
was  really  the  cause  of  death  ;  and,  second,  whether,  if  so,  the  act  was 
the  result  of  accident,  suicide,  or  homicide.  This  last  question  does  not 
concern  a  medical  Avitness  so  much  as  a  jury,  who  will  determine  it  from 
the  facts,  medical  and  general,  proved  before  them. 

There  is  one  case,  of  rare  occurrence,  in  which  a  practitioner  would  be 
apt  to  be  misled  by  trusting-  to  appearances  found  on  the  drowned.  If  a 
dead  body  were  removed  from  water  with  a  deep  ecchymosed  circle  round 
the  neck,  evidently  produced  by  a  cord  or  ligature  no  traces  of  which 
could  be  found,  it  is  not  improbable  that  a  strong  suspicion  would  be  raised 
that  deceased  had  been  murdered  b}^  strangulation  and  the  body  after- 
wards thrown  into  water.  A  mark  was  produced  on  the  neck  of  a  woman 
who  was  accidentally  drowned,  as  a  result  of  the  compression  produced 
by  the  string  of  her  cloak.  Marks  resembling  those  of  strangulation  have 
been  produced  on  the  necks  of  bodies  floating  in  water  when  soon  after 
death  they  have  been  driven  by  a  strong  cui-rent  against  the  stumps  of 
trees  or  other  obstables  in  the  stream.  It  might  be  said  that,  in  cases  of 
this  description,  circumstantial  evidence  would  commonly  show  how  the 
mark  had  originated.  In  admitting  the  truth  of  this  observation  we  must 
remember  that  circumstances,  as  matters  of  proof,  do  not  always  present 
themselves  to  our  notice,  or  occur  to  our  judgment,  at  the  precise  time 
that  the  law  stands  most  in  need  of  them.     While,  then,  we  use  great 


390  MARKS    OF    VIOLENCE    ON    THE    DROWNED. 

caution  in  clrawin,2^  an  inference  when  there  are  such  strong  grounds  for 
suspicion,  we  should  not  neglect  to  examine  carefully  the  slightest  appear- 
ances of  violence  on  a  body. 

Fractures  are  not  often  met  with  in  the  drowned  as  the  result  of  acci- 
dent. Certain  fractures  likely  to  be  followed  by  immediate  death  may 
forbid  the  supposition  of  their  having  occurred  after  drowning,  and  a 
careful  examination  of  the  body  may  show  that  they  were  not  likely  to 
have  arisen  from  accident  at  or  about  the  time  of  submersion.  The  ques- 
tion has  arisen  whether  fractures  of  the  vertehrse  of  the  neck  can  occur 
from  accident  alone,  at  or  about  the  time  of  drowning.  In  1858  a  gentle- 
man, in  jumping  from  a  bathing  machine  head  foremost  into  water  more 
shallow  than  he  had  expected,  caused  a  fracture  and  displacement  or  the 
cervical  vertebras  which  led  to  death.  A  similar  accident  occurred  in  181'7. 
The  deceased  in  this  case  dived,  rose  to  the  surface  foaming  at  the  mouth, 
and  immediately  sank.  He  was  removed  from  the  water  and  taken  to  St. 
Thomas's  Hospital.  He  recovered  consciousness,  but  lost  all  power  in  his 
limbs  from  his  arms  downwards.  He  soon  died,  and  it  was  found  that 
t4iere  was  fracture  and  displacement  of  the  vertebra;  of  the  neck.  The 
accident  was  caused  by  deceased's  head  coming  in  contact  with  the  brick 
bottom  of  the  bath.  South  quotes  the  Case  of  a  man  who  threw  himself 
into  a  river  to  bathe  from  a  height  of  seven  or  eight  feet,  the  water  being 
only  three  feet  deep.  He  rose  to  the  surface,  but  fell  back  senseless. 
When  he  recovered  his  consciousness  the  account  he  gave  of  the  accident 
was  that  he  felt  his  hands  touch  the  bottom  of  the  river,  but  to  save  his 
head  drew  it  violently  back,  upon  which  he  lost  all  consciousness.  He 
died  in  about  ten  hours,  and  on  examination  the  skin  of  the  back  of  the 
neck  was  much  ecchymosed,  the  interspaces  of  the  muscles  were  gorged 
and  the  spinal  canal  was  filled  with  blood.  The  body  of  the  fifth  vertebra  of 
the  neck  was  Ijroken  across  about  the  middle  of  its  depth,  and  the  two 
pieces  were  completely  separated  from  the  lateral  parts.  As  there  was  no 
mark  of  contusion  or  dirt  on  the  head  Reveillon,  who  reports  the  case, 
believes  that  the  fracture  arose  from  muscular  action  and  not  from  a  blow 
received  by  striking  the  bottom  ;  but  this  is  doubtful.  In  another  in- 
stance a  sailor  jumped  headlong  into  the  sea  to  bathe,  a  sail  being  spread 
three  feet  below  the  surface.  He  immediately  became  motionless  and  died 
in  forty-eight  hours.  The  fourth  and  fifth  vertebra3  of'  the  neck  were 
found  extensively  fractured,  and  the  spinal  marrow  was  crushed  and  lac- 
erated. (Chelius's  Surgery,  Part  6  :  Fractures.)  In  this  case  the  fracture 
must  have  resulted  from  contact  with  the  water  or  the  sail ;  but  as  the 
latter  was  freely  floating  this  would  be  a  yielding  medium  ;  hence  this 
serious  injury  may  occur  accidentally  in  cases  in  which  we  might  not  be 
prepared  to  look  for  it.  Delens  has  directed  attention  to  fractures  and 
other  injuries  found  on  the  drowned  bodies  recovered  from  the  Seine  in 
Paris.  Some  of  these  have  been  wronglv  referred  to  acts  of  murderous 
violence.     (Ann.  d'Hyg.,  1878,  t.  2,  p.  433.) 

There  is  some  reason  to  believe  that  cases  of  homicidal  violence  are 
frequently  overlooked  in  the  inspection  of  bodies  found  in  water.  (See 
Brit.  Med.  Jour.,  1S78,  i.  p.  96.)  There  is  usually  no  post-mortem  ex- 
amination made  for  a  coroner's  inquest,  the  external  inspection  is  hastily 
conducted,  and  the  common  verdict  of  "  found  drowned  "  means  simply 
found  in  the  water.  In  April,  1891,  the  editor  found  strychnine  in  fatal 
dose  in  the  stomach  of  a  child  whose  dead  body  was  found  in  a  weighted 
basket  at  the  bottom  of  a  river.  It  is  easy  to  perceive  that,  had  no 
analysis  been  made,  this  child  might  have  been  supposed  to  be  drowned. 


HOMICIDAL    AND    SUICIDAL    DROWNING.  391 

Was  Drrmming  the  result  of  Homicide,  Suicide,  or  Accidevt? — Drown- 
ing is  a  frequent  cause  of  death.  From  a  return  made  to  the  House  of 
Commons  in  1878,  it  appears  that  the  total  deaths  by  drowning-  in  the 
inland  waters  of  England  and  AVales  during  the  year  1877  were  2G62, — 
namely,  2140  maleb"  and  522  females.  Of  the  2GG2,  U23  perished  in 
rivers  or  running  waters,  G37  in  canals,  and  G02  in  lakes  or  ponds. 
Although  the  question  whether  the  act  of  drowning  was  the  result  of  sui- 
cide or  murder  properly  falls  within  the  province  of  a  jury,  there  are 
certain  points  in  relation  to  it  which  require  to  be  noticed  by  a  medical 
witness.  In  the  first  place,  it  is  not  to  be  imagined  that  an  examination 
of  the  body  will  show  any  differences  in  either  of  the  three  supposed 
kinds  of  death.  So  far  as  the  phenomena  of  drowning  are  concerned, 
they  are  the  same,  and  they  are  accompanied  by  the  same  appearances 
after  death  in  each  case.  In  drowning  which  is  accidental  or  suicidal,  it 
is  not  usual,  as  it  has  already  been  observed,  to  meet  with  marks  of  vio- 
lence on  the  person,  except  such  as  are  purely  of  accidental  origin,  and 
have  commonly  been  produced  after  death.  In  accidental  drowning  this 
is  almost  a  constant  rule  ;  but  if  the  person  has  fallen  from  any  height, 
his  body  may  be  injured  in  the  fall,  either  by  projections  on  the  banks  of 
a  river  or  canal,  or  by  mere  concussion  on  the  water — allowance  for  either 
of  which  we  must  be  prepared  to  make,  according  to  the  situation  of  the 
spot  from  which  the  person  is  supposed  to  have  fallen. 

The  following  curious  case  of  supposed  suicidal  droAvning,  though 
the  appearances  might  well  give  rise  to  suspicion  of  homicide,  was 
communicated  to  the  editor  by  Lowndes,  of  Liverpool.  It  occurred 
in  the  autumn  of  1884.  The  body  of  a  girl,  a^t.  12i  years,  was 
found  floating  in  a  canal,  perfectly  nude.  The  post-mortem  exam- 
ination led  to  the  conclusion  that  death  had  resulted  from  drown- 
ing; the  body  had  not  been  immersed  more  than  twenty-four  hours. 
On  the  middle  of  each  thigh  was  an  extensive  wound,  apparently 
of  a  post-mortem  character,  and  attributable  to  the  body  having  been 
injured  by  the  lock-gates.  There  were  no  other  wounds  or  bruises.  The 
state  of  the  genitals  pointed  to  recent  sexual  intercourse;  but  the  immer- 
sion of  the  body  in  water  would  have  removed  blood  and  semen.  Several 
weeks  later  the  girl's  clothes  were  found  in  the  mud  of  the  canal.  They 
bore  evidence  of  rough  usage,  the  sleeves  of  the  jacket  being  torn  off — one 
being  turned  inside  out,  and  the  other  being  missing.  It  was  thought 
that  the  clothing  might  have  been  washed  off  by  a  powerful  sluice  of 
water.  The  sexual  intercourse  was  consistent  with  the  lewd  habits  of  the 
deceased. 

It  is  calculated  that  in  England  drowning  is  the  cause  of  death  in  nearly 
one-half  of  all  suicides  ;  but  this  of  course,  will  vary  according  to  locali- 
ties. In  suicidal  drowning  we  have  a  difficulty  to  encounter  which  we 
do  not  meet  with  in  that  which  is  accidental.  A  man  may  have 
attempted  suicide  by  some  other  means  previous  to  throwing  himself 
into  the  water  ;  thus,  then,  besides  the  accidental  violence  of  accidental 
drowning,  we  may  meet  with  violence  on  the  person,  evidently  indicating 
wilful  perpetration.  What  is  the  nature  of  this  violence?  Is  it  to  be 
defined  ?  Can  it  always  be  distinguished  from  that  which  is  positively 
homicidal  ?  The  answers  to  these  questions  must  depend  on  the  circum- 
stances proved  in  each  case. 

Drowning  in  Shalloio  Water. — Homicide  has  been  sometimes  presumed 
from  the  peculiar  circumstances  under  which  a  bod}^  has  been  discovered. 
Thus,  for  instance,  it  has  been  a  debated  question  whether  a  person  intent 
on  suicide  can  voluntarily  drown  himself  in  shallow  water,  as  in  a  bath, 


392  DROWNING    IN    SHALLOW    WATER. 

by  turning  upon  his  face  and  retaining  this  position  with  the  mouth 
below  the  level  of  the  water.  This  question  has  been  long  since  settled 
in  the  affirmative  by  the  occurrence  of  well-authenticated  cases.  It  ap- 
pears to  have  been  raised  originally  on  the  theoretical  view  that  the  reso- 
lution of  a  suicide  would  fail  him  in  such  a  situation,  and  that,  having  the 
means  of  escape,  he  would  lose  no  time  in  extricating  himself.  It  need 
hardly  be  stated  that  the  mere  immersion  of  the  mouth  in  water  not 
more  than  a  few  inches  deep  will  produce  all  the  phenomena  of  death  by 
drowning ;  Avith  the  exception  that  little  or  no  water  would  probably 
be  found  in  the  stomach.  A  man  may  thus  die  in  two  or  three 
minutes.  Devergie  mentions  an  instance  where  a  man  was  found 
drowned  in  a  small  stream,  his  face  towards  the  ground,  and  his  head  just 
covered  by  the  water,  which  was  not  more  than  a  foot  in  depth.  On  dis- 
section, there  were  all  the  appearances  of  drowning  present,  and  a  large 
quantity  of  sand  and  gravel  was  found  occupying  the  windpipe  and 
smaller  air-tubes.  In  1874,  a  drunken  man  fell  with  his  head  across  a 
shallow  ditch.  He  was  found  dead,  and  it  was  obvious  that  his  body  had 
so  dammed  up  the  water  that  it  had  flowed  over  his  face,  and  thus  caused 
his  death  by  drowning.  He  was  powerless  to  save  himself.  A  woman 
committed  suicide  by  breaking  a  hole  in  the  ice  of  a  pond  during  the 
winter  and  thrusting  her  head  into  the  water,  the  rest  of  her  body  being 
out.  A  man  was  found  dead  with  his  face  downwards  in  a  small  stream 
of  water  only  six  inches  deep.  The  water  was  so  shallow  that  it  did  not 
cover  the  deceased's  body  or  his  head.  There  was  clear  evidence  that 
this  was  a  case  of  suicidal  drowning. 

Although  a  person  has  for  a  short  time  the  power  of  removing  from  a 
position  in  Avhich  he  must  speedih^  die,  that  power  is  soon  lost.  If  the 
mouth  is  kept  below  water  by  a  strong  voluntary  effort  for  half  a  minute 
or  longer,  the  unaerated  blood  is  circulated  through  the  brain,  and  the 
person  becomes  powerless,  so  that  his  fate  is  not  now  in  his  own  hands. 
Lunatics  and  other  persons  have  thus  destroyed  themselves  in  shallow 
baths,  when  left  unwatched  by  the  attendant  for  only  lour  or  five  minutes. 
The  discovery  of  dead  bodies  under  these  circumstances  is,  therefore,  quite 
consistent  with  suicide,  but  it  does  not  necessarily  prove  that  the  act  was 
suicidal.  It  cannot  be  denied  that  a  person,  if  young  or  enfeebled  by  dis- 
ease or  age,  may  be  held  by  others  in  such  a  position  sufficiently  long  to 
produce  death  from  drowning,  but  if  he  is  capable  of  making  resistance, 
we  ought  to  find  some  marks  of  violence  on  the  limbs  or  body.  So, 
again,  such  a  position  is  b}^  no  means  incompatible  with  accidental  drown- 
ing; and  on  this  it  may  happen  that  a  medical  practitioner  will  be  called 
to  express  an  opinion.  A  man  in  a  state  of  intoxication,  or  when  suddenly 
attacked  by  syncope,  epilepsy,  or  apoplexy,  may  fall  with  his  face  in  a 
gutter,  ditch,  or  small  pool  of  water  ;  and  he  may  die  in  this  position,  not 
having  the  power  to  extricate  himself.  Even  marks  of  violence  on  the 
bodv  must  not  be  too  hastily  construed  into  proofs  of  murder.  Some 
veai-s  since  a  case  of  this  description  gave  rise  to  a  trial  for  murder  in  one 
of  the  midland  counties.  A  man  was  found  dead  with  his  face  in  some 
melted  snow,  and  there  Avere  several  severe  bruises  on  his  body.  The  evi- 
dence showed  that,  after  a  quarrel,  he  had  left  a  neighboring  inn  much 
intoxicated  ;  and  it  was  rendered  probable  that  he  had  perished  accidentally 
on  his  way  home.  There  was  no  reason  to  suppose  that  he  had  been 
murdered.  Infants,  from  mere  helplessness,  may  be  drowned  under  similar 
circumstances;  but  at  the  same  time,  an  assassin  may  select  this  mode  of 
destroying  life  in  order  to  give  the  appearance  of  accident. 


DROWNING    FROM    PARTIAL    IMMERSION  —  LIGATURES.       393 

Death  from  Partial  Immersion. — There  is  no  doubt  that  murder  by 
drowning-  may  be  perpetrated  without  the  whole  of  the  body  being  im- 
mersed in  water.  A  case  of  this  kind,  which  was  the  subject  of  a  criminal 
trial,  occurred  in  1841  (Reg-,  v.  Yaxley,  Norwich  Lent.  Ass.),  and  the 
prisoner  was  convicted.  It  appears  that  the  mode  in  which  the  prisoner 
destroyed  her  infant  cliild  was  by  immersing-  its  head  for  a  few  minutes 
in  a  pail  of  water.  She  removed  it  before  it  was  quite  dead  ;  but  it  soon 
died,  after  slight  convulsive  movements  of  ihe  limbs.  The  case  was 
rendered  obscure  by  the  fact  that  the  whole  of  the  body  had  evidently 
not  been  immersed  ;  and  the  only  conceivable  means  of  drowning  were  in 
a  small  duck-pond  adjoining  the  house,  which  was  covered  with  weeds; 
but  no  weed  was  found  in  the  stomach  of  the  child,  although  a  quantity  of 
water  was  present. 

Suicide  by  drowning  may  take  place  as  the  result  of  partial  immersion — 
the  immersion  of  the  head.  Several  cases  of  this  kind  have  occurred.  In 
1877,  a  Mr.  Stagg,  of  Birmingham,  was  found  dead  with  his  head  down- 
wards in  a  water-butt,  and  his  legs  protruding  over  the  top.  In  1877,  a 
woman  was  found  dead  in  London  ;  she  was  in  a  stooping  position  on  the 
floor,  and  her  face  downwards  in  a  pail  of  water.  In  1878,  a  woman  wa-s 
found  dead  with  her  head  immersed  in  a  water-tank  only  a  foot  wide  ;  she 
had  so  placed  her  head  that  it  was  under  the  bar  of  the  ball-tap.  These 
cases  show  determined  acts  of  suicide.  On  several  occasions,  however, 
persons  whilst  examining  water-cisterns  have  fallen  into  them  and 
perished  accidentally — the  head  only  being  immersed. 

Ligatures  on  the  Hands  and  Feet. — When  a  drowned  body  is  removed 
from  water  with  the  hands  or  the  hands  and  feet  bound  with  cords,  it  is 
usually  considered  that  we  have  therein  presumptive  evidence  of  homicide  ; 
but  numerous  cases  are  recorded  in  which  suicides  have  actually  bound 
themselves  in  this  manner,  or  have  attached  heavy  weights  to  their  bodies 
before  throwing  themselves  into  water,  for  the  express  purpose  of  prevent- 
ing any  chance  of  their  escaping  death. 


394  HANGING — CAUSE  OF  DEATH. 


HANGING. 


CHAPTEE    XXXIX. 

CAUSE    OP    DEATH. DEATH    FROM    THE    SECONDARY  EFFECTS. POST-MORTEM    APPEARANCES. 

MARK    OF    THE     CORD     OR     LIGATURE. WAS    DEATH     CAUSED    BY    HANGING  ? HANGING 

AFTER      DEATH. SUMMARY      OF      MEDICAL     EVIDENCE. —  MARKS       OF     VIOLENCE      ON     THE 

HANGED. WAS     THE     HANGING     THE     RESULT    OP     ACCIDENT,    SUICIDE,    OR    HOMICIDE  ? 

THE    POSITION    OF    THE    BODY. 

Cause  of  Death.  Asphyxia. — By  hanging  we  are  to  understand  that 
kind  of  death  in  which  the  body  is  wholly  or  partially  suspended  by  the 
neck  and  the  constricting  force  iS  the'weight  of  the  body  itself,  while  in 
strangulation  the  constricting  force  is  due  to  some  other  cause.  In  both 
cases  death  commonly  results  from  asphyxia  (p.  64),  although  this  must 
depend  in  a  great  measure  upon  the  position  of  the  ligature  on  the  neck  as 
well  as  on  the  degree  of  pressure  produced.  If  the  cord  is  loose,  or  ap- 
plied to  the  upper  part  of  the  neck,  a  small  quantity  of  air  may  still  reach 
the  lungs,  and  then  the  cerebral  circulation  may  become  interrupted  by 
the  compression  of  the  great  vessels  of  the  neck.  In  this  case  apoplexy  of 
the  congestive  kind  is  induced,  and  operates  as  the  immediate  cause  of 
death.  It  is  easy  to  conceive  that  there  may  be  a  mixed  condition  of 
asphyxia  and  apoplexy,  and  according  to  the  observations  of  Casper  and 
Remer,  this  is  actually  met  with  in  a  great  number  of  cases  of  death  from 
hanging.  A  man,  set.  57,  committed  suicide  by  hanging.  After  being 
suspended  for  an  hour,  he  was  cut  down.  As  the  doubled  rope  was 
slackened  from  the  neck,  air  escaped  through  the  larynx,  and  a  prolonged, 
rather  loud  groan  was  heard.  As  an  explanation,  Holland  suggests  that 
the  suicide,  in  hanging  himself,  drew  in  a  deep  breath,  and  the  sudden  and 
violent  constriction  of  the  neck  retained  the  air  in  the  chest  until  the  liga- 
ture was  removed.     (Brit.  Med.  Jour.,  1S75,  i.  p.  575.) 

In  the  execution  of  criminals,  death  takes  place  at  different  intervals  of 
time  after  suspension.  This  difference  is  probably  dependent  on  the 
greater  or  less  degree  of  constriction  produced  by  the  ligature.  If  the 
rope  should  press  upon  the  larynx  or  above  this  organ,  the  closure  of  the 
air-passages  will  not  be  so  complete  as  if  pressed  upon  the  windpipe  im- 
mediately below  the  cricoid  cartilage.  A  slight  degree  of  respiration 
might  in  the  former  case  continue  for  a  short  interval,  in  which  the  life  of 
a  person  would  be  prolonged,  while,  in  the  latter,  death  would  be  im- 
mediate. If  the  windpipe  is  in  part  ossified,  the  pressure  of  the  ligature 
is  less  perfect,  and  death  will  then  take  place  more  slowly.  Louis  found 
that  an  occasional  cause  of  death  in  hanging  was  a  displacement  of  the 
second  vertebra  of  the  neck,  whereby  the  spinal  marrow  was  suddenly 
compressed.  As  a  general  rule,  this  cause  of  death  is  only  likel}'  to  be 
observed  in  corpulent  or  heavy  persons,  when  a  long  drop  is  given,  and 
when  much  violence  has  been  at  the  same  time  employed  by  the  exe- 
cutioner.    Fractures  of  the  vertebrae  may  occur,  and  prove  fatal  by  com- 


SECONDARY    CAUSES    OF    DEATH.  .       395 

pressing  the  spinal  marrow.  Death  may  also  be  caused  suddenly,  by 
cerebral  congestion  from  pressure  on. the  bloodvessels  or  by  the  effusion 
of  blood  on  the  spinal  membranes.  This  is  likely  to  happen  when  the 
head  falls,  or  is  bent  suddenly  backwards,  so  that  the  weight  of  the  body 
is  supported  on  the  back  of  the  neck. 

Death  from  hanging  appears  to  take  place  very  rapidly  and  without 
causing  any  physical  suffering  to  the  person.  It  is  observed  that  in  those 
criminals  who  are  executed,  there  are  sometimes  violent  convulsions  of 
the  limbs  and  trunk.  There  is  no  reason,  however,  to  believe  that  the 
individual  suffers  pain,  any  more. than  in  the  convulsions  of  an  epileptic 
fit.  On  recovery  there  is  an  entire  loss  of  consciousness  of  pain  in  both 
cases.  The  circulation  of  dark-colored  blood  through  the  brain  and  spinal 
cord  may  account  for  these  effects.  Efforts  to  inspire  are  made  for  one  or 
two  minutes  after  the  closure  or  compression  of  the  windpipe.  The 
diaphragm  and  intercostal  muscles  act  spasmodically,  but  no  air  enters 
the  lungs  ;  and  it  is  probable  that  in  the  act  of  hanging,  part  of  the  air 
contained  in  the  organs  is  convulsively  expelled.  When  the  suspension 
of  the  body  has  continued  only  a  few  minutes,  it  has  often  been  found 
impossible  to  restore  life  ;  and  indeed,  the  period  at  which  resuscitation 
may  take  place  varies  according  to  circumstances.  Supposing  the  hang- 
ing- to  be  unattended  with  violence  to  parts  about  the  neck,  some  persons 
might  be  resuscitated  after  five  minutes'  suspension  or  longer,  but  then  it 
has  been  observed  that  they  have  subsequent!}^  died  from  secondary  causes 
affecting  the  brain  and  nervous  system.  Others,  again,  may  not  be  re- 
covered when  they  are  cut  down  immediately  after  suspension — a  fact 
which  depends  probably  on  the  different  degrees  to  which  asphyxia  or 
apoplexy  has  extended.  When  the  ligature  is  so  placed  as  to-  press  on  the 
windpipe  below  the  larynx,  insensibility  and  death  are  almost  instan- 
taneous. 

Patenko  has  investigated  asphyxia  due  to  mechanical  causes,  and  draws 
a  clear  distinction  between  the  appearances  met  with  according  as  the 
access  of  air  is  shut  off  at  the  end  of  an  expiration  or  at  the  end  of  an 
inspiration.  He  shows  that  if  a  dog  be  hanged,  the  drop  taking  effect  as 
expiration  is  completed,  the  efforts  at  inspiration  result  in  engorgement 
of  the  lungs ;  whereas  if  the  drop  takes  effect  at  the  moment  when  in- 
spiration is  completed,  the  lungs  are  comparatively  bloodless.  (Ann. 
d'Hyg.,  1885,  t.  1,  p.  209.) 

Death  from  the  Secondary  Effects. — It  by  no  means  follows  that,  be- 
cause we  have  succeeded  in  restoring  the  respiratory  process,  a  person  is 
safe.  Death  may  take  place  by  a  fatal  relapse  at  various  periods  after  the 
accident.  A  case  of  this  description  was  published  by  Brodie.  A  boy, 
set.  17,  was  found  hanging.  When  cut  down  he  was  insensible,  his  face 
livid,  his  lips  of  a  dark  purple  color,  the  pulse  not  perceptible,  the  pupils 
dilated  and  motionless.  Artificial  respiration  was  used,  and  in  a  quarter 
of  an  hour  the  diaphragm  began  to  act.  He  breathed  at  irregular  intervals 
with  stertor  and  with  a  rattling  noise  in  the  throat.  The  pulse  became 
perceptible,  but  often  flagging,  and  the  surface  of  the  body  was  cold.  The 
countenance  was  still  livid,  but  the  pulse  and  breathing  had  improved. 
At  the  end  of  another  hour  an  attempt  was  unsuccessfully  made  to  take 
some  blood  from  the  arm,  and  the  patient  was  placed  in  a  warm  bath. 
The  breathing  was  stertorous  through  the  night,  and  in  the  morning 
twelve  ounces  of  blood  were  taken  from  the  arm  ;  but  there  was  no  relief. 
He  continued  insensible,  and  cold  on  the  surface  ;  there  was  frothing  at 
the  mouth,  and  he  died  twenty-four  hours  after  he  was  cut  down.     The 


396  SECONDARY    CAUSES    OF    DEATH. 

boy  was  carefully  examined.  The  vessels  of  the  brain  were  very  full  of 
blood:  this  was  the  only  morbid  appearance. 

We  learn  from  those  who  have  been  resuscitated,  as  well  as  from  ex- 
periments performed  bv  persons  upon  themselves,  that  the  insensibility  of 
asphyxia  comes  on  in  the  most  insidious  manner  in  death  from  hanging-, 
and  that  a  slight  constriction  of  the  windpipe  will  speedily  produce  loss  of 
consciousness  and  muscular  power.  (Devergie,  2,  370.)  The  onlv  svmp- 
toms  of  which  the  hanged  persons  have  been  conscious  were  a  hissing-  in 
the  cars,  a  flash  of  light  before  the  eyes,  then  darkness  and  oblivion.  The 
only  profitable  inference,  in  a  medicorlegal  view,  which  can  be  drawn 
from  observations  of  this  kind  is  that  asphyxia  is  not  only  rapidly  induced, 
but  that  it  supervenes  under  circumstances  where  it  would  not  be  generally 
expected  to  occur — i.e.  when  the  weight  of  the  body  is  in  great  part  sup- 
ported. Fleischmann  found  that  a  cord  might  be  placed  round  his  neck 
between  the  chin  and  hyoid  bone,  and  tightened  either  laterally  or  poste- 
riorly without  perceptibly  interrupting  respiration  ;  but  while  the  respi- 
ratory process  Avas  thus  carried  on,  his  face  became  red,  his  eyes  prominent, 
and  his  head  felt  hot.  These  symptoms  were  followed  by  a  sen-se  of 
weight,  a  feeling  of  incipient  stupefaction,  and  a  hissing  noise  in  the  ears. 
On  the  occurrence  of  this  last  symptom,  the  experiment,  he  says,  should 
be  discontinued,  or  th.e  consequences  may  be  serious.  His  first  experi- 
ment on  himself  lasted  two  minutes ;  but  in  the  second,  owing  to  the  cord 
by  its  pressure  more  completely  interrupting  respiration,  the  noise  in  the 
ears  appeared  in  half  a  minute.  When  the  pressure  was  applied  on  the 
windpipe,  the  effect  was  instanto/neous,  but  when  on  the  cricoid  cartilage 
it  was  not  immediate.  If  it  was  applied  between  the  hyoid  bone  and  the 
thyroid  cartilage,  or  on  the  hyoid  bone  itself,  the  period  during  which  a 
person  could  breathe  was  extremely  short ;  and  this  result  was  more  strik- 
ing when  the  act  of  expiration  was  performed  at  the  moment  of  applying 
the  presure. 

The  death  of  Scott,  the  American  diver,  in  1840,  shows  how  readily 
asphyxia  may  be  induced  by  a  slight  compression  of  the  throat,  even  when 
a  person  might  be  supposed  to  have  both  the  knowledge  and  the  power  to 
save  himself.  This  man  was  in  the  habit  of  making  public  experiments 
on  hanging,  and  had  frequenth'  before  gone  through  them  without 
danger  ;  but  on  the  last  occasion  it  is  probable  that  a  slight  shifting  of  the 
ligature  from  under  the  jawbone  caused  so  much  compression  on  the  throat 
between  the  chin  and  larynx  as  speedily  to  produce  asphyxia.  Xo  at- 
tempt was  made  to  save  him  until  it  was  too  late,  and  he  was  not  brought 
to  a  hospital  until  thirty-three  minutes  had  elapsed.  He  was  allowed  to 
hang  thirteen  minutei<,  the  spectators  thinking  that  the  deceased  was  only 
prolonging  the  experiment  for  their  gratification.  The  very  insidious  and 
painless  manner  in  which  a  person  who  is  suspended  passes  from  life  into 
death  is  also  well  illustrated  in  the  report  of  the  case  of  Hornshaw. 
(Lancet,  184t,  i.  p.  404.)  This  man  was  on  three  occasions  resuscitated 
from  hansring- — a  feat  which,  like  Scott,  he  had  performed  in  London  for 
public  gratification.  He  stated  that  on  the  last  occasion  he  lost  his  senses 
almo.'^t  at  once ;  it  seemed  as  if  he  could  not  get  his  breath,  and  that  some 
great  weight  was  attached  to  his  feet:  he  felt  that  he  could  not  move  his 
hands  or  legs  to  save  himself,  and  that  the  power  of  thinking  was  gone. 
It  is  not  improbable  that  many  persons  have  thus  lest  their  lives  by 
privately  attempting  these  experiments,  and  their  cases  have  been  wrongly 
set  down  to  acts  of  suicide.  There  is  reason  to  believe  that  boys  have 
thus  frequently  but  unintentionally  destroyed  themselves,  from  a  strange 
principle  of  imitation  or  curiosity.     In   1874,  a  boy,  set,  11,  in  order  to 


HANGING — POST-MORTEM    APPEARANCES.  397 

frighten  bis  parents,  tied  a  ]<not  in  his  handkerchief  and  put  one  part  of 
it  over  the  Ivnob  of  the  uprig-ht  at  the  foot  of  the  staircase,  and  the  other 
underneath  his  chin,  so  that  the  ligature  did  not  go  round  his  neclc.  His 
dead  body  was  found  suspended  in  the  loop,  which  had  pressed  against 
the  windpipe  and  produced  speedy  unconsciousness. 

Fost-inortem  Apjtearances. — The  external  appearances  met  with  in  the 
hanged  have  been  generally  taken  by  medico-legal  writers  from  those  seen 
in  the  bodies  of  criminals  who  have  been  executed,  or  those  who  have  been 
violently  hanged.  Thus  among  them  are  the  following :  lividity  and 
swelling  of  the  face,  especially  of  the  lips,  which  appear  distorted ;  the 
eyelids  swollen,  and  a  bluish  color ;  the  eyes  red,  projecting  forwards,  ' 
and  sometimes  partially  forced  out  of  their  carvities ;  the  tongue  enlarged, 
livid,  and  either  compressed  between  the  teeth  or  sometimes  protruded ; 
the  lower  jaw  retracted,  and  a  bloody  froth  about  the  lips  and  nostrils. 
There  is  a  deep  and  ecchymosed  impression  around  the  neck,  indicating 
the  course  of  the  cord,  the  skin  being  occasionally  excoriated  ;  laceration 
of  the  muscles  and  ligaments  in  the  hyoideal  region  ;  laceration  or  contu- 
sion of  the  larynx,  or  of  the  upper  part  of  the  windpipe.  There  are  also, 
commonly,  circumscribed  patches  of  ecchymosis,  varying  in  extent,  about 
the  upper  part  of  the  body  and  the  upper  and  lower  limbs,  with  a  deep  livid 
discoloration  of  the  hands;  the  fingers  are  generally  much  contracted  or 
firmly  clenched,  and  the  hands  and  nails,  as  well  as  the  ears,  are  livid ;  the 
urine,  feces,  and  spermatic  or  prostatic  fluid  are  sometimes  involuntarily 
expelled  at  the  moment  of  death.  Such  appearances  will  rarely  be  found 
in  those  cases  of  suicidal  hanging  which  are  likely  to  come  before  a  medi- 
cal practitioner.  In  these,  the  face  is  generally  pale,  and  the  mark  on  the 
neck  is  a  simple  depression  in  the  skin,  usually  without  ecchymosis,  and 
acquiring  a  horny  or  parchment  color  only  after  some  time.  Esquirol 
found,  in  one  instance,  that  when  the  body  was  examined  immediately 
after  death  the  face  was  not  livid,  but  it  first  began  to  assume  a  violet 
hue  in  eight  or  ten  hours.  He  thought  that  when  the  cord  was  left  round 
the  neck  the  face  would  be  livid,  but  if  moved  immediately  after  suspen- 
sion, pale.  This  view  is  not,  however,  borne  out  by  observation.  The 
tongue  is  not  always  protruded.  Devergie  found  that  there  was  protru- 
sion of  this  organ  in  eleven  out  of  twenty-seven  cases.  This  protrusion 
w^as  formerly  supposed  to  depend  upon  the  position  of  the  ligature :  thus 
it  was  said,  when  this  was  below  the  cricoid  cartilage,  the  whole  of  the 
larynx  was  drawn  upwards  with  it ;  while,  when  above  the  hyoid  bone, 
the  tongue  was  drawn  backwards.  The  protrusion  or  non-protrusion 
of  the  tongue  does  not  depend  upon  any  mechanical  effect  of  this  kind, 
but  simply  upon  congestion  ;  for  it  is  occasionally  met  with  thus  protrud- 
ing in  cases  of  drowning  and  suffocation.  Besides,  the  protrusion  has  not 
been  found  to  have  any  direct  relation  to  the  position  of  the  ligature. 

There  is  another  appearance  on  which  a  remark  may  be  made — namely, 
the  state  of  the  hands.  As  a  general  rule,  in  violent  hanging  or  strangu- 
lation, the  hands  are  clinched.  This  appearance  may  not  always  be  found, 
as  it  may  exist  and  be  destroyed  before  the  body  undergoes  medical  in- 
spection. When  the  constriction  of  the  neck  is  produced  suddenly  and 
with  great  violence,  we  niay  expect  to  meet  with  it.  Thus  it  is  found  in 
the  cases  of  executed  criminals  and  in  strangulation  attended  with  great 
violence,  whether  the  act  be  due  to  homicide  or  suicide.  In  cases  in  which 
the  constriction  is  gradually  produced,  the  clenched  state  of  the  hands  may 
not  be  found.  Convulsions  generally  attend  violent  hanging  or  strangu- 
lation. The  influence  of  these  on  the  attitude  or  dress  may  not  appear 
unless  the  body  is  in  a  sitting  position  or  lying  down. 


398        EXTERNAL  AND  INTERNAL  APPEARANCES. 

Internally,  we  meet  with  the  appearances  of  asphyxia — i.e.  engorgement 
of  the  lungs  and  venous  system  generally  with  dark-colored  fluid  blood  ; 
the  lungs  otherwise  present  no  particular  appearance.  In  the  case  of  an 
executed  criminal  they  were  in  a  state  of  extreme  collapse.  (Lancet,  1861, 
ii.  p.  576.)  This  is  an  unusual  appearance.  The  right  side  of  the  heart, 
and  the  great  vessels  connected  with  it,  are  commonly  distended  with 
blood.  But  when  the  inspection  has  been  delayed  for  several  days  this 
distention  may  not  be  observed.  The  mucous  membrane  of  the  windpipe 
is  more  or  less  congested,  and  is  sometimes  covered  with  a  fine  bloody 
mucous  froth.  This  may  be  owing  to  imperfectly  obstructed  respiration, 
and  to  spasmodic  efforts  at  breathing.  The  vessels  of  the  brain  are  com- 
monly found  congested;  and  in  some  rare  instances  it  is  said  extravasa- 
tion of  blood  has  been  met  with  on  the  membranes  or  in  the  substance  of 
the  organ.  Effusion  of  blood  is,  however,  so  rare  that  Bemer  found  this 
appearance  described  only  once  among  one  hundred  and  one  cases;  and 
in  one  hundred  and  six  cases  recorded  by  Casper  it  was  found  in  a  single 
instance.  In  one  case  Brodie  found  a  large  effusion  of  blood  in  the  sub- 
stance of  the  brain,  and  he  refers  to  another  case  in  which  there  was  a 
considerable  effusion  between  the  membranes.  (Lect.  on  Pathology,  p. 
58.)  The  venous  congestion  of  the  cerebral  vessels  is,  however,  rarely 
greater  than  in  other  cases  of  asph3^xia,  and  is  probably  dependent  on  the 
degree  in  which  the  lungs  have  been  engorged.  In  most  instances  there 
is  increased  redness  of  the  substance  of  the  brain,  so  that,  on  making  a 
section  of  the  hemispheres,  a  greater  number  of  bloody  points  (puncta 
cruenta)  then  usual  will  appear.  The  kidneys  have  been  found  much  con- 
gested. A  more  important  circumstance  has  been  noticed  by  Yellowh-  — 
namely,  that  in  examining  the  stomachs  of  five  criminals  who  had  been 
hanged,  he  found  great  congestion  in  all,  while  there  was  blood  coagulated 
upon  the  mucous  membrane  in  two.  Such  an  appearance  might,  it  is 
obvious,  be  attributed  in  a  suspicious  case  to  the  action  of  some  irritant 
substance.  (See  p.  90,  ante;  Ann.  d'Hyg.,  1830,  p.  166;  1835,  p.  208; 
1838,  p.  471.)  In  the  case  of  Good,  who  was  executed,  the  stomach  was 
found  on  inspection  to  present  over  its  whole  surface  a  well-marked  red- 
ness, resembling  the  effect  produced  by  an  irritant  poison.  The  redness 
was  especially  observed  at  the  pyloric  end,  where  it  assumed  a  somewhat 
striated  character.  A  drawing  representing  the  appearance  of  the  interior 
of  the  stomach  is  preserved  in  the  Museum  of  Guy's  Hospital.  In 
another  case  the  stomach  and  the  intestines,  especially  the  inner  coat  of 
the  former,  were  much  congested  and  inflamed,  as  if  the  man  had  died  from 
poisoning.  The  contents  of  the  stomach  were  analyzed,  but  no  poison 
was  found.  Chevers,  who  quotes  this  case,  states  that  he  has  more  than 
once  verified  Yellowly's  observation,  and  he  found  the  mucous  membrane 
of  the  stomach  much  congested  in  death  from  hanging.  (Med.  Jurispr. 
for  India,  p.  397.) 

The  most  striking  external  appearance,  however,  is  the  mark  produced 
on  the  neck  by  the  cord  or  ligature.  The  skin  is  commonly  depressed, 
and  is  sometimes  ecchymosed,  but  rarely  throughout  its  M^hole  extent ;  it 
is  frequently  free  from  all  traces  of  discoloration  as  the  result  of  ecchymo- 
sis,  the  skin  in  the  depression  being  then  hard,  brown,  or  of  a  parchment 
color  and  consistency ;  or  there  may  be  only  a  thin  line  of  blue  or  livid 
color  in  the  upper  or  lower  border  of  the  depression,  and  chiefly  in  front. 
The  course  of  the  mark  is  generally  oblique,  being  lower  in  the  forepart 
than  behind,  and  it  is  often  interrupted.  It  is  most  commonly  above  the 
larynx.  If  the  noose  should  happen  to  be  in  front,  the  mark  may  be  cir- 
cular, the  jaw  preventing  the  ligature  from  rising  upwards  in  the  same 


APPEARANCES    OF    THE    NECK.  399 

degree  before,  as  it  commonly  does  behind.  The  mark  is  generally  single, 
but  we  may  meet  with  it  double,  as  when  the  ligature  has  been  formed 
into  two  circles  or  loops  previously  to  its  application.  Its  other  characters 
will  depend  upon  the  nature  of  the  ligature  employed.  Thus  a  large  and 
wide  ligature  rarely  produces  ecchymosis — the  mark  is  wide  and  super- 
ficial ;  but  a  small  ligature  produces  a  narrow  and  deep  depression  some- 
times accompanied  with  abrasion  of  the  cuticle  and  effusion  of  blood  beneath 
the  skin.  The  ligature  or  cord  should  always  be  examined  for  blood,  hair, 
or  other  suspicious  substances. 

It  was  formerly  believed  that  the  mark  on  the  skin  produced  by  the 
cord  was  invariably,  discolored  from  effusion  of  blood,  or  ecchymosis;  but 
more  correct  observation  has  shown  that  this  condition  is  an  exception  to 
the  general  rule.  When  ecchymosis  does  exist,  it  is  commonly  superficial 
and  of  slight  extent.  There  is  rarely,  if  ever,  effusion  of  blood  in  the 
cellular  tissue.  In  the  bodies  of  criminals  who  have  been  executed  it  is 
not  unusual  to  find  ecchymosis,  but  even  here  it  is  not  always  present,  or 
only  in  front  of  the  neck.  Riecke  found  only  once  in  thirty  cases  an  effu- 
sion of  blood  beneath  and  on  both  sides  of  the  depression  produced  by  the 
ligature.  The  tongue  was  generally  between  the  teeth,  and  in  most  cases 
■wounded  by  them.  He  attributed  death  to  stretching  of  the  spinal  mar- 
row. (Henke's  Zeitschrift,  1840,  27  Erg.  H.  332.)  In  a  case  which  the 
author  had  an  opportunity  of  examining,  there  was  only  a  slight  trace  of 
ecchymosis  in  one  spot  where  the  knot  in  the  cord  had  produced  contu- 
sion. That  it  should  occur  in  criminal  executions  is  not  surprising,  con- 
sidering the  violence  employed  on  these  occasions ;  but  it  has  been  some- 
what too  hastily  assumed  that  the  appearances  found  in  executed  crimi- 
nals are  met  with  in  all  cases  of  death  from  hanging.  King,  in  examining 
the  neck  of  an  executed  criminal,  did  not  discover  the  smallest  effusion  of 
blood,  in  the  course  of  the  cord,  although  in  this  case  the  body  had  been 
allowed  to  fall  from  a  height  of  seven  feet  and  a  half,  with  a  fearful  jerk. 
(Dub.  Quart.  Jour.,  1854,  ii.  p.  86  ;  and  "Cases  of  Ruptured  Intestine," 
1855,  p.  12.)  The  theory  of  the  production  of  ecchymosis  has  been  car- 
ried so  far  that  a  livid  mark  in  the  course  of  the  cord  was  formerly  said 
to  be  the  best  criterion  for  distinguishing  hanging  in  the  living  from 
hanging  in  the  dead  body.  This  statement,  however,  is  not  in  accordance 
with  facts.  In  a  large  number  of  cases  the  skin,  instead  of  being  blue  or 
livid,  or  presenting  an  effusion  of  blood  in  the  cellular  tissue  beneath,  is 
hard  and  of  a  yellow  color,  resembling  parchment.  It  has  that  appear- 
ance which  the  cutis  commonly  assumes  when  the  cuticle  has  been  re- 
moved from  it  two  or  three  days ;  and,  on  dissecting  it,  the  cellular  mem- 
brane beneath  often  appears  condensed  and  of  a  silvery  whiteness.  Chevers 
states  that  in  cases  of  death  from  hanging  he  has  not  met  with  any  ecchy- 
mosis in  the  skin  along  the  course  of  the  mark.  (Op.  cit.,  p.  389.)  The 
editor  can  confirm  this  observation.  In  some  instances  the  mark  has  pre- 
sented itself  simply  as  a  white  depression;  this  has  been  chief! 3"  observed 
in  fat  subjects.  The  observations  of  Casper  on  this  point  were  that  in 
two-thirds  of  all  the  cases  examined  ecchymosis  was  entirely  absent.  He 
also  found  that  there  was  no  difference  in  the  appearance  whether  the  lig- 
ature w^as  removed  sooner  or  later  after  death. 

Injuries  to  the  muscles  and  deep-seated  parts  of  the  neck  are,  of  course, 
only  likely  to  be  seen  when  considerable  violence  has  been  used  in  hang- 
ing. It  is  now  customary  in  criminal  executions  to  give  a  long  drop  to 
the  body,  i.  e.  from  six  to  eight  or  more  feet.  Under  these  circumstances, 
the  muscles  of  the  neck  are  found  bruised  and  lacerated.  In  two  instances 
the  head  was  wrenched  off.     The  sterno-cleido-mastoid  muscle  has  been 


400  THE    MARK    OF    THE    CORD. 

found  torn  throug'h,  and  its  ends  nearly  two  inches  apart.  In  other  in- 
stances the  lining  membrane  of  the  common  carotid  artery  has  been  found 
lacerated.  Congestion  and  swelling  of  the  genital  organs  in  both  sexes 
have  been  set  down  among  the  common  consequences  of  hanging;  but 
many  observers  have  not  met  with  these  conditions,  and  it  is  doubtful 
whether,  unless  the  body  is  examined  speedily  after  suspension,  any 
marked  difference  would  be  discovered.  A  more  common  sign,  perhaps, 
is  a  discharge  from  the  urethra  in  the  male,  by  spasmodic  action,  at  the 
moment  at  which  death  takes  place.  It  appears  that  no  reliance  can  be 
placed  upon  evidence  derivable  from  this  appearance,  and  yet  it  has  suf- 
ficed to  give  rise  to  a  violent  controversy  among  French  medical  jurists. 
(Ann.  d'Hyg.,  1839,  t.  1,  pp.  169,  467  ;  t.  2,  p.  393;  1840,  t.  2,  p  314.) 
IJnless  death  from  hanging  is  strongly  established  by  other  facts,  neither 
the  examination  of  the  linen  of  the  deceased,  nor  the  application  of  the 
microscope  to  the  mucous  fluid  found  in  the  urethra,  would  be  of  any 
practical  value  in  elucidating  the  question.  In  a  criminal  execution  which 
took  place  at  Dublin,  in  which  there  was  a  fall  of  fourteen  feet,  the  head 
was  .severed  from  the  bod3^  There  was  no  dislocation  of  the  vertebrae. 
The  atlas  was  intact,  but  the  axis  was  fractured.  Blood  flowed  from  the 
head  in  greater  quantity  than  from  the  body.  The  carotid  arteries  con- 
tinued to  bleed  at  intervals  for  five  minutes  after  death.  (Lancet,  1871, 
L  p.  166;  ii.  p.  210.) 

The  following  may  be  regarded  as  a  summary  of  the  appearances  in 
hanging,  when  death  has  really  taken  place  from  asphyxia:  The  counte- 
nance is  cither  livid  or  pale;  the  eyes  are  prominent;  the  tongue  con- 
gested and  occasionally  protruded ;  the  lower  jaw  retracted;  the  skin  is 
covered  with  patches  of  cadaveric  lividity;  the  hands  are  livid  and 
clenched;  an  oblique  mark  is  found  on  the  neck,  sometimes  presenting 
traces  of  ecchymosis;  commonly,  however,  the  skin  is  only  broAvn  in 
color  and  hardened;  the  larynx,  windpipe,  and  subjacent  muscles  are 
lacerated,  depressed,  or  discolored;  the  vessels  of  the  brain  are  congested, 
as  well  as  those  of  the  lungs  and  the  right  cavities  of  the  hearty  a  mucous 
froth  tinged  with  blood  is  occasionally  found  in  the  windpipe.  These  ap- 
pearances will,  of  course,  be  modified,  or  they  may  be  altogether  absent, 
when  death  has  arisen  from  disorder  of  the  cerebral  circulation,  or  from 
injury  to  the  spinal  marrow,  either  by  great  congestion,  effusion  of  blood, 
fracture,  or  displacement.  Patenko  describes  intense  congestion  of  the 
medulla  oblongata  as  an  appearance  found  in  death  from  hanging.  (Ann. 
d'Hvg.,  1885,  t.  1,  p.  209.) 

Was  Death  caused  by  Hanging  ? — When  a  person  is  found  dead  and  his 
body  is  suspended,  it  may  be  a  question  whether  death  really  took  i>lace 
from  hanging  or  not.  In  investigating  a  case  of  this  kind,  it  is  necessary 
to  draw  a  distinction  between  the  external  and  intei-nal  appearances  of" 
the  body.  The  former  alone  can  assist  us  in  returning  an  answer  to  this 
question;  the  internal  appearances  of  the  body  can  furnish  only  the  gen- 
eral signs  of  asphyxia,  and  enable  us  to  say  whether  any  latent  cause  of 
death  existed. 

The  Mark  of  the  Cor^Z.— Among  the  external  appearances,  it  is  chiefly 
to  the  mark  produced  by  the  cord  on  the  neck  that  medical  jurists  have 
looked  for  the  determination  of  this  question.  As  the  form,  position,  and 
other  characteristics  of  thismark  have  been  already  described,  it  will  now 
be  necessary  to  allude  to  it  only  as  furnishing  evidence  of  life  at  the  time 
of  its  production.  It  has  been  stated  that,  so  I'ar  from  being  constantly 
livid  or  ecchymosed,  this  condition  is  in  reality  not  seen  in  more  than  one- 
half  of  the  cases  which  occur.     But  admitting  that  we  find  ecchymosis  in 


THE    MARK    OF    THE    CORD.  401 

the  course  of  the  ligature,  are  we  always  to  infer  that  it  must  have  been 
applied  while  the  person  was  living?  There  are  numerous  cases  which 
show  that  active  life  is  not  necessary  for  the  production  of  ecchymosis  in 
the  mark  ;  and  from  the  experiments  of  Devergie,  it  would  appear  that  if 
a  body  is  hanged  immediately  or  a  short  time  after  death,  an  ecchymosed 
mark  may  be  produced  on  the  neck  by  the  ligature.  (Op.  cit.,  t.  2,  p.  408.) 
If  a  few  hours  were  suffered  to  elapse,  so  that  the  body  had  become  cold 
before  suspension,  no  ecchymosis  was  produced  by  the  ligature.  Yrolik 
found,  however,  that  a  slightly  livid  mark  was  produced  on  the  neck  of  a 
dead  body  which  had  been  suspended  after  the  lapse  of  an  hour  from  the 
time  of  death.  (Casper,  Wochenschr.,  Feb.  1838.)  Hence  this  condition 
of  the  mark  in  the  body  found  dead  merely  indicates,  either  that  the 
deceased  must  have  been  hanged  while  living,  or  very  soon  after  death. 
It  would  be  for  a  jury  to  decide  between  these  two  assumptions,  and  to 
consider  why,  when  a  man  had  really  died  from  any  other  cause,  his  body 
should  have  been  hanged  in  secrecy  immediately  after  death.  (See  Ann. 
d'Hyg.,  1842,  t.  1,  p.  134.)  The  circumstance  that  an  ecchymosed  mark 
may  be  produced  by  suspending  a  recently  dead  body  bears  out  the  state- 
ment of  Merzdorff,  that  it  would  be  in  the  highest  degree  difficult,  if  not 
utterly  impossible  to  determine  medically,  from  an  inspection,  whether  a 
man  had  been  hanged  while  living,  or  whether  he  had  been  first  suffocated 
and  his  body  suspended  immediately  after  death.  In  making  this  admis- 
sion, it  is  proper  to  bear  in  mind  that  that  which  is  difficult  to  a  conscien- 
tious medical  jurist  in  confining  himself  to  the  medical  facts,  is  often  easily 
decided  by  a  jury  from  these  as  well  as  the  general  evidonce  afforded  to 
them. 

Sometimes,  besides  ecchymosis,  there  are  abrasions  of  the  skin  in  the 
course  of  the  cord,  and  these  are  known  to  have  been  produced  during 
life  by  the  effusion  of  blood  which  accompanies  them.  Devergie  never 
met  with  this  appearance  in  the  hanging  of  a  dead  body,  even  when  the 
hanging  took  place  immediately  after  death.  The  discovery  of  effused 
coagula  in  or  about  the  spinal  column  would  render  it  probable  that  the 
deceased  must  have  been  hanged  while  living.  Such  marks  of  violence 
are,  however,  rare  in  cases  of  hanging,  and  Avhen  they  are  found,  it  might 
be  assumed  that  the  effusion  and  coagulation  of  blood  had  been  caused  by 
violence  offered  to  the  neck  immediately  after  death  ;  but  this  assumption 
may  be  met  by  the  question  already  suggested — namely,  why  death  by 
hanging  should  be  simulated  in  the  body  of  a  person  who  is  alleged  to  have 
died  from  another  cause. 

With  regard  to  the  other,  or  more  common  kind  of  mark  in  suicidal 
hanging,  it  can  scarcely  be  said  to  furnish  any  evidence  in  relation  to  the 
question  which  we  are  here  considering.  The  depression  may  be  hard 
and  brown,  although  it  does  not  usually  acquire  this  color  until  some 
hours  have  elapsed  after  death  ;  for  it  appears  to  depend  simply  upon  a 
desiccation  or  drying  of  that  portion  of  the  skin  which  has  been  com- 
pressed by  the  ligature.  Sometimes  the  upper  and  lower  borders  only  of 
the  depression  present  a  faint  line  of  redness  or  lividity  ;  and  it  is  worthy 
of  remark  that  when  the  ligature  presents  any  knots  or  irregularities, 
those  portions  of  skin  which  sustain  the  greatest  compression  are  white, 
while  those  which  are  uncompressed  are  found  more  or  less  ecchymosed. 
It  is  in  this  manner  that  the  form  of  a  ligature  is  sometimes  accurately 
brought  out.  It  may  be  remarked  of  these  depressions  produced  by  the 
cord,  that  the  characters  which  they  present  are  the  same  whether  the 
iianging  has  taken  place  during  life  or  soon  after  death — the  appearances 
are  similar  in  the  two  cases. 
26 


402  SUMMARY    OF    MEDICAL    EVIDENCE. 

The  experiments  performed  on  dead  bodies,  by  Casper  and  other  ob- 
servers, show  that  the  ordinary  or  non-ecchymosed  marlc  caused  by  hang-- 
in,2:  during-  life  may  be  produced  by  a  ligature  applied  to  the  neck  of  a 
subject  ivithin  tivo  hours,  or  at  a  much  longer  period,  after  death  ;  conse- 
quently the  presence  of  this  mark  on  the  neck  is  no  criterion  whether  the 
hanging  took  place  during  life  or  after  death.  The  changes  in  the  skin, 
beneath  the  mark  are  also  destitute  of  any  distinctive  characters :  there  is 
a  similar  condensation  of  the  cellular  membrane  whether  the  hanging  has 
occurred  in  the  living  or  dead.  These  changes  are  the  simple  result  of 
mechanical  compression. 

Chevers  has  pointed  out  a  sign  of  death  from  hanging  which  is  un- 
doubtedly of  high  value.  Yer}^  commonly  in  hanging,  the  head  is  forced 
on  one  side  b}'  the  cord  that  suspends  the  body;  and  the  saliva  trickles 
from  one  angle  of  the  mouth,  from  which  point  it  descends  on  the  clothing 
in  a  perpendicular  direction.  This  appearance  is  not  produced  when  the 
body  is  suspended  after  death.     (Med.  Jurispr.  for  India,  p.  39T.) 

Summary  of  Medical  Evidence. — From  the  foregoing  considerations, 
we  draw  the  conclusion  that  there  is  no  special  or  distinctive  sign,  except 
the  last  mentioned,  by  which  the  hanging  of  a  Jiving  person  can  be  deter- 
mined from  an  inspection  of  the  dead  bod}^.  All  the  other  external  marks 
may  be  simulated  in  a  dead  body,  and  the  internal  appearances  furnish  no 
characteristic  evidence  whatever.  Still,  when  the  greater  number  of  the 
signs  enumerated  are  present,  and  there  is  no  other  satisfactory  cause  to  ac- 
count for  death,  we  have  strong  reason  to  presume  that  the  deceased  has  died 
from  hanging.  We  must  not,  however,  abandon  medical  evidence  on  these 
occasions  merely  because  plausible  objections  may  be  taken  to  isolated 
portions  of  it.  Facts  may  shoAv  that,  however  valid  such  objections  may 
be  in  the  abstract,  ttiey  are  wholl}^  inapplicable  in  the  concrete,  i.e.  to  the 
particular  case  under  investigation.  Perhaps  the  greatest  medical  diffi- 
culties occur  in  reference  to  cases  of  suicide,  owing  to  the  slight  appear- 
ances which  attend  this  form  of  death;  but  on  these  occasions,  moral  and 
circumstantial  proofs  are  so  generally  forthcoming  that  a  medical  inspec- 
tion of  the  body  is  scarcely  ever  deemed  necessary  by  a  coroner.  Even  if 
a  doubt  were  raised  in  any  particular  in.stance,  it  is  more  than  probable 
that  circumstantial  evidence  would  furnish  data  for  a  decision,  and  thus 
satisfactorily  make  up  for  the  want  of  strict  medico-legal  proofs.  If  when 
we  found  a  deeply  ecchymosed  or  livid  mark  around  the  neck  of  a  dead 
subject,  we  said,  all  other  circumstances  being  equal,  that  the  person  had 
most  probably  died  by  hanging,  we  should  not  be  departing  from  a  proper 
discharge  of  our  duty ;  since,  although  it  is  medically  possible  that  such  a 
mark  niay,  by  a  certain  amount  of  skill,  be  produced  after  death,  yet,  as 
it  would  be  only  a  murderer  who  would  think  of  hanging  up  a  recently 
dead  body  to  simulate  suicide,  so  it  is  certain  that  in  this  case  there 
would  be  some  obvious  indications  of  another  kind  of  violent  death  about 
the  person.  The  absence  of  these,  and  the  presence  of  ecchymosis  in  the 
course  of  the  cord,  would  leave  the  question  of  hanging  during  life  de- 
cidedly settled  in  the  affirmative.  Some  caution  should  be  used  in  express- 
ing an  opinion  that  hanging  had  taken  place  after  death,  even  in  cases  in 
which  there  is  no  ecchymosis  in  the  seat  of  the  ligature;  because,  while 
such  an  opinion  would  be  generalh"  correct,  it  might  in  some  instances 
lead  to  the  concealment  of  the  real  mode  of  death.  Many  facts  already 
adduced  show  that  numerous  cases  of  hanging  during  life  would  be  pro- 
nounced to  be  cases  of  hangring  after  death,  if  the  mere  absence  of  ecch}"- 
mosis  in  the  mark  were  taken  as  a  criterion.  The  discovery  of  marks  of 
violence  about  the  person  is  not  of  itself  sufficient  to  rebut  the  presumption 


MARKS    OF    VIOLENCE    ON    THE    HANGED.  403 

of  death  from  han,!iing  on  these  occasions.  The  violence  shouhl  at  least 
be  of  such  a  nature  as  to  account  for  the  immediate  destruction  of  life,  or 
it  can  throw  no  light  upon  the  question  whether  the  person  might  not 
have  died  from  hanging,  in  spite  of  the  marks  of  maltreatment  found  upon 
the  dead  body. 

If,  in  reference  to  a  body  found  hanging,  a  medical  jurist  should  assert 
that  death  had  not  taken  place  from  this  cause,  this  would  be  tantamount 
to  declaring  that  the  deceased  must  have  been  murdered,  because  it  is 
difficult  to  suppose  that  any  one  but  a  murderer  would  have  a  reasonable 
motive  for  hanging  up  a  recently  dead  person.  This  hanging  after  death 
has  been  frequentl}"  carried  out  with  the  view  of  concealing  the  real  mode 
of  death,  and  of  making  the  act  appear  to  be  one  of  suicide. 

Marks  of  Violence  on  the  Hanged. — The  presence  of  marks  of  violence 
on  the  body  of  ti  hanged  person  is  important,  and  therefore  a  witness 
should  notice  accurately  their  number,  situation,  extent,  and  direction. 
Having  satisfied  himself  that  they  must  have  been  received  during  life,  he 
will  have  to  consider  the  probability  of  their  being  of  accidental  origin  or 
not.  These  marks  of  violence  are  not  always  to  be  regarded  as  furnishing 
unequivocal  proofs  of  murder;  for  it  is  possible  that  they  may  have  been 
produced  by  the  person  himself  before  hanging,  and,  not  succeeding  in 
committing  suicide  by  these  attempts,  he  may  subsequently  have  resolved 
to  accomplish  his  purpose  by  suspending  himself.  Let  the  witness  duly 
reflect  on  these  circumstances  before  he  allows  his  opinion  to  implicate  any 
suspected  individual — let  him  consider  that  a  hanged  subject  may  bear  the 
marks  of  a  gunshot-wound,  his  throat  may  be  cut,  his  person  lacerated  or 
disfigured,  and  yet,  before  a  suspicion  of  homicide  is  allowed  to  be  enter- 
tained, it  ought  to  be  clearly  shown  that  such  injuries  could  not,  by  any 
probability,  have  been  self-inflicted.  The  importance  of  observing  caution 
in  such  a  case  will  be  still  more  manifest  when  there  is  no  ecchymosis  pro- 
Yluced  by  the  cord  and  the  face  does  not  present  the  usual  appearances  of 
hanging.     (See  Ann.  d'Hyg.,  1870,  t.  2,  p.  226.) 

Marks  of  violence  on  a  hanged  subject  may  in  some  instances  be  fairly 
ascril)ed  to  accident.  If  the  person  had  precipitated  himself  Avith  any 
violence  from  a  chair  or  table  in  a  furnished  apartment,  he  may  have  fallen 
against  articles  of  furniture,  and  thus  have  caused  lacerations  and  bruises, 
especially  on  the  limbs  or  body.  The  rope  may  have  given  way,  and  the 
person,  in  falling,  have  injured  himself;  but  he  may  afterwards  have  had 
resolution  enough  to  suspend  himself  again.  Such  an  occurrence  may  be 
rare;  but  when  the  presence  of  these  injuries  is  made  to  form  the  chief 
ground  of  accusation  against  another  person,  their  possibly  accidental 
origin  ought  not  to  be  lost  sight  of. 

The  falling  of  the  body  on  a  hard  pavement,  or  against  some  article  of 
furniture,  may  produce  accidental  injuries  which  might  be  wrongly 
assigned  to  homicidal  violence.  In  a  case  of  suicidal  hanging  in  the  gaol 
of  Newgate  there  was  a  copious  effusion  of  blood  from  injuries  produced 
accidentally  after  death.  In  death  from  asphyxia  the  blood  remains  fluid 
in  the  body  longer  than  in  other  cases,  so  that  accidental  wounds  after 
death  may  be  attended  with  comparatively  large  effusions.  The  bleeding 
post-mortem  is  also  favored  by  the  general  congestion  of  the  venous  system. 
(Ann.  d'Hyg.,  1868,  t.  2,  p.  218.)  Severe  injuries  may  be  found  on  the 
head  of  the  deceased,  and  vet  these  may  not  be  inconsistent  with  suicidal 
hanging.     (Ann.  d'Hyg.,  1867,  t.  1,  p.  164;  also  t.  1,  p.  460.) 

If  we  suppose  the  deceased  to  have  been  hanged  in  a  state  of  intoxica- 
tion or  stupefaction,  medical  evidence  alone  will  rarely  suffice  to  determine 
the  question  of  homicide  or  suicide.     The  absence  of  all  marks  of  violence 


404       ACCIDENTAL,    HOMICIDAL,    AND    SUICIDAL    HANGING. 

from  the  body  rai.irht  actually  lull  suspicion.  It  is  proper  on  these  occa- 
sions to  look  to  the  hands  of  the  deceased,  since  it  is  with  these  that  a 
person  defends  himself;  and,  unless  taken  unawares,  it  is-almost  certain, 
if  the  hanging  were  homicidal,  that  there  would  be  traces  of  violence  on 
these  parts.  The  clothes  would  be  torn  and  discomposed,  and  the  whole 
appearance  of  the  deceased  would  be  that  of  one  who  had  done  his  utmost 
to  resist  a  violent  murderous  attack.  There  might  be  some  injuries  which 
could  not  be  attributed  to  accident  under  any  circumstances.  Among  these 
we  may  enumerate  fractures,  dislocations,  deeply  penetrating  incised  and 
gunshot-wounds.  Now  the  question  is — Do  these  serious  injuries  neces- 
saril}^  establish  homicidal  hanging?  The  answer  must  be  in  the  negative  ; 
although  when  fractures  or  dislocations  exist  there  are  strong  grounds  for 
suspicion.     (Ann.  d'Hyg.,  1842,  t.  1,  p.  IfiO.) 

Suicides  frequently  make  attempts  on  their  lives  by  various  means,  as 
by  poison,  the  use  of  razors,  knives,  or  pistols,  and  still  retain  power  to 
hang  themselves.  Such  cases  as  these  are  generally  determined  by  cir- 
cumstantial evidence.  A  suicide  may  attempt  to  destroy  himself  with  a 
knife  or  pistol ;  he  may  fail  in  the  attempt,  and  ultimately  hang  himself. 
Any  description  of  wound,  provided  it  be  such  as  to  allow  of  a  person 
surviving  a  sufficient  time,  may  thus  be  found  on  a  hanged  subject,  and 
yet  constitute  no  proof  whatever  of  murder.  If  there  are  circumstances 
about  the  wound  or  injury  which  show  that  it  could  not  have  been  self- 
inflicted,  this,  of  course,  will  affect  the  conclusion  ;  but  when  such  circum- 
stances are  not  met  with  a  cautious  medical  jurist  should  say,  in  answer 
to  inquiries  respecting  the  origin  of  these  wounds,  that  they  may  have 
been  inflicted  either  by  the  deceased  himself  or  by  another.  The  medical 
facts  of  the  case  might  be  consistent  with  either  view.  In  one  instance  of 
suicidal  hanging  there  were  lacerated  wounds  upon  the  head  and  a  hand- 
kerchief was  found  blocking  up  the  mouth.  A  woman  committed  suicide, 
in  1868,  under  the  following  circumstances.  She  fastened  a  cord  to  the, 
top  of  a  bed-post,  put  her  head  in  a  noose  while  kneeling  on  the  bed,  and 
then  made  a  deep  wound  in  her  arm  with  a  razor;  she  closed  the  razor 
and  put  it  aside.  Becoming  faint  from  loss  of  blood  she  must  have  fallen 
forward,  and  the  pressure  of  the  cord  on  the  neck  caused  death.  Of 
course,  if,  in  any  case,  the  wounds  or  injuries  are  of  a  decidedly  mortal 
nature,  and  have  probably  caused  death,  the  presumption  of  murder  is 
very  strong;  for  who  but  a  murderer  would  suspend  the  dead  body  of  a 
person  so  wounded  immediately  after  death?  (Ann.  d'Hyg.,  1835,  t.  2, 
p.  410.) 

Was  the  Hanging  the  Result  of  Accident,  Homicide,  or  Suicide'? — 
Most  medical  jurists  have  passed  over  the  subject  of  accidental  hanging. 
In  the  sense  commonly  implied  by  the  term  it  is  certainly  unusual ;  but, 
although  rare,  it  is  a  possible  occurrence.  Circumstantial  evidence  will 
always  suffice  for  the  discrimination  of  accidental  hanging ;  and  we  have 
therefore  merely  to  inquire  whether,  when  the  body  of  a  person  is  found 
hanging  under  circumstances  Avhich  do  not  allow  of  the  suspicion  of  acci- 
dent, the  act  has  been  the  result  of  suicide  or  of  homicide.  A  medical 
witness  must  remember  that  this  is  strictly  a  question  for  the  jury.  It  is 
not  for  him  to  say  whether  a  man  has  hanged  himself  or  been  hanged  by 
others,  but  merely  to  state,  when  required,  those  medical  circumstances 
which  support  or  rebut  one  or  the  other  presumption.  The  jury,  under 
the  direction  of  the  judge,  will  arrive  at  a  conclusion  from  the  w^hole  of 
the  evidence,  medical  and  non-medical. 

Hanging  is  a  very  common  form  of  suicide  ;  and  of  the  persons  thus 
destroyed,  four-fifths  are  males.     It  has  been  truly  observed  that,  of  all 


HOMICIDAL    AND    SUICIDAL    HANGING.  405 

the  forms  of  committing'  murder  hanging  is  one  of  the  most  difficult,  and 
it  is  a  kind  of  murder  seldom  employed.  In  most  cases  when  a  person  has 
been  hanged  by  others  it  has  been  after  death  in  order  to  avert  a  suspicion 
of  homicide.  Hence  the  di.scovery  of  a  person  hanging  affords  prima 
facie  evidence  of  suicide,  supposing  it  to  be  rendered  absolutely  certain 
that  death  has  taken  place  from  this  cause.  We  must,  however,  admit 
that  a  man  may  be  murdered  by  hanging,  and  yet  the  appearances  about 
his  body  will  not  afford  the  smallest  evidence  of  the  fact.  The  circum- 
stances which  will  justify  a  medical  jurist  in  making  this  admission  are 
the  following:  First,  when  the  person  hanged  is  feeble  and  the  assailant 
a  strong,  healthy  man.  Thus  a  child,  a  youth,  a  woman,  or  a  person  at 
any  period  of  life  worn  out  and  exhausted  by  disease  or  infirmity,  may  be 
destroyed  by  hanging.  Second,  when  the  person  hanged,  although  usually 
strong  and  vigorous,  is  at  the  time  in  a  state  of  intoxication,  stupefied  hy 
narcotics,  asleep,  or  exhausted  by  his  attempts  to  defend  himself.  Third, 
in  all  cases,  murder  may  be  committed  by  hanging  when  many  are  com- 
bined against  one  person.  With  these  exceptions  a  practitioner  will  be 
correct  in  deciding,  in  a  suspected  case,  in  favor  of  the  presumption  of 
suicide.  Unless  the  person  labored  under  stupefaction,  intoxication,  or 
great  bodily  weakness,  we  must  expect  to  find  in  homicidal  hanging 
marks  of  violence  about  the  body  ;  for  there  are  few  who  will  allow  them- 
selves to  be  murdered  without  offering  some  resistance. 

Some  medical  jurists  have  thought  that  the  mark  left  by  the  cord  on 
the  neck  would  serve  as  a  criterion  of  murder  on  which  we  might  depend. 
Thus  it  has  been  said,  if  the  mark  is  circular  and  situated  at  the  lower 
part  of  the  neck,  it  is  an  unequivocal  proof  of  murder.  In  suicidal  hang- 
ing the  mark  of  the  cord  is  generally  oblique,  being  higher  at  the  back 
part  of  the  neck,  in  consequence  of  the  loop  formed  by  it  yielding  more  in 
this  direction  than  in  front.  But  it  is  an  error' to  suppose  that  this  want 
of  obliquity  in  the  impression  can  afford  any  evidence  in  favor  of  the  act 
having  been  homicidal.  Its  form  will  depend  in  a  great  degree  upon  the 
fact  of  the  body  being  supported  or  not,  for  it  is  the  weight  of  the  body 
which  causes  its  obliquity  ;  it  will  also  depend  on  the  manner  in  which  the 
cord  is  adjusted.  A  case  of  suicidal  hanging  is  related  by  Orfila  in  which  the 
mark  of  the  cord  extended  horizontally  round  the  neck  from  behind  for- 
wards. (Mdl  Leg.,  tom.  2,  p.  376.)  The  slip-knot  of  the  cord  was  in  front 
of  the  neck,  and  it  is  obvious  that  when  the  cord  is  thus  adjusted  by  a  sui- 
cide there  will  be  scarcely  any  obliquity  in  the  depression  produced  by  it. 
Equally  ill  founded  is  the  assertion  that  i\\e  existence  o[  two  impressions  on 
the  neck  affords  positive  proof  of  homicide.  One  of  these  impressions  may 
be  at  the  lower  part  of  the  neck  and  circular — the  other  at  the  upper  part 
and  oblique:  it  is,  therefore,  contended  that  the  deceased  must  have  been 
strangled  in  the  first  instance  and  afterwards  hanged.  The  possibility  of 
a  prior  attempt  being  made  by  a  suicide  to  strangle  himself,  and  thus  pro- 
duce the  mark,  is  not  adverted  to.  "  Si  Ton  observe  les  deux  impres- 
sions," says  Mahon,  "  I'assassinat  est  alors  parfaitement  prouve."  It  is 
fortunate  that  there  are  facts  on  record  to  oppose  to  this  very  positive 
statement.  One  of  the  first  cases  reported  by  Esquirol  is  that  of  a  female 
lunatic  who  committed  suicide  by  hanging  herself,  and  on  whose  neck  two 
distinct  impressions  were  seen — the  one  circular,  the  other  oblique.  These 
appear  to  have  arisen  from  the  cord  having  been  passed  twice  around  the 
neck,  the  body  being  at  the  same  time  partially  supported. 

In  some  instances  a  presumption  of  homicidal  interference  may  exist  if 
there  are  two  distinct  impressions,  but  it  cannot  be  admitted  that  they 
establish  the  fact  of  murder.     A  woman  was  found  hanging  to  the  branch 


406  CIRCUMSTANTIAL    EYIDEN'CE. 

of  a  tree,  the  feet  resting  on  the  ground.  There  were  two  marks  on  the 
neck,  one  like  that  of  strangling  with  the  same  ligature  as  that  hy  which 
the  body  was  hanging.  Walter  concluded  that  the  mark  produced  by  the 
suspension  of  the  body  was  the  result  of  post-mortem  hanging  after 
murder  by  strangulation.  (Tierteljahrsschr.  fiir  Gerichtl.  ]\Ied.,  1861,  1, 
p.  161.)  In  the  same  journal  (1871,  2,  p.  223)  a  case  is  reported  by 
Maschka  in  which  a  boy,  £et.  9,  was  found  hanging.  There  were  on  the 
neck  marks  of  pressure,  which  at  first  led  the  examiners  to  draw  the  in- 
ference that  the  boy  had  been  strangled  and  afterwards  hanged.  The 
reasons  for  this  opinion  were  not  satisfactory,  and  suicide  was  admitted 
to  be  not  only  possible  but  probable. 

The  injury  done  to  the  neck  by  the  cord  or  ligature  can  rarely  afford 
any  clue  to  the  manner  in  which  hanging  took  place,  unless  the  circum- 
stances under  which  the  body  is  found  favor  the  presumption  of  homi- 
cide or  suicide.  Thus  laceration  of  the  muscles  and  vessels  of  the  neck, 
rupture  of  the  windpipe  and  displacement  of  the  larynx,  stretching  of  the 
ligaments  of  the  spine,  and  effusion  of  blood  on  the  sheath  of  the  spinal 
marrow,  may  be  observed  in  suicidal  as  in  homicidal  hanging.  The  pre- 
sumption, however,  is  obviously  in  favor  of  the  latter  vrhen  these  violent 
injuries  are  found  to  be  accompanied  by  fracture  or  displacement  of  the 
vertebrae  of  the  neck,  and  the  body  of  the  deceased  is  not  corpulent,  the 
ligature  by  which  he  is  suspended  is  not  of  a  nature  to  produce  them,  and 
the  fall  of  the  body  has  not  been  great. 

A  much-disputed  question  has  arisen  in  medical  jurisprudence  whether 
the  vertebrse  of  the  neck  can  become  fractured  or  displaced  in  suicidal 
banging.  Most  medical  jurists  deny  the  possibility  of  this  accident  occur- 
ring— the  displacement  or  fracture  of  these  vertebra?  being  rarely  observed, 
even  in  criminal  executions  when  the  greatest  violence  has  been  used  by 
the  executioner.  The  author  found  no  case  of  sincide  on  record  in  which 
such  an  injury  to  the  neck  had  been  found.  Still,  it  must  be  admitted  to 
be  possible. 

Circurastantial  Evidence. — In  all  doubtful  instances  we  should  not 
lose  sight  of  moral  and  circumstantial  evidence.  We  should  ascertain 
whether  the  individual  had  been  previously  disposed  to  commit  suicide 
or  not :  we  should  observe  whether  the  doors  and  w  indows  of  the  apart- 
ments had  been  secured  on  the  inside  or  on  the  outside  ;  whether  the  dress 
of  the  deceased  is  at  all  torn  or  discomposed,  or  his  hair  dishevelled ; 
whether  the  attitude  of  the  body  is  such  as  to  show  interference  after 
death  ;  whether  there  are  marks  of  blood  about  the  body  or  the  ligature 
or  in  the  room ;  whether  the  hands  are  bloody,  or  present  marks  of 
wounding  or  struggling ;  whether  the  rope  or  ligature  corresponds  to  the 
impression  seen  around  the  neck;  and  lastly,  whether  the  cord  is  of  suffi- 
cient strength  to  support  the  weight  of  the  deceased.  The  strongest  evi- 
dence of  homicide  is  often  found  in  the  attitude  and  the  state  of  the  dress 
of  the  dead  body  ;  it  may  or  may  not  indicate  interference  or  change  after 
death,  irreconcilable  with  the  supposition  of  death  from  suicide  or  accident. 
On  this  point  the  minutest  circumstance  may  become  of  considerable  im- 
portance as  medical  evidence.  When  there  are  indications  of  violent 
struggling,  the  dress  may  be  found  disordered,  unless  it  has  been  smoothed 
or  arranged  by  the  murderer  after  the  death  of  the  deceased.  There  may, 
of  course,  be  no  evidence  of  disorder  or  discomposure  of  the  dress  in  the 
case  of  a  female,  when  the  body  is  freely  suspended.  These  points  fall,  it 
is  true,  more  within  the  province  of  the  officers  of  justice  than  of  a  medical 
practitioner  ;  but  the  latter  is  generally  the  first  who  is  called  to  see  the  de- 
ceased, and  therefore,  unless  such  facts  are  noticed  by  him   on  his  visit, 


POSITION    OF    THE    BODY.  407 

thev  may  remain  alto^s-ether  unknown.  The  medical  opinion  of  the  actual 
cause  of  death,  however,  should  be  based  only  on  medical  facts,  but  cir- 
cumstantial evidence  has  on  various  occasions  assisted  in  clearing-  up  a 
doul)tful  case.  Louis  states  that,  on  removing  the  body  of  a  man  who 
was  found  hanging,  the  rope  was  observed  to  be  stained  with  blood.  This 
simple  circumstance  led  to  further  investigation,  by  Avhich  it  was  dis- 
covered that  the  person  had  been  murdered,  and  his  body  afterwards  sus- 
pended. The  presence  of  marks  on  the  neck  indicative  of  strangulation, 
such  as  the  cord  was  not  likely  to  have  produced,  may  lead  to  a  suspicion 
that  hanging  followed  death. 

T/ie  Po.-^ition  of  the  Body. — Lastly,  it  has  been  contended  that  the 
position  of  the  dead  body  may  serve  to  distinguish  suicidal  from  homi- 
cidal hanging.  This  point  was  strenuously  argued  on  the  investigation 
which  took  place  relative  to  the  death  of  the  Prince  de  Conde,  in  183D. 
This  case  involves  two  glaring  errors  in.  reference  to  medical  evidence 
in  death  from  hanging:  First,  that  a  person  cannot  die  from  hanging 
when  the  body  is  in  any  way  supported ;  second,  that  in  all  cases  of  death 
from  hanging  the  mark  produced  on  the  neck  by  the  cord  or  ligature  must 
be  discolored  or  ecchymosed.  If  not  ecchymosed,  it  was  assumed  that 
death  must  have  taken  place  from  some  other  cause  and  the  body  have 
been  afterwards  suspended  for  the  concealment  of  crime.  It  is  scarcely 
necessary  to  state  that  these  propositions  are  utterly  inconsistent  with 
well-known  facts.  Since  this  trial,  many  cases  have  been  recorded  in 
which  death  has  taken  place  from  hanging,  when  the  feet  were  in  contact 
with  the  ground,  or  the  persons  w^ere  almost  sitting  or  recumbent :  they 
may  be  regarded  as  mixed  cases  of  hanging  and  strangulation.  The  fol- 
lowing case  fell  within  the  author's  own  knowledge.  In  1832,  a  man 
was  found  hanging  in  his  room,  with  his  knees  bent  forwards  and  his 
feet  resting*  upon  the  floor.  He  had  evidenth^  been  dead  for  some  time, 
since  cavaveric  rigidity  had  already  commenced.  The  manner  in  which 
this  person  (a  working  mechanic)  had  committed  suicide  was  as  follows  : 
He  had  made  a  slip-kaot  with  one  end  of  his  apron,  and  having  placed  his 
neck  in  this  he  threw  the  other  end  of  the  apron  over  the  top  of  the  door, 
and  shutting  the  door  behind  him  he  had  succeeding  in  wedging  it  in 
firmly.  At  the  same  moment  he  had  probably  raised  himself  on  tiptoe 
and  then  allowed  himself  to  fall ;  in  this  position  he  died.  The  weight  of 
his  body  had  already  sufficed  to  drag  down  a  part  of  the  apron,  for  it 
seemed  as  if  it  had  been  much  stretched.  The  deceased  was  in  the  position 
in  which  the  body  of  the  Prince  de  Conde  was  found,  and  the  depression 
produced  by  the  liu-ature  on  the  neck  was,  as  in  that  case,  nowhere  ecchy- 
mosed, These  facts,  so  far  from  being  considered  to  negative  suicide, 
were  treated  as  perfectly  in  accordance  with  it.  A  similar  case  of  suicide 
occurred  in  1872.  A  lady,  who  had  been  for  some  time  suffering  from 
great  depression,  was  found  dead,  hanging  b_Y  a  long  cloth  to  a  closed  door, 
over  the  top  of  which  she  had  thrown  the  other  end  of  the  cloth  (knotted), 
and  then  shut  the  door  upon  it.  (For  a  similar  case  see  Henke's  Zeit- 
schrift,  1843,  2,  50.)  Casper  reports  an  instance  in  which  a  man  was 
charged  with  the  murder  of  his  wife  because  her  body  was  found  hanging 
in  almost  an  erect  position.  (Ger.  Leich.-Geffn.,  vol.  2,  p.  92.)  For  other 
cases,  with  illustrations  of  the  positions  of  the  bod}^,  see  a  paper  by  Tardieu, 
Ann.  d'Hyg.,  1870,  t.  1,  p.  94.) 

In  a  case  of  suicide  at  Oxford,  in  1876,  the  body  of  deceased  was  found 
hanging  behind  the  door  of  his  bedroom.  His  feet  touched  the  ground 
and  his  knees  w^ere  bent.  A  woman,  set.  62,  confined  in  Clerkenwell 
prison  in  April,  1878,  was  soon  afterwards  found  dead  in   her  cell.     The 


408  POSITION    OF    THE    BODY. 

body  M^as  resting  on  the  ground,  suspended  from  a  gaspipe  about  four  feet 
high,  b}'  a  necicercbief  round  her  throat.  In  1877,  Spenser,  a  barrister, 
was  found  dead  in  his  bedroom  under  the  following  circumstances :  he 
was  in  a  sitting  position  on  the  floor,  with  the  bell-pull,  attached  to  the 
bed-post,  tied  round  his  neck.  There  was  no  doubt  that  this  was  an  act 
of  suicide.  In  another  case  of  suicide,  the  subject  of  an  inquest  in  1878, 
a  man  was  found  dead  suspended  by  a  handkerchief  to  a  cupboard  door. 
When  standing  upright  he  was  as  high  as  the  cupboard  door,  but,  after 
suspending  himself,  he  had  drawn  up  his  legs  behind  him,  and  had  died 
asphyxiated  in  this  singular  position.  In  1874,  a  lunatic  who  had  escaped 
from  his  keepers  was  found  hanging  in  a  wood  near  Highgate  to  a  sapling 
oak  by  a  pocket-handkerchief.  The  deceased  was  in  a  sitting  posture,  the 
tree  being  bent  down  by  his  weight. 

The  reports  of  eleven  cases  of  suicidal  hanging  or  strangulation  gave 
the  following  results  :  in  three,  the  deceased  were  found  nearly  recumbent ; 
in  four,  in  a  kneeling  posture,  the  body  being  more  or  less  supported  by 
the  legs ;  and  in  four,  the  persons  were  found  sitting.  In  one  case,  the 
deceased,  a  prisoner,  was  found  hanging  to  the  iron  bar  of  the  window  of 
his  prison,  which  was  so  low  that  he  was  almost  in  a  sitting  posture. 
Eemer  found  that  among  one  hundred  and  one  cases  of  suicidal  hanging, 
in  fourteen  the  body  was  either  standing  or  kneeling,  and  in  one  instance 
it  was  in  a  sitting  posture.  Duchesne  has  published  an  account  of  fifty- 
eight  cases  in  which  the  suspension  of  the  body  was  partial — the  feet  or 
trunk  being  more  or  less  supported.  The  reporter  drew  the  conclusion 
that  suicide  by  hanging  is  consistent  with  any  podure  of  the  body,  even 
when  resting  upon  the  two  feet.  (Ann.  d'Hyg.,  1845,  t.  2,  pp.  141  and 
346.)  Further  evidence  need  not  be  adduced  to  show  how  unfounded  is 
that  popular  opinion  which  would  attach  the  idea  of  homicidal  interference 
to  cases  in  which  a  body  is  loosely  suspended,  or  in  which  the  feet  are  in 
contact  with  any  support.  We  ought  rather  to  consider  these  facts  as 
removing  a  suspicion  of  homicide  ;  for  there  are  probably  few  murderers 
who  would  suspend  their  victims,  either  living  or  dead,  without  taking- 
care  that  the  suspension  was  not  partial,  but  complete.  Besides,  the  facts 
of  many  of  these  cases  are  readily  explicable:  thus,  if  the  ligature  is 
formed  of  yielding  materials,  or  if  it  is  only  loosely  attached,  it  will  yield 
to  the  weight  of  the  body  after  death,  and  allow  the  feet  to  touch  the  floor, 
which  they  might  not  have  done  in  the  first  instance.  If  there  is  reason 
to  believe  that  the  body  has  not  altered  its  position  after  suspension,  we 
must  remember  the  suddenness  with  which  insensibility  comes  on,  and  the 
rapidity  with  which  death  takes  place  in  this  form  of  asphyxia.  Under 
ver}'^  slight  pressure  on  the  windpipe  a  person  is  rendered  utterly  powder- 
less  to  help  himself  or  to  move  from  his  position.  (See  p.  410,  post ;  also 
Lond.  Med.  Gaz.,  vol.  xliv.  p.  85.)  In  spite  of  these  well-known  facts, 
the  most  serious  mistakes  ai'e  still  liable  to  be  made.  A  case  occurred  in 
France,  in  1872,  in  wiiich  a  young  man  was  charged  .with  the  murder  of  his 
brother  and  suspending  his  body  after  death.  The  only  grounds  for  this 
strong  medical  opinion  were  that  there  was  no  deep  ecchymosed  depres- 
sion round  the  neck  of  the  deceased,  and  the  body  was  found  hanging 
nearly  in  a  sitting  posture.  These  conditions  were  considered  to  be  in- 
consistent with  death  from  hanging.  The  cause  of  death  was  ascribed  to 
poisoning  with  phosphorus,  in  consequence  of  some  alkaline  phosphates 
and  phosphoric  acid  being  found  in  the  stomach.  On  this  series  of  medi- 
cal assumptions  and  mistakes,  the  young  man,  who  had  accidentally  dis- 
covered his  brother  hanging,  was  convicted  of  murder  and  sentenced  to 
the  galleys  for  twenty  years.     The  ignorance  displayed  by  the  medical 


SUICIDAL    HANGING.  409 

witnesses  who  gave  evidence  on  this  occasion  has  been  fully  exposed  by 
Boys  de  Loury,  Chevallier,  and  Fersonne.     (See  Ann.  d'Hyg  ,  18T3,  t,  2 
p.  113.) 

The  Limbs  secm-ed  in  Suicidal  H(i,iiging. — One  or  two  points  are 
.  worthy  of  notice  in  relation  to  this  medicu-Iegal  question.  The  hands  or 
le^cs,  but  more  conimouly  the  former,  have  been  found  tied  in  cases  of 
undoubted  suicidal  hanging-  (Ann.  d'Hyg  ,  18o2,  t.  1,  p.  419)  ;  and  yet  it 
has  been  gravely  debated  whether  it  was  possible  for  a  person  to  tie  or 
bind  up  his  hands  and  afterwards  hang  himself.  It  is  unnecessary  to  ex- 
amine the  ingenious  arguments  which  have  been  urged  against  the  possi- 
bility of  an  act  of  this  kind  being  performed,  since  they  are  refuted  by 
well-ascertained  facts.  (Lond  Med.  Oaz.,  vol  xlv.  p.  388;  and  Guy's 
Hosp.  Rep.,  1851,  p.  206.) 

It  has  also  been  a  debated  question  whether  corporeal  infirmity,  or  some 
peculiarity  affecting  the  hands,  might  not  interfere  with  the  power  of  an 
individual  to  suspend  himself.  This  question  can  be  decided  only  by 
reference  to  the  special  circumstances  of  the  case.  In  the  case  of  the 
Prince  de  Conde.  it  was  alleged  that  he  could  not  have  hanged  himself  in 
consequence  of  a  defect  in  the  power  of  one  hand  ;  it  was  also  said  that 
he  could  not  hftve  made  the  knots  in  the  handkerdhiefs  by  which  he  was 
suspended.  Allegations  of  this  kind  appear  to  have  been  too  hastily  made 
in  this  and  other  instances.  A  determined  purpose  will  often  make  up 
for  a  great  degree  of  corporeal  infirmity;  and  unless  we  make  full  allow- 
ance for  this  in  suicide,  we  shall  always  be  exposed  to  error  in  drawing 
our  conclusions.  Blindness  is  no  obstacle  to  this  mode  of  perpetrating 
suicide  ;  and  in  reference  to  age,  suicide  by  hanging  has  been  perpetrated 
by  a  boy  of  nine,  and  by  a  man  of  ninety-seven  years  of  age. 


410  STRANGULATION CAUSE  OF  DEATH. 


STRANGULATION. 


CHAPTER  XL. 

CAUSE    OF    DEATH. APPEARA>'CES    AFTER    DEATH. WAS    DEATH     CAUSED      BY     STRANGULA- 
TION,   OR    WAS    THE    COXSTRICTIOX    APPLIED    TO    THE    NECK     AFTER     DEATH  ? MARKS     OF 

VIOLENCE. ACCIDENTAL,    HOMICIDAL,    AND    SUICIDAL    STRANGULATION. 

Cause  of  Death.  Asphyxia. — Hanging  and  strangulation  are  usually 
treated  together,  and  some  medical  jurists  have  admitted  no  distinction  in 
the  meaning  of  these  terms.  In  hanging,  the  phenomena  bf  asjjhyxia  take 
place  in  consequence  of  the  suspension  of  the  body  ;  while  in  strangula- 
tion, asphyxia  may  be  induced,  not  only  by  the  constriction  produced  by 
a  liuature  round  the  neck  independently  of  suspension,  but  by  the  simple 
application  of  pressure,  through  the  fingers  or  otherwise,  on  the  wind- 
pipe. Tafdieu  considers  that  the  two  modes  of  death  should  be  kept  dis- 
tinct. The  external  and  internal  appearances  in  some  respects  differ;  and 
while  the  proof  of  death  from  hanging  leads  to  the  strongest  presumption 
of  suicide,  the  proof  of  death  from  strangulation  is  equally  presumptive  of 
murder.  (Sur  la  Pendaison,la  Strangulation  et  la  Suffocation,  p.  1.51.) 
This  medical  jurist  defined  "  strangulation  to  be  an  act  of  violence,  in 
which  constriction  is  applied  directly  to  the  neck,  either  around  it  or  in 
the  forepart,  so  as  to  prevent  the  passage  of  air;  and  thereby  suddenly 
suspending  respiration  and  life."  This  definition  obviously  includes  hang- 
ing, and  every  person  who  is  hanged  may  be  said  to  be  strangled  ;  but 
while  there  is  onl\^  one  method  of  producing  death  by  hanging,  there  are 
various  methods  of  producing  death  from  strangulation.  A  person  may 
be  strangled  by  the  use  of  a  cord,  band,  or  ligature  drawn  tightly  round 
the  neck,  or  by  manual  violence  to  the  front  of  the  neck,  w^hereby  respira- 
tion is  prevented.  The  ca.use  of  death  is  asphyxia.  The  rapidity  with 
which  it  takes  place  will  depend  on  the  degree  and  situation  of  the  press- 
ure and  the  completeness  Avith  which  the  act  of  breathing  is  obstructed. 

Faure  applied  a  ligature  forcibly  and  suddenly  to  the  neck  of  a  middle- 
sized  dog.  For  fifty-five  seconds  the  animal  did  not  appear  to  suffer;  but 
suddenly  became  violently  agitated,  its  body  stiffened,  and  it  rolled  con- 
vulsively on  the  ground.  A  bloody  froth  issued  from  the  nostrils  and 
throat,  and  the  animal  made  frequent  and  violent  efforts  to  breathe.  In 
three  minutes  and  a  half  it  was  dead.  In  a  second  experiment  an  elastic 
tube  was  introduced  into  the  windpipe,  Avhich  admitted  of  being  gradually 
closed  by  pressure.  The  animal  could  bear  the  pressure  up  to  the  reduc- 
tion of  one-half  of  the  caliljre  of  the  tube;  but  beyond  this  it  suffered 
greatly,  and  when  the  pressure  was  increased  convulsions  supervened. 
The  dog  died  in  great  suffering  before  the  tube  was  completely  closed. 
(Ann.  d'Hyg.,  1859,  t.  1,  p.  122.)  It  is  probable  that  human  beings  die 
more  quickly  than  animals,  especially  from  the  effects  of  manual  strangu- 
lation.    A  sudden  and  violent  compression  of  the  windpipe  renders  a  per- 


POST-MORTEM    APPEARANCES.  411 

son  powerless  to  call  for  assi.-tance  and  give  alarm,  and  it  causes  almost 
immediate  insensibility  and  death  without  convulsions.  When  a  ligatui'e 
or  bandage  is  used,  the  pressure  is  not  so  complete,  and  death  takes  place 
more  slowly  with  convulsive  movements.  The  circulation  of  dark-colored 
blood  continues  for  a  short  interval  (about  four  minutes),  as  in  other  cases 
of  asphyxia.  Owing- to  this,  the  face  and  lips,  in  accidental  strangulation, 
have  been  observed  to  acquire  a  dark  leaden  hue.  This  arises  partly  fi'om 
the  arrest  of  the  current  of  venous  blood  as  the  result  of  compression  of 
the  vessels  and  partly  from  the  circulation  of  uaaerated  blood.  There  is 
a  fair  chance  of  recovery  if  the  cause  of  constriction  is  removed,  and  air 
is  permitted  to  have  access  to  the  lungs  within  a  period  of  five  minutes ; 
this  is  on  the  assumption  that  no  great  mechanical  injury  has  been  done  to 
the  neck.  In  the  act  of  strangulation  a  much  greater  degree  of  violence 
is  commonly  employed  than  is  necessary  to  cause  death  ;  and  hence  the 
marks  produced  on  the  neck  will  be,  generally  speaking,  much  more  evi- 
dent than  in  hanging-,  where  the  mere  weight  of  the  body  is  the  medium 
by  which  the  windpipe  is  compressed. 

Post-mortem  Appearances. — The  appearances  after  death  are  similar  to 
those  of  hanging,  but  the  injury  done  to  the  parts  about  the  neck  is  com- 
monly greater.  Externally,  if  much  force  has  been  used  in  producing  the 
constriction,  the  windpipe,  with  the  muscles  and  vessels  in  the  forepart 
of  the  neck,  may  be  found  cut  or  lacerated,  and  the  vertebrse  of  the  neck 
may  be  fractured.  The  face  is  commonly  livid  and  swollen,  the  eyes  wide 
open,  prominent,  and  congested,  and  the  pupils  dilated.  The  tongue  is 
swollen,  dark-colored,  and  protruded;  it  is  sometimes  bitten  by  the  teeth, 
and  a  bloody  froth  escapes  from  the  mouth  and  nostrils.  The  principal 
external  signs  of  strangulation  are  seen  in  the.  marks  on  the  neck,  pro- 
duced either  by  a  cord  or  manual  pressure.  Tardieu  has  described  another 
appearance  which  might  be  overlooked.  This  consists  in  the  presence  of 
numerous  small  spots  of  ecchymosis  upon  the  skin  of  the  face,  neck,  and 
chest,  as  well  as  in  the  conjunctiva  or  membrane  of  the  eyes.  These 
parts  present  a  dotted  redness,  which  has,  however,  been  met  with  in 
other  cases  besides  death  from  strangulation.  Internally,  the  chief  signs 
are  to  be  looked  for  in  the  lungs,  which  are  sometimes  congested,  and  at 
others  normal.  Tardieu  describes  patches  of  emphysema,  and  also  effu- 
sions of  blood  into  the  substance  of  the  organs  (pulmonary  apoplexy), 
varying  in  diameter  from  five-eighths  of  an  inch  to  an  inch  and  a  half,  and 
states  that  the  internal  punctiform  ccchymoses  of  sufi'ocation  are  rare  in 
cases  of  strangulation.     (De  la  Strangulation.) 

The  mark  on  the  neck  when  a  ligature  has  been  used  is  commonly 
described  as  a  depression,  wide  but  not  deep,  and  corresponding  in  its 
characters  to  the  form  and  thickness  of  the  ligature  and  the  mode  in 
which  it  has  been  secured.  Too  much  importance  must  not  be  attached  to 
this  supposed  correspondence  when  the  ligature  is  not  forthcoming.  In  a 
case  of  accidental  strangulation  which  the  author  saw  in  1864,  the  mark 
round  the  neck  presented  the  appearance  which  might  be  expected  from 
the  use  of  a  narrow  cord.  But  in  this  instance  a  soft  silk  neckerchief 
was  the  means  of  constriction,  and  the  peculiar  narrowness  of  the  mark 
on  one  side  was  owing  to  the  great  tightness  with  which  it  had  been 
drawn.  The  mark  or  impression  produced  by  a  ligature  is  generally  cir- 
cular, from  the  mode  in  which  the  pressure  is  produced.  It  may  be  situated 
at  any  part  of  the  neck,  but  it  is  more  commonly  below  the  windpipe.  In 
manual  strangulation  the  marks  of  bruising  and  ecchymosis  will  generally 
be  in  the  front  of  the  neck,  chiefly, about  the  larynx  and  below  it.  In  a 
case   of  homicidal  strangulation  (Reg.   v.    Shaw,   Liverpool  Ass.,   Nov. 


412  POST-MORTEM    APPEARANCES. 

1884),  the  following  were  the  appearances  noted,  the  strangulation  of  a 
woman  having  been  eS'ected  by  means  of  the  fingers  and  thumb  applied 
to  the  sides  of  the  neck.  There  was  a  bruise,  with  extravasation  of  blood, 
immediately  beneath  the  lobule  of  the  left  ear ;  and  another,  also  with 
extravasation,  three-quarters  of  an  inch  below  the  lobule  of  the  right  ear. 
Corresponding  to  this  latter  bruise,  a  second  effusion  of  blood  had  taken 
place  into  the  deeper  tissues  half  an  inch  beneath  the  surface.  There  were 
other  bruises  over  each  eyebrow,  at  the  back  of  the  right  wrist,  over  the 
knuckle  of  the  left  little  finger,  at  the  inner  side  of  the  left  elbow,  and  at 
each  angle  of  the  mouth.  Within  the  mouth  was  a  contused  and  lacerated 
Avound  opposite  the  jagged  stump  of  the  canine  tooth,  and,  exactly  oppo- 
site to  this,  on  the  upper  lip  was  a  smaller  bruise,  with  extravasation  of 
blood.  The  tongue  was  bruised  on  the  right  side,  as  though  it  had  been 
caught  between  the  teeth.  The  left  lateral  upper  incisor  was  loosened, 
and  the  tongue  and  effused  blood  showed  that  the  wound  was  recent. 
The  blood  generally  was  dark  and  fluid.  The  brain  and  its  membranes 
were  intensely  congested.  There  were  no  marks  of  injury  to  the  throat. 
The  lungs  were  congested,  and  emphysematous  on  the  surface.  The  heart 
contained  a  cjjuantity  of  dark  fluid  blood.  The  abdominal  viscera  were  not 
noticeably  congested.  Urine  and  feces  had  escaped.  (Med.  Chron.,  i.  p. 
577.)  The  circular  direction  of  a  mark  produced  by  the  ligature  is  not  an 
absolute  indication  that  strangulation  has  taken  place  without  suspension 
of  the  body,  since  cases  of  hanging  have  occurred  in  which  a  circular  mark 
has  been  observed  ;  and  it  is  possible  that  some  degree  of  obliquity  may 
occasionally  exist  in  the  course  of  the  depression  produced  by  a  ligature 
in  strangulation.  A  medical  jurist  ought,  therefere,  to  weigh  all  the  facts 
connected  with  the  position  of  the  body  and  the  nature  and  direction  of 
the  ligature,  before  he  forms  an  opinion  from  the  appearances  presented 
by  the  mark  on  the  neck,  whether  the  person  has  been  hanged  or  not. 
Greater  importance  is  to  be  attached  to  the  lividity,  ecchymosis,  and  abra- 
sion of  the  skin  in  the  course  of  the  ligature  than  to  the  circularity  or 
obliquity  of  the  depression  produced  by  it.  In  the  strangling  of  a  living 
person  by  a  cord,  it  is  scarcely  possible  that  a  murderer  can  avoid  pro- 
ducing on  the  neck  marks  of  severe  injury,  and,  in  the  existence  of  these, 
we  have  evidence  of  the  violent  manner  in  which  death  has  taken  place. 

In  cases  in  which  great  violence  has  been  used  to  the  neck,  blood  may 
escape  from  the  mouth  and  nose.  It  is  a  matter  of  popular  belief  that,  if 
there  is  no  open  wound  in  the  body,  there  can  be  no  bleeding.  In  Reg. 
V.  Millar  (C.  C  C,  July,  1870),  the  prisoner  was  charged  with  the  murder 
of  a  Mr.  Huelin,  One  of  the  circumstances  which  led  to  the  discoverv  of 
the  crime  was  the  large  amount  of  blood  which  had  escaped  from  the 
mouth  and  nose  as  a  result  of  the  act  of  strangulation.  The  evidence  left 
it  clear  that  the  prisoner  had  murdered  Huelin  and  his  housekeeper,  and 
had  endeavored  to  conceal  the  dead  bodies.  He  bad  packed  the  body  of  the 
housekeeper  in  a  box,  and  requested  a  carrier  to  place  a  cord  round  it. 
The  man  observed  that  fluid  blood  was  oozing  from  the  box,  and  that 
there  was  a  large  stain  of  blood  on  the  floor  beneath.  On  opening  the  box 
the  body  of  the  woman  was  found  inside.  There  was  a  cord  tied  tiahtly 
round  the  neck  of  the  deceased,  and  blood  had  escaped  from  the  mouth  and 
nose  and  had  run  down  the  side  of  the  box.  The  deceased  had  been  stran- 
gled, and  such  an  amount  of  force  used  in  the  tightening  of  the  cord  round 
the  neck,  as  to  lead  to  a  copious  effusion  of  blood  from  the  mouth  and 
nose.  In  cases  of  asphyxia  the  blood,  ovring  to  its  liquidity,  continues  to 
flow  for  some  time  after  death  from  any  lacerated  wound  or  bloodvessel. 

On  the  other  hand,  a  person  may  be  strangled,  and  yet  the  ligature,  in 


EXTERNAL  AND  INTERNAL  APPEARANCES.         413 

consequence  of  its  being  soft  and  yiddiniz',  will  not  cause  a  perceptible 
depression  or  ecchymosis — scarcely  anything-  more  than  a  slight  depression 
of  the  skin.  If  we  except  cases  of  suicide,  such  a  condition  must  be  rare, 
because  assailants  usuall}^  produce  a  much  more  violent  constriction  of  the 
neck  than  is  necessary  to  insure  the  death  of  a  person.  The  general 
lividity  of  the  body,  contraction  of  the  fingers,  with  clenching  of  the 
hands,  and  swelling  and  protrusion  of  the  tongue,  are  more  marked  in 
strangulation  than  in  hanging.  A  thin  mucous  froth  tinged  with  blood 
is  occasionally  found  in  the  air-passages  in  both  cases.  In  some  instances 
of  violent  strangulation,  blood  has  escaped  from  one  or  both  ears  during 
the  act ;  but  this  is  not  a  usual  appearance.  In  two  well-marked  cases  in  ' 
which  the  author  was  consulted,  the  constriction  of  the  neck  was  carried 
•to  a  great  degree,  but  there  was  no  bleeding  from  the  ears.  Geoghegan 
examined  a  case  of  suicidal  strangulation  in  which  the  constriction  had 
been  produced  by  a  ribbon,  and  tiie  violence  applied  was  sufficient  to  pro- 
duce bleeding  from  one  ear ;  on  dissection  this  was  found  to  have  resulted 
from  a  rupture  of  the  membrane  of  the  drum  of  the  ear.  There  was  no 
froth  at  the  mouth  or  nostrils,  and  scarcely  any  lividity  or  swelling  of  the 
face.  It  was  further  observed  that  the  mark  on  the  neck,  which  was 
deep,  almost  disappeared  after  the  removal  of  the  ligature.  Wilde  met 
Avith  a  case  in  which  rupture  of  the  membrane  of  the  drum  of  the  ear, 
with  effusion  of  , blood,  was  caused  by  strangulation.  Bleeding  from  the 
oars,  as  a  result  of  rupture  of  the  membrane  of  the  drum,  must,  however, 
he  regarded  as  an  exceptional  appearance.  Chevers  does  not  mention  it 
as  having  been  noticed  in  any  one  of  the  numerous  cases  which  he  has 
collected  in  his  Indian  experience,  although  bleeding  from  the  nostrils  had 
been  observed.  (Med.  Jurispr.  for  India,  185G,  p.  374.)  Without  rupture 
of  the  membrane  of  the  drum,  blood  could  not  issue  from  the  ears,  and  In 
order  that  this  membrane  should  be  ruptured  certain  conditions  not 
commonly  met  with  are  recpiired. 

The  body  of  a  woman  v.- ho  had  been  homicidally  strangled,  presented 
the  following  appearances:  the  skin  of  the  head,  face,  neck,  and  chest  was 
darker  than  natural,  and  discolored  underneath,  particularly  that  of  the 
scalp.  The  brain  was  suffused  with  dark  blood,  the  lungs  gorged  and  of 
a  dark  color,  the  bow^els  of  a  dusky-red  color.  .  The  eyes  were  somewhat 
protruded  and  bloodshot,  the  lips  swollen  and  darker  than  natural,  the 
tongue  slightly  protruding  between  the  teeth,  and  froth  issuing  from  the 
nostrils.  There  was  a  mark  of  pressure  behind  the  right  ear,  aud  other 
marks  on  the  neck  and  chest,  with  discoloration  of  the  muscles.  (Chevers's 
Med.  Jurispr.  for  India,  pp.  378,  387.)  In  a  case  of  suicidal  strangulation 
which  occurred  at  Liverpool  in  1863,  the  body  of  the  deceased  was  found 
dead,  cold,  and  rigid,  about  seven  hours  after  he  had  been  seen  alive. 
The  arras  were  flexed,  and  the  hands  raised  a  little  above  the  breast. 
Round  the  neck,  just  below  the  cricoid  cartilage,  was  a  strip  of  the  de- 
ceased's shirt,  which  had  been  used  as  a  ligature  ;  it  was  tied  at  the  hack 
of  the  neck.  There  w^as  slight  ecchymosis  in  the  mark  beneath.  The 
skin  of  the  face  had  a  dark-red  color,  and  w^as  dotted  with  spots  of  a 
deeper  red.  The  conjunctivae  were  ecchymosed,  and  some  bloOd  had 
escaped  from  the  nose.  The  brain  was  congested,  and  much  fluid  effused. 
The  heart  was  empty  ;  the  lungs  were  deep  in  color  (congested).  (Lancet, 
1863,  ii.  p.  183.  See  also  Reg.  v.  Shaw,  p.  411,  ante.)  Many  of  the 
cases  of  strangulation  which  have  presented  themselves  have  been  too 
superficially  examined.  The  most  complete  account  of  the  appearances  is 
that  given  by  Tardieu.  It  is  based  on  observations  made  in  twenty- 
eight  inspections.     (Sur  la  Pendaison,  la  Strangulation  et  la  Suffocation, 


414  STATE    OF    THE    LUNGS    AND    HEART. 

p.  164.)  The  lining  membrane  of  the  larynx  and  windpipe  was  more  or 
less  reddened  from  congestion  ;  sometimes  it  was  livid  or  of  a  dark-red 
color.  There  was  a  bloodj  froth  extending  into  the  air-tubes.  The  state 
of  the  lungs  was  variable.  Contrary  to  what  is  generally  alleged  to  be 
characteristic  of  death  by  asph3rxia,  Tardieu  found  these  organs  to  contain 
bat  little  blood.  Sometimes  they  were  congested,  at  other  times  normal. 
There  were  ruptures  of  the  superficial  air-cells  producing  patches  of  em- 
physema, which  were  seen  singly  or  in  groups.  This  condition,  which 
was  rarely  absent,  gave  to  the  surface  of  the  lungs  the  appearance  of 
being  covered  with  white  layers  of  thin  false  membrane.  When  these 
patcljcs  were  punctured,  air  escaped.  There  was  an  absence  of  that  con- 
dition of  the  lungs  which  he  ob.served  in  death  from  simple  suffocation, 
namely,  dotted  ecchymosis  on  the  surface,  immediately  below  the  invest- 
ing membrane  (the  j)leura).  Throughout  the  substance  of  the  lungs, 
efi'usions  of  blood  varying  in  size  were,  however,  generally  found,  pro- 
vided an  early  inspection  of  the  body  was  made.  When  some  days  had 
elapsed,  the  lungs  were  found  pale  or  congested,  without  any  ecchymosed 
or  mottled  appearance.  The  ruptured  air-cells,  with  air  beneath  them, 
were  still  visible  on  the  surface. 

The  heart  presents  no  uniform  condition  ;  being  sometimes  quite  empty 
and  at  others  containing  dark  fluid  blood.  The  brain  is  occasionally  con- 
gested, but  more  commonlv  has  its  natural  appearance.  In  one  instance, 
blood  was  found  effused  on  the  brain,  but  this  is  unusual.  It  has  also 
been  stated  that  a  congested  state  of  the  sexual  organs,  both  in  males  and 
females,  was  one  of  the  appearances  connected  with  strangulation  ;  but 
this  has  not  been  confirmed  by  careful  observers.  Tardieu  met  with 
nothing  to  call  for  notice  in  this  respect  in  the  numerous  cases  which  he 
examined.  The  involuntary  discharge  of  feces,  urine,  and  seminal  or 
prostatic  fluid,  described  as  one  of  the  characters  of  death  by  hanging, 
may  occur  in  death  from  strangulation.  ISI'o  importance  can  be  attached 
to  this  as  a  sign,  of  death  from  asphyxia  in  any  form.  It  frequently 
occurs  in  sudden  and  violent  death  from  any  cause,  and  there  are  many 
instances  of  death  from  asphyxia  in  which  it  is  not  observed.  Among  the 
occasional  appearances  of  violent  strangulation  may  be  mentioned  injury 
to  the  windpipe  and  the  muscles  of  the  neck  around  it.  One  case  in  which 
the  rings  of  the  windpipe  were  split  as  a  result  of  pressure,  was  com- 
municated to  the  author  by  Inman.  Several  instances  of  laceration  and 
rupture  of  the  vcindpipe  are  quoted  by  Chevers.  (Op.  cit.,  pp.  381,  38J.) 
In  one  instance,  the  ossified  thyroid  cartilage  had  been  broken  and  forced 
inwards,  causing  suffocation.  In  Reg.  v.  O'Brien  (Liverpool  Wint.  Ass., 
185T),  a  case  of  alleged  murder  by  strangulation,  the  cartilage  of  the 
windpipe  was  broken ;  and  in  the  case  of  Pinckard  (Northampton  Lent 
Ass.,  1852),  the  windpipe  was  broken  longitudinally.  In  reference  to 
fractures  of  the  larynx,  see  Casper,  Klin.  Novellen,  18C3,  p.  497.  In 
suspected  homicidal  strangulation,  it  is  always  proper  to  examine  the  con- 
tents of  the  stomach  for  narcotic  poison.  In  all  cases,  the  cord  or  ligature, 
if  forthcoming,  should  be  carefully  examiq^ed,  in  order  to  determine  whether 
it  bears  upon  it  marks  of  blood,  or  whether  hair  or  other  substances  are 
adhering  to  it.  A  portion  of  it  should  be  reserved  for  the  purposes  of 
identity.  In  two  instances  of  homicidal  strangulation,  the  ligatures  found 
round  the  dead  bodies  were  proved  to  correspond  with  portions  of  the 
same  material  found  in  the  possession  of  the  persons  who  were  charged 
with  the  murders.  In  removing  the  ligature  from  the  neck,  the  precise 
mode  in  which  it  is  tied  or  secured  should  ])e  noticed,  as  this  may  be  a  fact 
of  importance  in  reference  to  an  allegation  of  suicide. 


INJURY    TO    THE    LARYNX.  415 

The  medico-legal  questions  relative  to  stvanuulatiun  are  of  the  same 
nature  as  those  which  have  been  already  considered  in  treating-  of  hang- 
ing. Thus,  in  examining  the  body  of  a  person  suspected  to  have  been 
strangled,  we  may  be  required  to  answer  the  following  questions  : — 

Was  deatli  canned  hy  atranriulation,  or  was  the  constricling  force 
applied  to  the  neck  after  death? — Medical  jurists  have  considered  that  the 
internal  appearances  throw  no  light  upon  this  question.  This  opinion 
probal)ly  arose  from  the  fact  that  inspections  have  not  been  made  until 
some  days  after  death,  when  the  peculiar  appearances  of  strangulation 
have  been  merged  in  those  of  putrefaction.  The  state  of  the  lungs,  how- 
ever, may  be  considered  as  characteristic.  It  would  be  impossible,  by 
the  application  of  a  ligature  round  the  neck  of  a  dead  body,  to  produce 
rupture  of  the  air-cells  on  the  surface  of  the  lungs  and  effusions  of  blood 
in  their  substance.  The  state  of  the  eyes  and  of  the  inside  of  the  larynx 
and  windpipe  in  persons  who  have  been  strangled  could  not  be  imitated 
be  any  constriction  of  the  neck  after  death  :  no  bloody  mucous  froth  would 
be  found  in  the  windpipe  or  air-tubes.  The  external  appearances  have 
been  considered  to  furnish  more  accurate  means  of  distinction.  Although 
the  condition  of  the  neck  generally  yields  the  strongest  evidence,  it  will  be 
proper  to  seek  for  that  appearance  of  dotted  redness  or  ecchymosis  in  the 
skin  of  the  face,  neck,  and  chest  described  by  Tardieu.  The  state  of  the 
eyes,  as  to  their  prominence  and  the  congestion  of  the  membranes,  as 
well  as  the  position  of  the  tongue,  should  also  be  examined.  The  ecchy- 
mosis about  the  dci)ression  of  the  neck,  when  a  ligature  has  been  em- 
ployed, with  the  accompanying  swelling  and  lividity  of  the  face,  are 
phenomena  not  likely  to  be  simulated  in  a  dead  body  by  the  application  of 
any  degree  of  violence.  When  the  constriction  is  produced  within  a  few 
minutes  after  death,  an  ecchymosed  depression  may  result ;  but  it  is  im- 
probable that  there  should  be  any  lividity  or  swelling  of  the  countenance. 
Casper  found  that,  when  the  constricting  force  was  not  applied  to  the 
neck  until  six  hours  after  death,  a  mark  indicative  of  vital  strangulation 
could  not  be  produced.  It  is  doubtful  whether  it  could  be  produced  in  the 
dead  body  even  an  hour  after  death.  The  period  cannot  be  determined 
with  positive  certainty ;  the  results  would  probably  vary,  according  to  the 
rapidity  with  which  the  body  had  cooled. 

This  question  was  of  importance  in  the  case  of  Marguerite  Dixblanc, 
tried  (C.  C.  C,  June,  1872)  for  the  murder  of  her  mistress,  Madame  Riel. 
The  body  of  the  deceased  was  found  with  marks  of  violence  abont  the 
head  sufficient  to  account  for  death,  and  there  was  a  rope  tightly  drawn 
round  the  neck.  In  the  defence  it  was  suggested  that  the  rope  had  been 
placed  round  the  neck  after  death  for  the  purpose  of  dragging  the  body  to 
the  place  where  it  was  found.  Another  theory  was  that  the  prisoner  had 
strangled  her  mistress  with  the  rope.  From  the  appearance  of  the  neck, 
the  medical  evidence  left  it  doubtful  whether  the  rope  had  been  applied 
during  life  or  soon  after  death.  If  the  former,  it  would  have  proved  a 
deliberate  design  to  murder.  The  prisoner  received  the  benefit  of  the 
doubt,  and,  although  found  guilty,  the  capital  sentence  was  commuted. 

It  is  difficult  to  conceive  under  what  circumstances  an  attempt  to  sinui- 
late  strangulation  in  a  recently  dead  body  could  be  made,  unless  for  the 
purpose  of  throwing  suspicion  upon  an  innocent  person  connected  with  the 
deceased.  When  an  individual  has  been  murdered,  it  is  not  likely  that 
the  murderer  would  attempt  to  produce  the  appearances  of  strangulation 
on  the  body  after  death,  under  the  idea  of  concealing  his  crime ;  for 
strangulation  is,  in  most  cases,  an  actual  result  of  homicide,  and  is  rarely 
seen  as  an  act  of  suicide.     A  rope  might,  however,  be  applied,  as  in  Dix- 


41G  MARKS    OF    VIOLENCE    ON    THE    NECK. 

Ijlanc's  case,  for  the  purpose  of  dragg-ing  the  boch^.  In  the  absence  of 
ecchymosis  from  the  neck,  it  will  be  difficult  to  form  an  opinion,  unless 
from  circumstantial  evidence  ;  but  there  may  not  be  an  ecchymosed  CircZe; 
for  a  person  may  be  strangled  by  the  application  of  pressure  to  the  wind- 
pipe through  the  medium  of  the  finger-nails, -or  of  any  hard  or  resisting 
substance.  The  ecch^'mosis  on  the  neck  in  such  cases  will  be  in  detached 
spots  or  patches.  In  the  absence  of  all  marks  of  violence  around  the  neck, 
we  should  be  cautious  in  giving  an  opinion  which  may  affect  the  life  of 
an  accused  person ;  for  it  is  not  probable  that  homicidal  strangulation 
could  be  accomplished  without  the  production  of  some  appearances  of  vio- 
lence on  the  skin  over  the  larynx  or  windpipe.  It  is  doubtful  whether 
strangulation  can  ever  take  place  without  some  mark  being  found  on  the 
neck  indicative  of  the  means  used.  The  bare  possibility  of  death  being 
caused  in  this  manner,  without  leaving  any  appreciable  trace  of  violence, 
must  be  admitted  ;  although  the  admission  scarcely  applies  to  those  cases 
which  require  medico-legal  investigation.  Suicides  and  murderers  generally 
employ  much  more  violence  than  is  necessary  for  the  purpose  of  destruc- 
tion :  hence  detection  is  easy.  But  if  a  soft  and  elastic  band  were  applied 
to  the  neck  with  a  gradually  regulated  force,  it  is  possible  that  a  person 
might  die  strangled  without  any  external  sign  being  discovered  to  indi- 
cate the  manner  of  his  death.  Indian  surgeons  inform  us  that  the  Thugs 
and  other  robbers  met  with  in  India  are  thus  accustomed  to  destroy  their 
victims  with  the  dexterity  of  practised  murderers. 

A  case  involving  this  question  of  strangulation  without  marks  of  vio- 
lence on  the  neck,  was  tried  in  France,  and  from  the  medical  evidence 
decided  in  the  affirmative.  (Gaz.  M4d.,  1846,  p.  375.)  The  medical  wit- 
ness should,  however,  be  prepared  to  consider  whether,  in  the  absence  of 
any  mark,  death  might  not  have  proceeded  from  another  cause,  and  leave 
it  to  the  authorities  of  the  law  to  decide,  from  circumstances,  in  favor  of 
or  against  the  prisoner.  There  is  nothing  sufficient  to  justify  a  medical 
witness  in  .stating  that  death  has  proceeded  from  strangulation,  if  there 
.should  be  no  appearance  of  lividity,  ecchymosis,  or  other  violence  about 
the  neck  or  face  of  the  deceased.  Congestion  in  the  organs  of  generation 
is  an  appearance  which  it  would  not  be  safe  to  take  as  positive  evidence 
of  death  from  strangulation.  The  state  of  the  countenance  will  not 
warrant  the  expression  of  an  opinion  unless  it  is  accompanied  by  other 
v,-ell-marked  signs  of  this  mode  of  death  ;  for  there  are  many  kinds  of 
death  in  which  the  features  may  become  livid  and  distorted  from  causes 
totally  unconnected  with  the  application  of  external  violence  to  the  throat. 
So,  again,  the  eyes  and  tongue  may  be  protruded  as  a  result  of  putrefac- 
tive changes.  Let  not  a  witness,  then,  lend  himself  as  an  instrument  for 
the  condemnation  of  a  person  against  whom  nothing  but  a  strong  suspi- 
cion from  circumstances  may  be  raised  and  where  medical  evidence  is 
unable  to  furnish  any  distinct  and  conclusive  proofs  of  death  from  strangu- 
lation. This  caution  is  especially  necessary  in  reference  to  the  inspection 
of  bodies  which  are  in  a  state  of  putrefaction.  A  medical  man,  already 
provided  with  a  theory  of  the  cause  of  death  by  the  discovery  of  a  rope 
or  other  means  of  constriction  found  near  a  dead  body,  ma}^  easily  arrive 
at  the  conclusion  that  death  has  taken  place  from  strangulation.  The 
al)sence  of  the  usual  confirmatory  appearances  in  the  body  may  be  ascribed 
to  decomposition,  and  those  caused  by  decomposition  may  be  set  down  to 
strangulation.  Where  there  is  obvious  mechanical  violence  to  tie  neck, 
such  as  fracture  of  the  larynx  or  windpipe,  with  laceration  of  the  muscles 
beneath,  a  visible  depression,  such  as  a  cord,  a  ligature,  or  manual  pressure 
would  produce,  a  medical  opinion  may  be  fairly  given  in  spite  of  putrefac- 


MARKS    OF    VIOLENCE    ON    THE    NECK.  417 

tion.  But  when,  in  a  putrefied  body,  indistinct  marks  on  the  neck  or 
patches  of  discoloration  are  relied  upon  as  evidence  of  homicide,  there  is 
great  risk  of  a  serious  mistake. 

In  cases  of  alleged  strangulation  a  question  may  be  put  to  a  medical 
witness  as  to  how  far  his  opinion  as  to  the  cause  of  death  has  been  influ- 
enced by  the  discovery  of  a  rope  or  ligature  around  the  neck  of  the  de- 
ceased, or  ia  the  apartment  in  which  a  dead  body  is  found.  A  medical 
opinion  should  rest  upon  the  clear  and  obvious  changes  produced  on  the 
neck  and  on  the  structures  below  the  skin,  and  not  upon  the  mere  presence 
of  a  cord  or  ligature.  This  might  be  put  round  the  neck  of  a  dead  body, 
or  near  to  it,  for  a  malicious  purpose.  The  act  of  strangulation  should 
be,  medically,  as  distinctly  provable  without  the  production  of  the  rope, 
as  the  act  of  stabbing  without  the  production  of  the  knife  which  inflicted 
the  stab.  If  these  principles  are  not  strictly  adhered  to  in  practice,  police-- 
nien  will  be  as  competent  as  medical  experts  to  give  evidence  of  the  cause 
of  death  in  cases  of  alleged  strangulation. 

It  is  scarcely  necessary  to  state  that  all  marks  of  violence  on  the  body 
of  a  supposed  strangled  person  should  be  accurately  noted,  as  the  questions 
respecting  them,  however  slight  the  marks  may  be,  are  material.  The 
witness  will  be  expected  to  state  whether  they  Avere  inflicted  before  or 
after  death;  if  before,  Avhether  they  were  suflicieni  to  account  for  death, 
or  whether  they  were  such  as  to  be  explicable  on  the  supposition  of  an 
accidental,  suicidal,  or  homicidal  origin.  It  should  be  observed  whether 
there  exist  any  morbid  changes  in  either  of  the  three  great  cavities  of  the 
body  sufficient  to  account  for  death,  as  this  kind  of  negative  evidence  may 
be  essential  in  the  progress  of  a  case.  In  reference  to  females,  whether 
children  or  adults,  the  surgeon  should  not  neglect  to  examine  the  sexual 
organs  in  order  to  ascertain  whether  there  are  any  marks  of  violation. 
Cases  have  occurred  in  which  rape  has  been  perpetrated,  and  strangula- 
tion resorted  to  for  the  purpose  of  concealing  the  crime. 

Strangulation,  like  hanging,  is  occasionally  the  result  of  accident,  but 
the  occurrence  may  be  looked  upon  as  rare.  When  the  body  is  not  sus- 
pended it  is  commonly  more  in  the  power  of  a  person  to  assist  himself, 
and  escape  from  the  constriction  ;  hence  cases  of  accidental  strangulation 
are  less  frequent  than  those  of  accidental  hanging.  As  a  general  rule, 
cases  in  which  the  constriction  of  the  neck  has  been  produced  by  some 
accident  present  no  difficulty  to  a  medical  jurist,  provided  the  relations 
of  the  body  to  surrounding  objects  and  the  compressing  force  have  not, 
been  disturbed.  Should  it  happen,  however,  that  the  body  has  been  re- 
moved from  the  place  in  which  it  was  first  discovered,  oi*  the  ligature 
taken  from  the  neck,  we  can  only  establish  a  presumption  of  accident  from 
the  description  given. 

When  a  charge  of  murder  is  instituted  against  a  person  an  attempt  is 
not  unfrequently  made  by  counsel  for  the  defence  to  show  the  probability 
that  the  deceased  might  have  fallen  while  in  a  state  of  intoxication,  and 
have  become  accidentally  strangled,  either  by  a  tight  cravat  or  by  some 
foreign  substance  exerting  pressure  on  the  windpipe.  If  we  admit  the 
possibility  of  an  occurrence  of  this  nature  we  must  not  lose  sight  of  the 
existence  of  other  more  probable  causes  of  death,  nor  should  we  allow  our 
judgment  to  be  swayed  as  to  abandon  what  is  probable  for  that  which  is 
merely  possiI)le. 

Suicidal  Strangulation. — This  mode  of  suicide  is  of  rare  occurrence, 

and,  except  under  particular  circumstances,  impossible.     The  possibility  of 

an  individual  strangling  himself  was  for  a  long  time  denied  by  medical 

jurists;  for  it  was  presumed  that  when  the  force  was  applied  by  the  hand 

27 


418  SUICIDAL    STRANGULATION. 

all  power  would  be  lost  as  soon  as  the  compression  of  the  windpipe  com- 
menced. Physiologically  correct,  this  reasoning  is,  however,  only  appli- 
cable to  those  cases  in  which  the  windpipe  is  voluntarily  compressed  by 
the  fingers.  When  a  person  determined  on  suicide  allows  the  windpipe 
to  be  compressed,  by  leaning  with  the  whole  weight  of  his  body  on  a  cord 
passed  around  his  neck  and  attached  to  a  fixed  point,  he  may  perish  in  this 
manner  almost  as  readily  as  if  he  had  hanged  himself;  for  insensibility 
and  death  will  soon  supervene.  In  the  chapter  on  Hanging  it  was  stated 
that  suicides  were  often  found  with  their  bodies  in  close  contact  with  the 
ground  ;  and  cases  are  reported  in  which  strangulation  was  accompli.<hed 
in  the  manner  above  described,  while  the  suicide  was  in  a  sitting  or  kneel- 
ing posture  (p.  416).  On  other  occasions  the  peculiar  disposition  or 
nature  of  the  ligature  has  enabled  a  person  bent  on  suicide  to  strangle 
himself  without  much  difficulty.  An  instance  is  related  by  Orfila  in 
which  two  cravats,  ihat  were  twisted  several  times  round  the  neck  of  the 
deceased,  who  was  discovered  lying  on  his  bed,  bad  effectually  served  the 
purpose  of  self-destruction.  (Mdd.  Leg.,  vol.  2,  p.  389.)  Sometimes 
strangulation  has  been  suicidally  effected  by  a  rough  cord  passed  repeat- 
edly round  the  neck  and  tightened  by  being  pulled  with  each  hand.  The 
number  of  coils  would  still  cause  some  pressure  to  be  exerted  even  when 
the  grasp  was  relaxed  by  death.  (Guy's  Hosp.  Rep.,  1851,  p.  371.) 
Other  cases  are  related  in  which  suicides  have  succeeded  in  strangling 
themselves  by  tightening  the  ligature  with  a  stick  (ibid.,  -p.  371);  or, 
when  the  ligature  was  formed  of  thick  and  rough  materials,  by  simply 
tying  it  in  a  knot.  In  the  case  of  a  youth  found  dead  in  a  field  with  the 
handle  of  a  pitchfork  passed  under  the  necktie,  there  were  marks  of  strang- 
ulation on  the  larynx,  the  eyeballs  protruded  as  well  as  the  tongue,  which 
was  livid  and  marked  by  the  teeth.  The  brain  was  full  of  fluid  venous 
blood.  There  was  no  doubt  that  death  had  taken  place  by  strangulation, 
probably  suicidal,  as  it  is  difficult  to  conceive  that  the  handle  of  the  fork 
could  have  come  by  any  accident  into  the  position  in  which  it  was  found. 
A  case  occurred  in  1875,  in  which  a  man  was  found  dead  in  bed,  with  his 
handkerchief  tied  round  his  neck  and  twisted  from  right  to  left  by  means 
of  a  razor-strop.  There  was  no  doubt  that  this  was  a  case  of  suicidal 
strangulation. 

Although  suicidal  strangulation  may  be  effected  under  unexpected  cir- 
cumstances, 3"et  in  a  case  of  murder  by  strangulation  it  would  not  be  easy 
to  simulate  suicide:  it  would  at  any  rate  require  great  skill  and  premedi- 
tated contrivance  on  the  part  of  the  murderer  so  to  dispose  of  the  body  of 
his  victim,  or  to  place  it  in  such  a  relation  to  surrounding  objects,  as  to 
render  a  suspicion  of  suicide  even  probable.  Thus,  if  the  cord  or  ligature 
should  be  found  loose  or  detached  ;  if  the  ecchymosis  or  mark  in  the  neck 
should  not  accurately  correspond  to  the  points  of  greatest  pressure  ;  if, 
moreover,  the  means  of  compression  were  not  evident  when  the  body  was 
first  discovered  and  before  it  had  been  removed  from  its  situation,  there 
would  be  fair  grounds  for  presuming  that  the  act  was  homicidal.  In 
those  cases  in  which  strangulation  has  resulted  from  a  compression  of  the 
windpipe  by  the  fingers  and  where  there  are  fixed  ecchymosed  marks 
indicative  of  direct  manual  violence,  we  have  the  strongest  presumptive 
evidence  of  murder;  for  neither  accident  nor  suicide  could  be  urged  as 
affording  a  satisfactory  explanation  of  their  presence. 

E.  Hofmann  met  with  an  instance  of  this  kind  in  which  he  rightly  con- 
eluded,  from  the  deep  depressions  in  the  neck  of  the  deceased,  attended 
with  abrasion  of  the  cuticle  and  effusion  of  blood,  as  well  as  from  the 
great  injury  done  to  the  parts  about  the  larynx  and  windpipe,  that  the 


HOMICIDAL    STRANGULATION.  419 

straiignilation  was  homicidal.  (Vierteljahrsschr.  fiir  Gerichtl.  Med.,  1873, 
2,  p.  89.)  This  case  is  reniai-kable  for  another  fact.  The  assassin  had 
wiped  his  hand,  which  must  have  been  stained  with  blood  from  the  vio- 
lence used,  on  a  towel  which  was  found  concealed,  but  was  subsequently 
traced  to  his  possession.  It  was  affirmed,  in  defence,  that  the  blood  on 
the  towel  was  of  old  date,  but  the  spectroscope  showed  that  it  had  the 
characters  of  recent  blood.  That  this  had  been  used  for  the  purpose 
stated  was  proved  by  the  discovery  on  it  of  the  shreds  of  epidermis  and 
the  fine  downy  hairs  of  the  deceased,  such  as  would  have  been  removed 
under  violent  pressure  with  the  fingers. 

Homicidal  Strangulation. — Strangulation  occasionally  comes  before  our 
courts  as  a  question  of  murder  :  and  when  a  person  has  been  tried  upon 
a  charge  of  this  kind  the  circumstances  have  been  commonly  so  clear  as 
to  render  the  duty  of  a  medical  witness  one  of  a  simple  nature.  When 
the  cause  of  death  is  contested,  or  when  it  is  contended  in  defence  that  the 
strangulation  is  suicidal,  a  medical  witness  must  be  prepared  to  give  his 
reasons  for  affirming  that  the  act  was  one  of  strangulation,  and  not  done 
by  the  deceased  himself.  He  must  be  prepared  to  meet  and  explain  the 
differences  between  the  case  under  investigation  and  those  reported  cases 
which  are  admitted  to  have  been  suicidal.  The  attitude  of  the  body,  the 
condition  of  the  dress,  the  means  of  strangulation,  .the  presence  of  marks 
of  violence  or  of  blood  on  the  person  of  the  deceased,  on  his  clothes  or 
the  furniture  of  the  room,  or  on  the  rope  or  ligature,  are  circumstances 
from  which,  if  observed  at  the  time,  important  medical  inferences  may  be 
drawn.  As  a  rale,  a  criminal  who  attempts  to  imitate  suicide  under  such 
a  form  of  murder  must,  when  the  facts  are  properly  investigated,  inevit- 
ably fail  in  his  object.  The  assassin  either  does  too  little,  or  he  does  too 
much.  In  one  case  of  murder  by  strangulation,  the  woman  who  perpe- 
trated the  crime  had  been  a  nurse  in  an  infirmary  and  accustomed  to  lay 
out  dead  bodies.  After  the  act  of  murder  she  appears  to  have  carried  out, 
unthinkingly,  her  professional  practice,  by  smoothing  the  clothes  under 
the  body,  placing  the  legs  at  full,  length,  the  arms  out  straight  by  the  side, 
and  the  hands  open  and  laid  out.  Such  a  condition  of  the  body  was  quite 
inexplicable  on  the  supposition  of  suicide,  considering  the  amount  of  vio- 
lence which  must  have  attended  the  strangulation.  In  another  case,  the 
criminal  had  attempted  to  make  the  death  appear  like  an  act  of  suicide  by 
placing  the  lower  end  of  tlie  rope  near  the  hand  of  the  deceased  ;  but  he 
selected  the  left  hand,  whereas  the  deceased  was  right-handed,  and  he  did 
not  leave  enough  rope  free  from  the  neck  for  either  hand  to  grasp  in  order 
to  produce  the  very  violent  constriction  of  the  neck  which  had  been  caused 
by  the  two  inner  coils.  Both  of  these  criminals  confessed  their  crimes 
before  execution. 

Sometimes  the  appearance  of  the  mark  on  the  neck  will  allow  us  to 
establish  a  slight  presumption  for  or  against  homicide.  In  homicidal 
strangulation,  from  the  unnecessary  violence  used,  we  may  expect  to  find 
the  skin  much  ecchymosed,  lacerated,  or  excoriated;  and  the  deep-seated 
parts,  such  as  the  muscles  and  vessels,  as  well  as  the  windpipe  itself,  more 
or  less  bruised,  lacerated,  or  extensively  injured.  Such  a  degree  of  vio- 
lence is  not  eommonl}^  found  in  cases  of  suicidal  strangulation.  Fractures 
of  the  hyoid  bone,  larynx,  and  windpipe  generally  indicate  an  amount  of 
violence  inconsistent  with  suicide.  In  Reg,  v.  Woodford  (Lewes  Spring 
Ass.,  18t6),  a  case  of  alleged  murder  by  strangulation,  the  medical  evi- 
dence showed  not  only  the  marks  of  a  thumb  and  fingers,  as  if  the  de- 
ceased had  been  seized  by  the  throat,  but  the  hyoid  bone  was  found 
fractured  at  a  spot  corresponding  to  a  mark  on  the  throat.     There  was  no 


420  HOMICIDAL    STRANGULATION. 

doubt  that  these  wore  the  results  of  homicidal  violence,  and  the  prisoner 
was  convicted.  The  mark  on  the  neck  has  sometimes  furnished  evidence 
of  this  mode  of  death,  even  under  circumstances  in  which  it  might  be 
supposed  all  evidence  would  be  destroyed,  Schiippel  described  a  case  in 
which  he  was  able  to  verify  the  fact  of  strangulation  after  the  burning  of 
the  body.  In  1869,  a  fire  took  place  in  a  cottage  in  which  there  were  at 
the  time  a  man,  his  wife,  a  stepson  (set,  10),  and  a  newborn  infant.  The 
man  escaped  with  the  infant,  and  said  that  his  wife  and  stepson  had  left 
the  house  before  the  fire.  This  was  proved  to  be  a  falsehood :  their  dead 
bodies  were  subsequently  discovered  much  burnt.  A  suspicion  of  incen- 
diarism and  murder  arose,  and  the  remains  were  examined  by  Schiippel. 
On  the  burnt  remains  of  the  neck  of  the  boy  there  was  a  horizontal  mark 
or  depression  encircling  the  greater  part  of  the  neck,  about  a  quarter  of 
an  inch  wide,  and  presenting  a  smooth  surface,  quite  distinct  from  the 
broken,  blistered,  and  carbonized  skin  above  and  below  it ;  and  the  tongue 
protruded  from  the  mouth.  From  this  condition  of  the  neck  and  tongue, 
Schiippel  drew  the  conclusion  that  the  boy  had  died  from  strangulation 
and  that  the  ligature  had  been  applied  to  the  neck  while  the  boy  was  living 
and  had  been  burnt  with  the  body.  (Vierteljahrsschr.  fiir  Gerichtl.  Med., 
18t0,  2,  p.  140.)  The  man  was  found  guilty  of  the  murder  of  his  wife 
and  stepson,  and  a  few  days  afterwards  he  committed  suicide  by  hanging 
himself  while  in  prison.  He  had  set  fire  to  the  house  after  the  murder  in 
order  to  conceal  this  double  crime. 

In  1889  a  man  was  convicted  of  the  murder  of  his  wife,  at  Dundee. 
The  prisoner  went  to  the  police-station  and  informed  the  officer  that  his 
wife  had  hung  herself  some  days  before  ;  but  on  the  police-officer  proceed- 
ing with  him  to  the  house,  there  was  no  nail  in  the  wall,  nor  any  mark  to 
show  that  one  had  been  there  to  which,  as  alleged  by  the  prisoner,  she 
could  have  fixed  the  cord.  The  case  was  clearly  one  of  homicidal  strangu- 
lation.    (Lancet,  1889,  i.  p.  696.) 

In  Reg.  V.  Lunnum  (Warwick  Lent  Ass.,  1873),  a  w^oman  was  charged 
with  the  murder  of  her  child,  a  month  old,  by  strangulation,  There  were 
five  ciuite  recent  marks  on  the  throat,  such  as  would  be  produced  by  the 
pressure  of  four  fingers  and  a  thumb.  The  prisoner  stated  that  these 
marks  were  produced  by  her  a  fortnight  previously  in  trying  to  get  a 
button  out  of  the  child's  throat.  They  were  too  recent  to  admit  of  this 
explanation,  and  she  was  convicted  of  manslaughter.  In  the  case  of  the 
Countess  of  Goerlitz  (ante,  p.  371),  whose  body  was  destroyed  by  burn- 
ing, the  tongue  protruded  from  the  mouth,  thus  indicating  death  by- 
strangulation.  In  another  case  some  of  the  appearances  of  strangula- 
tion were  found  in  spite  of  the  subsequent  burning  of  the  body. 

It  is  proper  to  notice  in  this  place  the  occurrence  of  what  are  called 
Garrote  robberies.  The  s.ystem  of  murder  normally  pursued  by  the 
Thugs  in  India  appears  to  have  been  imported  into  England,  and  many- 
lives  have  been  destroyed  by  the  employment  of  strangulation  for  the 
purposes  of  robbery.  The  rigorous  proof  required  of  facts  which  under 
these  assaults  can  rarely  admit  of  proof,  confers  impunity  on  the  assailants. 
The  attack  is  made  during  darkness;  the  person  is  seized  by  the  windpipe 
from  behind,  or  a  bandage  is  thrown  around  his  neck  ;  and  this  is  sud- 
denly tightened,  while  accomplices  are  engaged  in  perpetrating  robber3% 
The  nature  of  the  assault,  by  pressure  on  the  windpipe,  renders  it  impos- 
sible to  give  an  alarm  or  call  for  assistance.  The  person  assaulted,  if 
he  should  recover,  is  seldom  able  to  identify  an  assailant :  he  is  attacked 
from  behind,  is  rendered  immediately  unconscious  and  powerless,  and  can 
rarely  offer  resistance.     Recovery  or  death  in  such  cases  depends  on  the 


MARKS    OF    VIOLENCE    ON    THE    BODY.  421 

lapse  of  a  few  seconds,  more  or  less,  during  which  the  constriction  of  the 
neck  is  continued ;  on  the  degree  of  constriction  ;  and  on  the  age,  sex, 
and  strength  of  the  constitution  of  the  person  assaulted.  An  attempt  at 
strangulation,  as  in  garrotiug,  besides  inflicting  serious  local  injury  to  the 
windpipe  and  other  parts  near  to  it,  may  cause  a  state  of  insensibility 
which  may  continue  for  some  hours.  There  is  severe  pain  in  the  throat, 
with  difficulty  of  speaking  and  swallowing,  and  if  the  larynx  be  seriously 
injured  there  may  be  loss  of  voice.  Dumbness,  however,  is  not  one  of  the 
secondary  sjanptoms,  and  loss  of  voice  is  usually  only  temporary  during 
the  pressure.  By  24  and  25  A^ict.,  c.  100,  s.  14,  it  is  enacted,  inter  alia, 
that  "  whosoever  shall  attempt  to  drown,  suffocate,  or  strangle  any  person, 
with  intent  to  commit  murder,  shall,  whether  any  bodily  injury  be 
effected  or  not,  be  guilty  of  felony ;  and  being  convicted  thereof  shall  be 
liable,  at  the  discretion  of  the  court,  to  be  kept  in  penal  servitude  for  life,, 
or  for  any  term  not  less  than  three  years,  ...  or  to  be  imprisoned  for 
any  term  not  exceeding  two  years."  As  the  intent  in  these  cases  is  to 
perpetrate  robbery,  and  not  murder,  another  section  (21)  has  been  framed 
for  the  prevention  of  the  crime  of  garroting :  "  Whosoever  shall,  by  any 
means  whatsoever,  attempt  to  choke,  suffocate,  or  strangle  any  other  per- 
son, or  shall  by  any  means  calculated  to  choke,  suffocate,  or  strangle, 
attempt  to  render  any  other  person  insensible,  unconscious,  or  incapable 
of  resistance,  with  intent,  in  any  of  such  cases,  to  enable  himself,  or  any 
other  person,  to  commit,  or  with  intent  in  any  of  such  cases  thereby  to 
assist  any  other  person  in  committing  any  indictable  offence,  shall  be 
guilty  of  felony  ;  and  being  convicted  thereof  shall  be  liable,  at  the  discre- 
tion of  the  court,  to  be  kept  in  penal  servitude  for  life,  or  for  any  term  not 
less  than  five  years,  ...  or  to  be  imprisoned  for  any  term  not  exceeding 
two  years,"  etc. 

3Iarks  of  Violence. — It  may  be  inquired  whether  viarks  of  violence  on 
the  body,  or  blood-stains  on  the  clothes,  furniture,  or  in  the  apartment,  do 

not  afford  strong  evidence  of  homicidal  strangulation.     The  answer  is if 

the  marks  of  violence  are  such  that  they  could  not  possibly  have  arisen 
from  any  accident  before  death,  or  that  they  could  not  possibly  have  been 
self-inflicted,  they  afford  the  strongest  evidence  of  murder.  But  the  cases 
wherein  so  positive  an  answer  can  be  returned  are  exceptional.  It  is  not 
always  in  our  power  to  distinguish  accidental  or  self-infiicted  from  homi- 
cidal violence  ;  and  we  are  always  bound  to  look  to  the  probability  of 
accident  or  of  previous  attempts  at  suicide  being  a  source  of  those  injuries 
which  may  be  apparent  on  a  strangled  body.  There  may  be  several 
marks  on  the  neck,  but  then  the  person  may  have  tried  to  strangle  him- 
self more  than  once.  The  throat  may  be  cut ;  there  may  be  a  deep-seated 
stab  or  gunshot-wound,  involving  some  of  the  important  organs  of  the 
body  ;  or  poison  may  be  found  in  the  stomach  ;  but  in  a  purely  medical 
point  of  view,  how  are  we  to  know  that  the  deceased  did  not  actually 
make  the  marks,  inflict  the  wounds,  or  take  the  poison  before  he  succeeded 
in  strangling  himself?  In  the  chapters  on  Drowning  and  Hanging,  we 
have  seen  what  suicides  can  do  when  they  are  desperately  bent  on  destroy- 
ing themselves.  Wounds  and  personal  injuries  often  create  serious  diffi- 
culties to  a  medical  jurist,  which  it  requires  the  greatest  caution  and 
prudence  on  his  part  to  meet  and  explain.  The  prejudice  of  the  public 
mind  is  such,  that  the  discovery  of  a  strangled  person,  with  any  marks  of 
personal  injury,  or  of  poisoning  in  his  stomach,  would,  in  most  cases,  lead 
to  a  charge  of  murder,  unless  the  facts  rendered  it  clearly  impossible  that 
any  attempt  could  have  been  made  on  his  life.  It  is  against  this  prejudice 
that  a  medical  witness  must  strenuously  guard  himself;  he  may  be  abused 


422  MARKS    OF    VIOLENCE    ON    THE    BODY. 

for  not  joining'  in  the  outcry  of  the  vulgar,  but  the  best  recompense  for 
this  abuse  will  be  the  conviction  that  he  is  interposing  the  shield  of  science 
to  protect  a  possibly  innocent  fellow-creature  from  the  senseless  denuncia- 
tions of  ignorance.  Further,  before  a  charge  of  murder  by  strangulation 
is  raised  against  any  person  from  marks  or  appearances  found  on  the  dead 
body,  care  should  be  taken  that  they  admit  of  no  other  reasonable  expla- 
nation than  the  direct  application  of  violence.  Even  if  marks  indicative 
of  strangulation  are  discovered,  the  question  arises  whether  they  may  not 
have  been  produced  by  the  deceased  upon  himself  in  an  attempt  at  suicide 
Avhich  may  have  failed.  If  the  body  of  a  person  is  allowed  to  cool,  with 
a  handkerchief,  band,  or  tightly-fitting  collar  round  the  neck,  a  mark 
resembling  that  of  strangulation  will  bo  produced.  Before  any  opinion 
is  given  that  murder  has  been  perpetrated  or  attempted,  the  medical 
proofs  on  which  reliance  is  placed  should  be  clear,  distinct,  conclusive,  and 
satisfactory. 

In  the  dead  bodies  of  infants  and  children,  in  M'hom  the  neck  is  short, 
a  mark  is  occasionally  seen,  which  arises  from  the  bending  of  the  head ; 
and  in  short-necked  persons  a  similar  mark  or  depression  has  been  noticed 
after  death  in  front  of  the  neck.  This  mark  may  also  be  produced  by  the 
pressure  of  a  cap-string.  These  marks  are  then  rendered  more  prominent 
by  their  assuming  a  livid  appearance.  The}^  might,  at  first,  be  mistaken 
for  marks  produced  by  a  ligature  in  an  attempted  strangulation.  In  one 
case  a  death  from  apoplexy  was  attributed  to  homicidal  strangulation, 
from  a  cadeveric  change  of  this  kind.  (Ann.  d'TIyg.,  1859,  t.  1,  p.  189, 
and  t.  26,  p.  149.)  The  matter  was  set  right  by  Ollivier.  In  1888  a  sup- 
posed murder  occurred  in  Whitechapel,  from  a  drunken  woman  having' 
died  from  the  accidental  pressure  of  a  bonnet-string  on  her  throat.  Homi- 
cidal strangulation  may  be  perpetrated  on  the  weak  and  infirm  without 
causing  any  noise  or  creating  alarm.  In  the  first  place,  if  the  throat  is  at 
once  seized  and  firndy  compressed,  no  cr}^  can  be  made,  nor  any  noise 
produced  to  excite  the  attention  of  those  who  are  near.  An  aged  woman 
was  strangled  in  her  shop  by  an  apprentice  in  so  short  a  time  and  so 
quietly,  that  her  husband,  who  was  separated  from  her  by  only  a  slight 
partition,  heard  no  noise  or  disturbance  during-  this  act  of  murder.  (Ann. 
d'Hyg.,  1859,  t.  1,  p,  157.) 

It  cannot  be  disputed  that,  in  contested  questions  of  suicidal  or  homi- 
cidal strangulation,  rare  as  they  are,  we  must  be  often  greatly  indebted  to 
evidence  founded  on  circumstances,  as  well  as  to  moral  presumptions. 
How  far  a  medical  jurist  may  be  allowed  to  make  use  of  these  in  the 
formation  of  an  opinion,  it  will  be  for  the  court  to  determine.  Generally 
speaking,  his  duty  is  rigorously  confined  to  the  furnishing  of  medical  evi- 
dence from  medical  data  alone  ;  but  instances  present  themselves  in  which 
this  rule  must  be  departed  from,  or  the  course  of  justice  will  be  impeded. 
Besides,  there  are  numerous  circumstances  of  a  collateral  nature  which 
may  materially  modify  a  medical  opinion.  Thus  the  sight  of  a  ligature, 
the  state  of  the  dress,  and  the  attitude  of  the  deceased  when  discovered, 
although  not  strictly  medical  circumstances,  bear  directly  upon  medical 
opinions  ;  and  that  evidence  ought  not  to  be  objected  to  which  is  partly 
founded  upon  facts  of  this  nature.  It  must  occur  to  all  that,  without  cir- 
cumstantial evidence,  the  best  medical  opinion  in  these  cases  will  often 
amount  to  nothing.  It  may  be,  for  example,  no  more  than  this:  The 
case  is  either  one  of  homicide  or  suicide;  and  why  is  such  an  indefinite 
answer  to  be  returned?  Because,  in  the  abstract  view  of  strangulation 
it  is  not  easy  to  determine  whether  a  ligature  was  suicidally  applied  round 
the  neck  or  not.     The  appearances  may  be  in  many  cases  the  same,  and, 


IMPUTED    STRANGULATION. 

where  tbey  are  different,  this  difference  may  be  due  to  accident,  80  that  it 
is  a  mistake  to  suppose  that  we  must  look  to  medical  circumstances  alone 
for  clearing-  up  this  intricate  question.  On  some  occasions  the  theory  of 
homicide  or  suicide  will  be  equally  consistent  with  the  facts.  The  cases 
of  Dr.  Franck  and  his  son,  which  occurred  at  Brighton  in  1855,  were  of 
this  ambiguous  character.  Whether  the  son  strangled  himself,  or  was 
strangled  by  his  father,  was  a  question  which  could  not  be  satisfactorily 
solved  by  medical,  moral,  or  circumstantial  evidence.  Unfortunately,  the 
bodies  did  not  undergo  a  proper  medico-legal  inspection. 

In  all  fatal  cases  resulting  from  acts  of  suicide,  the  means  by  which 
strangulation  was  produced  will  be  found  upon  the  neck.  The  condition 
of  the  mark  on  the  neck,  the  course  and  direction  of  the  cord,  the  mode  in 
which  it  was  secured  or  fixed  in  order  to  produce  effective  pressure  on  the 
windpipe,  the  amount  of  injury  to  the  muscles  and  parts  beneath,  are  cir- 
cumstances from  which,  if  observed  at  the  time,  a  correct  medical  opinion 
may  generally  be  formed.  If  the  means  of  constriction  are  removed,  or 
the  cord  or  ligature  is  loosely  applied,  these  facts,  unless  explained,  are 
presumptive  of  homicidal  interference. 

There  is  another  condition  in  which  a  presumption  of  homicide  will  be 
justifiable.  A  man,  in  strangling  himself,  is  not  likely  to  vary  the  means. 
The  act  is  commonly  due  to  a  sudden  impulse,  if  we  may  judge  from  the 
moral  proofs  afforded  in  the  instances  on  record.  The  article  which  is 
nearest  to  the  suicide  is  seized  and  made  the  instrument  of  self-destruc- 
tion. It  has  already  been  stated  as  doubtful  whether  a  person  could 
strangle  himself  by  the  mere  application  of  the  fingers  to  the  windpipe  ; 
the  discovery  of  such  marks  only  as  would  indicate  this  kind  of  strangu- 
lation, therefore,  renders  suicide  in  the  highest  degree  improbable.  But 
these  marks  may  be  sometimes  ascribed  to  the  deceased  having  fallen  with 
his  hand  possibly  applied  to  his  neck,  and  the  inference  will  be  drawn  that 
they  have  accidentally  resulted  from  the  pressure  of  his  own  fingers.  This 
is  an  improbable  mode  of  accounting  for  the  production  of  ecchymosis  or 
excoriation  of  the  skin  in  front  of  the  neck.  If,  besides  these  marks  of 
fingers,  we  find  a  circular  mark,  with  a  ligature  still  around  the  neck,  the 
presumption  of  murder  becomes  very  strong.  It  may  be  said  that  a  per- 
son might  at  first  try  to  strangle  himself  with  his  fingers,  and,  not  succeed- 
ing, might  afterwards  employ  a  cord.  But  the  degree  in  which  the  coin- 
cidental impressions  exist  will  in  general  remove  this  objection. 

Imputed  Strangulation. — Hitherto  the  subject  of  strangulation  has  been 
considered  in  reference  to  the  dead.  But  a  living  person  may  charge 
another  with  attempting  murder  under  such  circumstances,  and  here  a 
medical  jurist  will  have  the  not  very  arduous  duty  of  detecting  and  ex- 
posing the  imposture.  It  has  been  considered  so  improbable  that  any  one 
would  seriously  attempt  to  strangle  himself,  and  then  impute  the  act  to 
another,  that  medical  jurists  have  given  but  little  attention  to  this  subject. 
A  case  tried  in  France  in  1864  (Affaire  Armand  et  Maurice  Roux)  has 
shown  the  great  importance  of  it,  and  how  easily  medical  men  and  the 
public  may  be  deceived  by  a  plausible  story  (p.  424,  pout).  As  in  refer- 
ence to  imputed  wounds  so  in  these  cases  impostors  rarely  produce  such 
injury  to  themselves  as  to  place  their  lives  in  jeopardy.  The  cord  is  loose 
round  the  neck,  or  there  would  be  speedy  death  ;  it  is  not  so  secured  as  to 
press  with  great  force  on  the  air-passages,  to  cause  the  tongue  to  protrude, 
or  to  produce  lividity  of  the  face  and  neck,  or  ecchymosis  in  the  conjunc- 
tivae and  the  skin.  It  is  either  a  ligature  or  a  rope  which  is  used  by  the 
impostor:  he  does  not  commonly  resort  to  manual  violence  to  his  throat. 
The  marked  feature  of  a  really  homicidal  attempt  is  in  the  great  amount 


424  IMPUTED    STRANGULATION. 

of  violence  done  to  the  neck;  and  the  account  given  by  the  impostor  will 
be  inconsistent  in  its  details  and  not  reconcilable  with  the  ordinary  effects 
of  homicidal  strangulation.  Tardieu  met  with  a  case  in  which  a  young 
woman  of  good  social  position  wishing  to  excite  public  sympathy  alleged 
that  she  had  been  made  the  victim  of  a  political  conspiracy.  One  evening 
she  was  found  at  the  door  of  her  room  apparently  in  a  very  alarming 
state  :  she  could  not  speak,  but  indicated,  partly  by  gestures  and  partly 
by  Avriting,  that  as  she  was  entering  her  room  a  man  had  attempted  to 
strangle  her  by  pressing  his  hand  upon  her  neck  and  at  the  same  time 
had  stabbed  her  in  the  chest  with  a  dagger.  On  close  examination  it  was 
found  that  there  were  two  stabs  which  had  penetrated  only  through  the 
outer  clothing.  But  the  most  singular  effect  of  the  alleged  attempt  at 
strangulation  was  that,  instead  of  producing  a  difficulty  of  speaking  and 
alteration  of  the  voice,  it  had  been  followed  by  complete  dumbness. 
Tardieu  could  find  on  the  neck  no  trace  of  any  attempt  at  strangulation ; 
and  on  reassuring  the  young  lady  that  the  loss  of  voice  under  such  circum- 
stances could  not  last  for  more  than  a  minute,  she  at  once  admitted  that 
there  was  no  foundation  for  the  charge.  (Ann.  d'Hyg.,  1859,  t.  1,  p. 
163.)  On  this  occasion  no  person  was  accused  ;  but  the  case  is  different 
Avhen,  for  the  purpose  of  extortion  or  other  base  motives,  one  or  more  per- 
sons are  charged  with  an  attempt  at  murder.  A  flagrant  instance  of  this 
kind  occurred  in  France,  in  which  a  wealthy  merchant  of  Montpelier  was 
charged  by  his  servant,  Maurice  Roux,  with  having  attempted  to  n)urcler 
him  by  strangulation.  The  case  was  tried  in  March,  1864,  before  the 
Court  of  Assizes  of  the  Bouches  du  Rhone;  and,  fortunateh^,  for  the  in- 
terests of  justice,  as  well  as  for  the  credit  of  medico-legal  science  in 
France,  it  ended  in  an  acquittal  of  the  accused.  (Affaire  Armand  et 
Maurice  Roux,  Paris,  1864;  Relat.  Med.  Leg.  de  I'Affaire  Armand,  etc., 
par  Tardieu;  Ann.  d'Hyg.,  1864,  t.  1,  p.  415.) 

It  may  be  observed,  in  reference  to  these  imputed  cases,  that  men  who 
deliberately  strangle  others  either  draw  a  cord  tightly,  or  secure  it  by  a 
knot.  The  pressure  to  the  neck  is  not  so  gentle  as  to  leave  no  mark  what- 
ever, or  to  allow  the  strangled  person  to  breathe  and  watch  all  that  goes 
on  around  him.  Slight  marks  of  violence  about  the  neck  should  be  there- 
fore viewed  on  these  occasions  with  suspicion.  If,  as  is  most  improbable 
in  attempted  homicide,  the  cord  is  left  only  loosely  coiled  around  the  neck, 
the  person  assaulted  necessarily  retains  the  power  of  breathing  and  calling 
for  assistance ;  but  if  the  hand  of  a  murderer  has  been  at  work  it  is  effec- 
tually tightened  and  the  person  dies  in  a  few  minutes.  A  charge  of  this 
kind,  where  there  can  be  no  witness  but  the  person  making  it,  requires  to 
be  supported,  not  by  medical  probabilities,  but  by  the  strongest  medical 
facts.  These  ought  to  show  that  there  are  marks  of  violence  on  the  neck 
such  as  an  assassin  would  be  likely  to  inflict,  and,  at  the  same  time,  such 
as  the  person  making  the  charge  would  not  be  likely  to  produce,  or  have 
the  power  of  producing,  on  himself. 


DEATH    FROM    SUFFOCATION.  425 


SUFFOCATION. 


CHAPTER  XLI. 

spffocation  fkom  mechanical  causes. cause  of  death. appeakances  after  death.  . 

evidexxce  of   death   from   suffocation. accidental,    suicidal,   and  hojiicidai. 

Suffocation. — smothering. 

By  suffocation  we  are  to  understand  that  condition  in  which  air  is  pre- 
vented from  penetrating  into  the  lungs,  not  by  constriction  of  the  wind- 
pipe, but  by  .some  mechanical  cause  operating  on  the  mouth  externally,  or 
on  the  throat,  windpipe,  or  air-pa.ssages  internally.  In  this  sense  it  will 
be  perceived  that  drowning  is  one  form  of  death  from  suffocation,  the 
water  being  an  effectual  medium  for  preventing  access  of  air  to  the  lungs. 

The  term  "  suffocation"  is  applied  to  various  conditions  in  which  the 
symptoms  and  effects  differ.  There  may  be  a  simple  privation  of  air  ;  the 
air  respired  may  not  be  rei.ewed  from  the  want  of  proper  ventilation ;  or 
the  air  which  is  breathed  may  be  mixed  with  certain  noxious  gases  or 
vapors  which,  by  absorption  into  the  blood  through  the  air-cells  of  the 
lungs,  may  destroy  life  like  poisons.  The  symptoms  preceding  death,  the 
disposition  to  recovery,  and  the  post-mortem  appearances  in  fatal  cases 
will  differ  under  the  circumstances.  It  will  be  sufficient  at  present  to 
consider  the  most  simple  form  of  suffocation  which  is  within  the  reach  of 
experiment,  namely,  that  which  depends  on  the  privation  of  air  by  sub- 
stances blocking  up  the  air-passages,  or  by  the  covering  of  the  mouth  and 
nostrils.  A  committee  of  the  Medico-Chirurgical  Society  performed  a 
series  of  experiments  on  dogs,  in  which  a  tube  was  inserted  into  the  wind- 
pipe and  breathing  either  took  place  or  was  completely  arrested,  accord- 
ing to  whether  the  tube  was  kept  open  or  closed  by  an  accurately-fitting 
plug.  When  the  tube  was  closed,  the  animal,  after  a  variable  number  of 
seconds,  made  strong  efforts  to  breathe  ;  and  when  these  ceased,  unless  air 
was  speedily  admitted,  it  died.  From  nine  experiments  on  the  dog,  the 
average  duration  of  the  respiratory  movements,  after  the  animal  had  been 
completely  deprived  of  air,  was  four  minutes  and  five  seconds.  The 
average  duration  of  the  heart's  action  was  seven  minutes  and  eleven 
seconds;  and  it  further  appeared  that,  on  an  average,  the  heart's  action 
continued  for  three  minutes  and  fifteen  seconds  after  the  animal  had 
ceased  to  make  these  efforts  to  breathe.  In  respect  to  the  rapidity  with 
which  death  takes  place  in  animals,  the  following  conclusions  were  drawn  : 
first,  a  dog  may  be  deprived  of  air  during  a  period  of  three  minutes  and 
fifty  seconds,  and  afterwards  recover  without  the  application  of  artificial 
means;  and  second,  a  dog  is  unlikely  to  recover,  if  left  to  itself,  after 
having  been  deprived  of  air  during  a  period  of  four  minutes  and  ten 
seconds.  As  in  drowning,  the  shorter  the  interval  between  the  last 
respiratory  efforts  and  the  readmission  of  air  the  greater  the  probability 
of  recovery.     (Med.-Chir.  Trans.,  1862,  vol.  45,  p.  454.)     The  results  of 


426  SUFFOCATION TIME    OF    DEATH. 

these  experiments  in  reference  to  the  duration  of  life  under  privation  of 
air  may  be  considered  applicable  to  a  human  being.  It  is  not  likely  that 
a  man  would  survive  under  these  circumstances  longer  than  a  dog,  and  it 
may  therefore  be  fairly  inferred  that  the  life  of  a  man  would  be  destroyed 
in  from  four  to  five  minutes  after  the  power  of  breathing  had  been  conj- 
pletely  arrested. 

There  are  many  varieties  of  death  by  sufFocation,  all  which  are  of  great 
medico-legal  interest :  1.  The  close  application  of  the  hand  over  the 
mouth  and  nostrils,  or  the  placing  of  a  plaster  or  cloth  over  these  parts, 
combined  with  pressure  on  the  chest :  this  was  formerly  not  an  unfrequent 
form  of  homicidal  suffocation.  2.  Smothering,  or  the  covering  of  the  head 
and  face  with  articles  of  clothing,  etc.,  which  effectually  prevent  breathing. 
3.  The  accidental  or  forcible  introduction  of  foreign  bodies  into  the  mouth 
and  throat.  4.  The  flow  of  blood  into  the  windpipe  from  a  severe  wound 
in  the  throat,  or  from  the  bursting  of  a  bloodvessel  or  aneurismal  sac.  5. 
In  wounds  of  the  throat,  when  the  windpipe  is  completely  divided,  the 
lower  end  may  be  so  drawn  into  the  wound  as  to  produce  a  closure  of  the 
orifice  and  intercept  the  passage  of  air.  One  or  other  of  these  causes  fre- 
quently operates  to  render  a  wound  in  the  throat  fatal.  6.  The  plunging 
of  the  face  into  mud,  snow,  dust,  ashes,  feathers,  leaves,  or  similar  sub- 
stances. In  all  these  cases  death  takes  place  from  asphyxia,  and  v;ith 
great  rapidity,  if  the  chest  sustains  at  the  same  time  an}^  degree  of  forcible 
compression.  7.  Swelling  or  spasm  of  the  glottis  produced  by  the  contact 
of  corrosive  liquids  or  boiling  water.  In  one  case  death  was  probably 
caused  by  the  application  of  a  strong  solution  of  nitrate  of  mercury  to  an 
ulcer  in  the  throat. 

Suffocation  may  arise  from  morbid  causes  operating  mechanically  to 
prevent  respiration,  such  as  a  diseased  slate  of  the  parts  about  the  throat, 
an  enlargement  of  the  glands,  the  bursting  of  a  tonsillary  abscess,  or  the 
effusion  of  lymph,  blood,  or  pus  into  the  windpipe  or  about  the  opening 
of  the  larynx  (rima  glottidis).  Any  of  these  causes  may  suddenly  arrest 
the  act  of  breathing — a  fact  which  can  only  be  determined  by  a  careful 
examination  of  the  air-passages.  Accidental  suffocation  ma}^  arise  from 
large  masses  of  food  blocking  up  the  larynx.  If  the  glottis  (the  opening 
of  the  windpipe)  be  completely  closed  by  food,  death  may  take  place  sud- 
denly ;  although  the  person  so  situated  may  be  capable  of  making  some 
exertion  or  of  moving  from  the  spot.  Mackenzie  relates  a  case  in  which 
a  man  was  suddenly  choked  by  swallowing  a  large  piece  of  meat ;  he  im- 
mediately walked  across  the  street  to  a  chemist's  shop,  and,  soon  after 
entering  it,  he  fell  down  in  a  state  of  insensibilit}".  After  death,  the  throat 
was  found  to  be  filled  Vv'ith  a  piece  of  beef,  which  rested  on  the  glottis, 
and  had  pressed  the  epiglottis  forward.  Part  of  the  mass  had  entered  the 
windpipe  through  the  rima  glottidis,  and  had  thus  caused  death  by  suffo- 
cation. It  is  probable  that,  in  this  and  similar  cases,  the  foreign  body 
does  not  so  completely  close  the  aperture  as  to  prevent  some  degree  of  re- 
spiration, but,  the  blood  being  imperfectly  aerated,  asphyxia  is  speedily 
induced.  (Edin.  Month.  Jour.,  July,  1851,  p.  C8.)  A  man,  set.  31,  was 
put  to  bed  drunk,  having  previously  vomited;  and  shortly  afterwards  he 
was  found  dead.  On  inspection,  Jackson  discovered  the  usual  appearances 
of  asphyxia,  i.  e.  congestion  of  the  lungs  and  of  the  right  cavities  of  the 
heart.  He  was  thus  led  to  exaniine  the  air-passages  carefully,  and  he 
found  lying  over  the  upper  opening  of  the  larynx  (rima  glottidis)  a  thin 
and  transparent  piece  of  pofato-slcin  so  closely  ap))lied  to  the  fissure  as  to 
prevent  breathing.  The  man  had  died  accidentally  suffocated  from  this 
mechanical  cause.     He  had  had  potatoes  for  dinner  the  day  Tdc fore ;   the 


SUFFOCATION    FROM    ACCIDENT    OR    DISEASE.    '  427 

piece  of  skin  had  probaljly  been  thrown  up  at  the  time  of  vomiting-,  and 
had  been  drawn  back  by  inspiration  into  the  singular  position  in  which  it 
was  found.  Owing  to  intoxication,  tlie  deceased  was  unable  to  cough  it 
up.  (Edin.  Med.  and  Surg.  Jour.,  April,  1844,  p.  390.)  Wright  describes 
the  case  of  an  old  woman  who,  during  a  violent  fit  of  coughing,  suddenly 
fell  back  in  her  bed,  struggled  convulsively,  and  died  in  a  few  seconds. 
After  death,  a  pellet  of  tough  mucus  was  found  in  the  riraa  glottidis,  so 
that  the  deceased  was  literally  suffocated  with  her  own  phlegm.  (Pathol. 
Kesearches,  1850,  p.  7.)  A  man  was  suli'ocated  while  at  dinner  by  swal- 
lowing his  artilicial  teeth.  In  another  case,  a  man  died  from  suffocation 
by  swallowing  an  oyster.  In  the  case  of  a  child,  agt.  8,  it  was  proved  that 
suffocation  had  been  caused  by  a  gooseljerry  which  had  been  swallowed, 
blocking  up  the  glottis.  In  the  Lond,  Med.  Gaz.,  vol.  xxix.  p.  14C,- there 
is  a  case  reported  in  which  a  child  was  suffocated  by  a  pea. 

A  person  may  die  suffocated,  not  from  the  act  of  swallowing  food,  but" 
by  reason  of  part  of  the  contents  of  the  stomach  finding  their  way  into 
the  air-passages.  Whenever  vomiting  is  followed  by  an  inspiration  while 
the  vomited  matters  are  in  the  mouth,  the  food  is  liable  to  be  drawn  b}'' 
aspiration  into  the  windpipe,  bronchi,  and  pulmonary  cells,  and  to  cause 
suffocation.  Pressure  on  the  body  may  have  the  same  effect  as  the  act  of 
vomiting.  A  man  was  struck  several  blows  with  the  fist;  he  was  then 
stabbed  in  the  nape  of  the  neck,  and  finally  his  body  was  trampled  on  by 
his  assailants.  He  died  before  any  assistance  could  be  rendered.  On  in- 
spection the  air-passages  were  found  to  contain  a  large  quantity  of  pulpy 
matter  such  as  existed  in  the  stomach.  The  wounds  received  were  only 
flesh  wounds,  no  large  bloodvessel  having  been  injni-ed.  Nevertheless, 
one  expert  attributed  death  to  loss  of  blood  from  the  wounds  ;  another 
assigned  it  to  asphyxia  from  the  food  vomited  by  the  deceased  passing 
into  the  lungs  during  an  inspiration.  Engel  and  Hauska  were  able  to 
prove  that  asphyxia  was  the  cause  of  death,  and  that  the  assailants  were 
responsible.  The  food  had  been  forced  into  the  fauces  by  the  act  of 
trampling  on  the  body.  (Ann.  d'Hyg.,  18G8,  t.  1,  450;  t."2,  226;  and 
18()9,  t.  1,  471.)  This  mode  of  death  by  suffocation,  as  a  result  of  vio- 
lence to  the  abdomen,  is  probably  more  frequent  than  it  is  commonly  sup- 
posed to  be.  It  is  likely  to  occur  in  the  maltreatment  of  drunken  persons. 
In  1889  a  man  was  convicted  of  the  murder  of  a  woman,  Selina  Troughear 
(Reg.  V.  Kerr,  Carlisle,  Sum.  Ass.,  1889).  From  the  evidence  it  appeared 
that  the  woman  died  whilst,  or  shortly  after,  a  rape  was  committed"  on  her 
by  the  prisoner,  accompanied  with  brutal  violence.  The  actual  cause  of 
death  was  suffocation  brought  about  by  the  vomiting  of  a  hearty  meal. 
In  connection  with  this  case  I  am  indebted  to  a  distinguished  Queen's 
Counsel  for  the  following  legal  memorandum  :  If  a  man  in  committing  a 
rape  on  a  woman,  or  in  assaulting  her  to  cause  grievous  bodily  harm,  causes 
her  to  vomit,  whereby  she  is  suffocated,  he  commits  an  act  of  constructive 
murder ;  but  if  the  vomiting  and  death  were  the  result  of  an  attem])t  onlv 
at  rape,  he  is  guilty  of  man.slaughter.  If,  on  the  other  hand,  the  woman 
consented  to  have  carnal  intercourse,  and  all  that  the  man  did  to  her  was 
the  rude  violence  of  a  rough  drunken  man  without  intent  to  injure  he 
would  have  committed  no  offence  whatever,  even  though  what  he  did 
caused  her  to  vomit,  and  thus  led  to  her  death  from  suffocation.  Behrend 
has  reported  a  case  in  which  suffocation  was  caused  by  the  aspiration 
of  food,  with  a  full  account  of  the  post-mortem  appearances,  in  Horn's 
A^'ierteljahrsschrift,  1868,  1,  123.  Accidental  suffocation  from  food  is  one 
of  those  causes  of  violent  death  which  is  recorded  in  the  Registrar-General's 


428  •  SUFFOCATION — CAUSE    OF    DEATH. 

returns.  It  appears  from  the  report  of  mortality  in  England  and  Wales 
that  in  one  year  there  were  81  deaths  from  this  cause. 

A  person  has  been  wrongl}^  charged  with  causing  the  death  of  another 
when  the  cause  was  really  owing  to  the  impaction  of  food  in  the  larynx. 
An  instance  of  this  kind  occurred  at  Hillingdon -(Lancet,  1850,  i.  p.  313). 
The  deceased  had  a  quarrel  with  the  accused,  and  they  were  seen  to  fall 
to  the  ground  together  while  struggling  and  fighting.  They  were  sepa- 
rated. About  two  hours  afterwards  the  deceased,  who  appeared  quite 
Avell,  was  observed  to  rise  from  the  dinner-table  and  leave  the  room.  He 
Avas  found  leaning  against  the  cottage,  as  if  in  a  falling  position,  and  he 
expired  in  two  or  three  minutes.  The  person  with  whom  the  deceased 
had  been  fighting  was  charged  with  manslaughter  before  a  magistrate. 
At  the  inquest  the  medical  witness  stated  he  found  the  organs  of  the 
bod}^,  excepting  the  brain,  in  a  very  healthy  state.  The  brain  was  exces- 
sivel}^  congested,  and  he  attributed  death  to  apoplexy.  The  coroner  desired 
the  witness  to  examine  the  mouth  and  throat  (which  he  had  omitted  to  do 
at  the  inspection),  as,  from  the  suddenness  of  death  after  eating,  he  (the 
coroner)  thought  the  man  might  have  been  choked.  This  opinion  turned 
out  to  be  correct.  A  large  piece  of  meat  was  found  wedged  in  the  opening 
of  the  throat ;  this  had  caused  death  by  suffocation.  It  had  not  completely 
closed  the  air-passages  in  the  first  instance  ;  hence  the  man  was  able  to 
move  from  the  dinner-table.  The  person  accused  of  manslaughter  was 
discharged.  A  medical  jurist,  however,  must  not  lose  sight  of  the  fact 
that  a  foreign  substance  may  be  homicidally  impacted  in  the  lar^-nx,  and 
that,  except  by  a  careful  examination  of  the  body,  death  may  be  wrongly 
assigned  to  accident.  A  case  reported  b}^  Littlejohn  is  in  this  respect 
instructive.  In  examining  the  body  of  a  woman  who  it  was  stated  had 
died  suddenly,  he  found  a  quart-bottie  cork  inserted  tightly  into  the  upper 
part  of  the  larynx.  The  sealed  end  was  uppermost,  and  was  roughened 
by  the  passage  of  the  screw.  Fractures  of  the  ribs  were  found,  and  it 
was  quite  clear  that  deceased  had  not  died  a  natural  death.  It  was  sug- 
gested that  the  deceased  while  extracting  the  cork  from  the  bottle  with 
her  teeth,  might,  by  the  sudden  impetus  of  the  contained  fluids,  have 
drawn  it  into  the  position  in  which  it  was  found.  But  this  theory  was 
negatived  by  the  sealed  end  of  the  cork  being  uppermost  in  the  throat,  as 
well  as  by  the  structure  of  the  parts.  The  medical  opinion  was  that  the 
cork  must  have  been  forcibly  placed  there  by  another  person  while  the 
w^oman  was  in  a  helpless  state  of  intoxication.  There  was  no  reason  to 
doubt  that  this  was  a  deliberate  act  of  murder.  Five  persons  were  present 
with  the  deceased  at  the  time  of  her  death,  but  it  was  impossible  to  fix 
with  certainty  upon  the  person  who  had  committed  the  act,  and  the  man 
on  whom  the  stroncest  suspicion  fell  was  acquitted  on  a  verdict  of  "not 
proven."  (Edin.  Med.  Jour.,  Dec.  1855,  p.  511  ;  and  for  a  report  of  the 
trial,  see  p.  540.) 

Cause  of  Death. — In  suffocation  death  takes  place  from  asphyxia  ;  and 
this  occurs  with  a  rapidity  proportioned  to  the  degree  of  impediment  ex- 
isting to  the  passage  of  the  air.  There  does  not  seem  to  be  any  reason  to 
attribute  death  to  apoplexy.  The  congestion  of  the  cerebral  vessels  may 
be  regarded  as  a  consequence  of  the  disturbance  of  the  functions  of  the 
lung.s.  If  the  veins  of  the  neck  were  opened,  so  as  to  prevent  an  accumula- 
tion of  blood  in  the  vessels  of  the  l)rain,  it  is  pretty  certain  that  the  pre- 
vention of  respiration  would  destroy  life  under  the  same  circumstances 
and  within  the  same  period  of  time  ;  therefore  we  may  regard  death  from 
suffocation  as  resulting  from  pure  asphyxia.  In  treating  a  case  of  suffo- 
cation, we  have  .simply  to  allow  of  the  renewal  of  air  by  removing,  if  this 


POST-MORTEM    APPEARANCES.  429 

be  possible,  the  mechanical  obstacle  to  respiration.  The  resnlts  of  experi- 
ments on  dog'S  already  cited  (p.  425)  show  that,  even  with  a  perlect 
closure  of  the  windpipe,  an  animal  may  recover  spontaneously  after  nearly 
four  minutes''  deprivation  of  air.  In  hangin.ii;'  and  strangulation  there  is 
sometimes  g-reat  violence  done  to  the  parts  about  the  neck.  In  sufl'ocation 
these  accidental  obstacles  to  recovery  do  not  exist,  and  the  surgeon  has 
simply  to  readmit  the  air  into  the  lungs.  All  experiments  go  to  show 
that,  even  in  this  form  of  asphyxia,  which  is  most  favorable  for  recovery, 
the  complete  suspension  of  respiration  for  five  minutes  is  fatal.  Hanging 
and  strangulation  prove  fatal  from  asphyxia  within  the  same  period  of 
time,  and  drowning  within  a  shorter  period. 

Vierordt  has  shown  that  the  spectroscope  will  enable  a  skilful  observer 
to  note  the  time  at  which  life  has  passed  into  death,  and  whether  there  is 
a  probability  that  life  can  be  restored  after  a  certain  interval.  If  the 
fourth  and  fifth  fingers  are  placed  one  over  the  other  in  a  living  body,  and- 
the  line  of  union  is  brought  before  the  slit  of  a  spectroscope  against  the 
sunlight,  or  a  very  powerful  light,  the  two  absorption-bands  of  oxy-hsemo- 
globin  will  be  visible  (p.  272.)  In  the  body  of  one  really  dead,  whether 
from  asphyxia  by  suffocation  or  any  other  cause,  only  one  band,  that  of  de- 
oxidized haemoglobin,  will  be  seen.  Yierordt  found  that,  even  in  the  living 
body,  by  a  compression  of  the  fingers,  local  death  by  the  withdrawal  of 
oxygen  takes  place  rapidly,  and  the  two  bands  pass  into  one.  On  remov- 
ing the  temporary  pressure  the  oxygenated  blood  again  circulates,  and  the 
two  bands  are  restored. 

Post-mortem  Ajypearances. — There  are  rarely  any  considerable  marks 
of  violence  externally.     When  the  body  has  become  perfectly  cold  there 
may  be  patches  of  lividity  diffused  over  the  skin  ;  but  these  are  not  always 
present.     Tardieu  has  found  upon  the  skin  of  the  neck,  face,  and  shoulders 
dotted  or  punctiform  ecchymoses.     (La  Pendaison,  la  Strangulation,  et  la 
Suffocation,  p.  267.)     The  lips  are  livid ;  the  skin  of  the  face  and  neck 
may  be  pale  or  present  a  dusky-violet  tint,  with  small  patches  of  ecchy- 
mosis.     The  eyes  are  congested  ;  there  is  a  mucous  froth  about  the  lips 
and  mouth.     The  mouth,  throat,  and  parts  about  the  windpipe  should  be 
carefully  examined  for  foreign  substances.     Internally  the  lungs  and  right 
cavities  of  the  heart  may  be  found  distended  with  blood.     The  state  of 
the  lungs  and  heart  is,  however,  subject  to  variation.     The  lungs  are  not 
necessarily  found  congested  ;  and  sometimes,  as  in  a  case  referred  to  the 
author  in  1864,  one  lung  may  be  found  congested  and  the  other  not.     In 
1883  a  terrible  catastrophe  occurred  in   Sunderland,  whereby  about  two  \ 
hundred  children  lost  their  lives  by  suffocation.     By  the  closing  of  a  door  \ 
the  children,  pouring  down  a  staircase,  trampled  one  another  to  death,   \ 
their  bodies  being  heaped  upon  one  another  to  a  height  of  several  feet.    | 
The  same  characteristic  appearances  were  observed  in  nearly  every  case,    \ 
namely,   a  congested   puffy  face,   purple  or  blackish  turgescence  of  the    | 
vessels  of  the  neck,  closed   eyelids,  protruding  and  fixed  eyeballs,  pupils   ^ 
dilated  to  the  utmost,   bloody  froth  issuing  from  the  nose  and  mouth,    I 
giving  the  appearance  of  an  intense  degree  of  suffering  and  anxiety  ;  yet,    | 
in  twenty-four  hours  after  death,  much  of  this  passed  off  and  the  face    j 
exhibited  a  slight   smile,  as  if  in  sleep.     (Brit.   Med.   Jour.,  1883,  1.  p.     I 
1248.)     Tardieu  states,  from   his  observations,  that  the   lungs  are  of  a 
reddish  color,  sometimes  pale,  and  not  distended,  and  presenting  occasion- 
ally only  a  slight  degree  of  congestion  at  the  base  and  posteriorly,     A 
special  character  which  he  states  he  has  invariably  noticed  in  these  organs 
consists  in  the  presence  of  small  ecchymosed  spots  or  patches  beneath  the 
pleura  or  investing  membrane.     He  describes  these  spots  as  of  a  dark 


430  STATE    OF    THE    LUNGS. 

color,  and  varying  in  size  from  a  pin's  head  to  a  lentil.  In  the  adult  they 
are  of  Ftill  larger  size.  Their  number  is  variable;  sometimes  five  or  six 
may  be  found,  at  others  twenty  or  thirty,  and  in  other  eases  the  surface 
of  the  lung  may  be  so  studded  with  them  as  to  give  to  it  a  granite-like 
appearance.  These  spots  of  ecchymosis  are  sometimes  agglomerated,  at 
other  times  separated,  but  their  outline  is  generally  distinct  and  well 
defined  on  the  surface  of  the  lungs.  They  are  most  frequently  seen  at  the 
root  of  the  lungs,  at  their  bases,  and  about  their  lower  margin.  They  are 
owing  to  small  effusions  of  blood  from  ruptured  vessels,  like  true  ecchy- 
mosis. The}'  may  be  distinguished  so  long  as  the  tissue  of  the  lungs 
remains  unchanged.  Tardieu  states  that  he  has  seen  these  subpleurul 
ecchymoses  in  the  lungs  of  an  infant  which  had  been  13'ing  ten  months  in 
the  soil- of  a  privy.  He  admits,  however,  that  they  ma}'  also  be  found  in 
the  lungs  of  children  that  have  not  breathed;  hence  no  inference  of  death 
from  suffocation  should  be  drawn  from  this  appearance  in  the  lungs, 
unless  they  have  actually  received  air.  In  three  instances  he  met  with 
subpleural  ecchymoses  in  lungs  which  sank  in  water,  and  had  all  the 
usual  characters  of  these  organs  in  a  fcetal  state.  The  children  had  been 
born  living,  prematurely,  and  under  conditions  in  which  life  by  respiration 
could  not  be  perfectly  established  ;  one  of  them  had  made  several  cries 
without  effectually  receiving  air  into  the  lungs.  (  See  Casper's  Klin. 
J^ovellen,  1863,  p.  4*11.)  This  struggle  to  breathe  may  have  produced 
the  appearance  resembling  that  of  suffocation.  In  newborn  children 
dying  from  suffocation  the  thymus  gland  has  been  found  in  a  similar 
condition.  The  same  appearance  may  be  produced  during  the  birth  of  a 
child  by  pressure  on  the  navel  string,  when  this  is  prolapsed  whilst  the 
head  of  the  child  is  passing  down  the  vagina.  The  value  of  medical  evi- 
dence derivable  from  the  presence  of  subpleural  ecchymoses  in  the  lungs 
has  been  also  investigated  by  Legroux.  (Ann.  d'Hyg.,  1878,  t.  2,  pp. 
114  and  335.)  He  believes:  1.  That  they  may  be  seen  in  the  lungs  under 
various  conditions,  independently  of  the  cause  of  death.  2.  They  are  met 
with  in  different  degrees  in  the  different  forms  of  death  by  asphyxia.  3. 
Unless  accompanied  by  other  indications  of  the  mode  of  death,  their 
presence  will  not  enable  us  to  determine  the  cause.  In  death  from  suffo- 
cation they  are  very  numerous,  from  strangulation  less  numerous,  and 
from  hanging  least  numerous.  4.  The  presence  of  subpleural  ecchymoses 
indicates  a  rapid  and  violent  death,  whether  the  violence  be  from  internal 
or  external  causes.  A  Committee  of  the  Soci^te  de  Medecine  Ldgale  was 
appointed  to  examine  the  value  of  this  post-mortem  appearance  as  a 
positive  indication  of  death  by  suffocation.  They  reported:  (1)  that 
subpleural  ecchymoses  may  arise  from  spontaneous  conditions  irrespective 
of  the  cause  of  death;  (2)  that  they  may  be  met  with  in  violent  asphyxia  by 
hanging,  strangulation,  submersion,  by  compression  of  the  chest,  and  by  suf- 
focation, but  in  different  degrees ;  (3)  they  are  of  value  only  when  associated 
with  other  signs  indicating  the  mode  of  death.  (Lancet,  1878,  ii.  p.  305.) 
According  to  Tardieu,  this  dotted  appearance  of  the  surface  of  the  lungs 
in  suffocation  is  not  attended  with  the  apoplectic  effusions  in  their  sub- 
stance which  are  met  with  in  death  from  strangulation.  Emphysema,  or 
escape  of  air  from  rupture  of  the  air-cells,  is  occasionally  observed.  The 
more  rapidly  suffocation  has  taken  place,  the  more  strongly  marked  are 
these  ecchymosed  spots.  On  the  other  hand,  when  the  interruption  of 
breathinir  has  been  slow  and  gradual,  the  substance  of  the  lungs  is  more 
congested  with  blood,  and  then  these  dots  or  patches  are  merged  in  the 
general  violet  color  of  the  surface  of  the  organs.  The  lining  membrane 
of  the  windpipe  and  larger  air-tubes  is  sometimes  pale,  but  commonly 


STATE    OF    THE    HEART.  431 

dark-colored  when  the  lungs  are  congested.     In  the  air-passages  there  is 
occasionally  a  frothy,  reddish-colored  liquid  in  small  vesicles. 

Linian  disputes  the  accuracy  of  the  observations  of  Tardieu  regarding 
this  appearance  described  by  him  as  characteristic  of  death  from  suffoca- 
tion. (Ann.  d'Hyg.,  1867,  t.  2,  p.  388.)  According  to  Ogston,  Sen.,  the 
subpleural  or  punctiforni  ecchymoses  observed  by  Tardieu  were  not 
present  in  the  cases  of  nine  adults  who  had  died  from  suffocation.  (Brit. 
Med.  Jour.,  1868,  ii.  p.  382.)  On  the  other  hand,  they  may  be  found  in 
cases  in  which  death  has  taken  place  from  drowning,  hanging,  and  strangu- 
lation. Too  much  reliance  must  not,  therefore,  be  placed  on  their  presence 
or  absence.  These  spots  of  ecchymosis  were  found  by  Ogston,  not  only  on 
the  surface  of  the  lungs,  but  on  the  heart,  the  scalp,  the  pericranium,  the 
thymus  gland,  and  other  parts.  That  the\'  are  frequently  absent  in  death 
from  suffocation  is  shown  by  the  observations  of  other  medical  jurists. 
(See  Vierteljahrsschr.  fiir  Gerichtl.  Med.,  1867,  2,  p.  146.)  In  an  elabo- 
rate paper  published  in  the  same  journal,  Lukomsky  has  endeavored  to 
show,  by  a  variety  of  experiments,  the  circumstances  under  which  we  may 
expect  to  find  these  ecchymoses  in  death  from  suffocation,  and  the  cases  in 
which  they  are  likelv  to  be  absent.  (Vierteljahrsschr.  fiir  Gerichtl.  Med., 
1871,  2,  p.  58.) 

Page,  who  has  experimented  on  this  subject,  agrees  wn'th  the  above- 
named  medical  jurists  in  considering  that  Tardieu  has  been  too  hasty  in 
making  these  dotted  or  subpleural  ecchymoses  a  certain  diagnostic  sign  of 
death  from  suffocation.  According  to  him,  they  probably  arise  from  the 
continued  and  violent  efforts  to  breathe  in  the  early  stage  of  asphyxia. 
Their  occurrence  in  the  lungs  of  a  hanged  person  would  not,  therefore, 
justify  the  inference  that  the  person  had  been  first  suffocated  and  after- 
wards hanged.  The  same  remark  applies  to  drowning.  Page  found,  on 
drowning  animals,  that  subpleural  ecchymoses  were  so  numerous  on  the 
lungs  as  to  give  to  the  organs  a  granitic  aspect.  (On  the  Value  of  Cer- 
tain Signs  of  Death  from  Suffocation,  Edinb.,  1873.)  He  has  drawn  the 
following  conclusions  from  his  experiments:  1.  The  ecchymoses  or 
patches  of  extravasated  blood  found  on  the  surfaces  of  certain  internal 
organs,  and  notably  of  the  lungs,  are  not  peculiar  to  any  one  mode  of 
death  by  asphyxia,  but  are  common  to  all.  2.  The  ecchymoses  are  not, 
therefore,  diagnostic  of  death  from  suffocation.  3.  They  probably  occur 
with  greater  frequency  in  suffocation,  owing  to  the  absence  of  interference 
with  the  cerebral  circulation,  and  the  opportunity  which  the  means  usually 
employed  afford  for' respiratory  struggles. 

The  heart  presents  no  special  appearance  indicative  of  the  mode  of 
death,  if  we  except  the  presence  of  small  spots  of  ecchymosis  found  below 
the  investing  membrane,  like  those  met  with  on  the  lungs.  They  have 
been  found  near  the  roots  or  origin  of  the  great  vessels,  but  are  not  so 
frequently  observed  in  this  organ  as  in  the  lungs.  The  blood  is  generallv 
dark  and  fluid ;  but  sometimes  coagula  are  met  with.  The  stomach  and 
intestines  have  been  observed  to  present  patches  of  lividity.  Casper  has 
found  the  kidneys  more  strongly  congested  with  blood  than  the  liver, 
spleen,  and  other  organs.  The  vessels  of  the  brain  are  sometimes  con- 
gested, but  at  other  times  they  do  not  appear  to  be  more  than  ordinarily 
full.  Their  condition  may  be  affected  by  the  congested  state  of  the  lungs, 
as  well  as  by  the  slowness  or  rapidity  with  which  death  takes  place. 
Other  appearances  which  have  been  described  are  of  an  accidental  nature, 
and  are  not  connected  with  death  from  suffocation. 

In  a  case  of  alleged  murder  by  suffocation,  respecting  which  the  author 
was  consulted  in  1857,  the  following  appearances  were  met  with.     The 


432  EVIDENCE  OP  THE  CAUSE  OF  DEATH. 

bodj  was  lying  on  the  bed :  the  right  leg  was  drawn  up  towards  the 
body  ;  the  right  arm  was  bent,  with  the  hand  directed  towards  the  face  ; 
the  left  hand  was  lying  upon  the  chest.  The  lips  were  livid,  the  tongue 
protruded  and  swollen,  and  there  was  a  bloody  fluid  issuing  from  the 
nostrils.  There  was  no  mark  of  constriction  on  the  neck ;  the  eyes  were 
half-open  ;  the  body  was  rigid  and  still  warm.  The  face  and  neck  were 
much  swollen,  and  the  skin  of  these  parts,  as  well  as  of  the  chest,  abdo- 
men, arms,  and  legs,  was  covered  with  dark  livid  patches.  The  brain 
was  gorged  with  venous  blood.  The  lungs  were  congested.  The  heart 
was  soft  and  flaccid,  and  its  cavities  were  empty.  The  mucous  mem- 
brane, as  well  as  the  tissues  of  the  air-passages,  was  much  congested 
with  dark  liquid  blood — the  blood  was  everywhere  liquid.  The  stomach 
contained  a  small  quantity  of  dark-colored  liquid,  and  the  greater  end  was 
reddened.  The  spleen  was  congested.  The  emptiness  of  the  cavities  of 
the  heart  was  at  first  considered  to  be  incont^istent  with  death  from 
asphyxia  ;  but  this  condition  of  the  heart  is  occasionally  found.  It  may  be 
stated  that  in  this  case  the  deceased,  a  female,  was  greatly  exhausted  by 
sickness  and  purging.  On  the  second  day  of  her  illness  she  was  found 
dead  in  the  state  described,  and  her  husband  was  charged  with  having 
suff"ocated  her. 

Evidence  of  Death  from  Sv.ffocation. — In  medical  jurisprudence  there 
is  not,  perhaps,  an  instance  in  which  we  have  fewer  medical  data  upon 
which  to  base  an  opinion  than  in  a  case  of  alleged  death  from  suffocation. 
The  inspection  of  the  body  of  a  person  suffocated,  if  we  except  the  peculiar 
condition  of  the  surface  of  the  lungs  described  by  Tardieu,  presents  so 
little  that  is  peculiar,  that  a  medical  man,  unless  his  suspicions  have  been 
roused  by  circumstantial  evidence,  or  by  the  discovery  of  foreign  sub- 
stances in  the  air-passages,  would  probably  pass  it  over  as  a  case  of  death 
without  any  assignable  cause — in  other  words,  from  natural  cavi^e?;.  In 
examining  the  body  of  the  woman  Campbell,  who  was  suffocated  by  Burke 
in  Edinburgh,  Christison  was  unable  to  come  to  a  conclusion  respecting 
the  cause  of  death  until  some  light  had  been  thrown  on  the  case  by  collat- 
eral evidence.  On  this  occasion  a  violent  death  was  suspected,  because 
there  were  marks  of  violence  externally,  and  the  face  of  the  deceased  pre- 
sented some  of  the  characters  of  strangulation.  These  conditions,  how- 
ever, are  by  no  means  essential  to  death  from  suffocation,  and  when  they 
exist  they  can  only  be  regarded  as  purely  accidental  accompaniments. 
Appearances  similar  to  those  found  in  the  bodies  of  suffocated  persons,  if 
we  except  the  dotted  ecchymoses  on  the  lungs,  are  frequently  met  with  in 
inspections  when  death  has  taken  place  as  a  consequence  of  disease  or 
accident.  They  can,  therefore,  furnish  no  conclusive  evidence  of  the  kind 
of  death;  they  scarcely  permit  a  witness  to  establish  a  presumption  on 
the  subject,  until,  by  a  careful  examination  of  the  body,  he  has  ascertained 
that  there  is  no  other  cause  of  death  depending  on  organic  disease  or  on 
violence.  Medical  evidence  may,  however,  be  serviceable  in  some  in- 
stances. Thus,  let  the  general  evidence  establish  that  a  deceased  person 
has  probably  been  suffocated,  the  witness  may  have  it  in  his  power  to 
state  that  the  appearances  in  the  body  are  consistent  with  this  kind  of 
death;  that  the  body  is  in  all  respects  healthy  and  sound;  and  that  death 
was  probably  sudden — as  where,  for  instance,  undigested  food  is  dis- 
covered in  the  stomach.  The  presence  of  ecchymoses  on  the  surface  of  the 
lungs  may  justify  an  opinion  of  death  by  suffocation  when  no  other  cause 
is  apparent.  In  all  cases  of  this  description,  we  must  bear  in  mind  that 
an  opinion  relative  to  the  supposed  cause  of  death  is  to  be  formed  from 
the  medical  circumstances  and  from  what  we  have  ourselves  seen,  unless 


SUFFOCATION    FROM    ACCIDENTAL    CAUSES.  433 

it  be  othorwise  allowed  by  the  court.  From  this  want  of  clear  evidence, 
a  great  dili'crence  of  opinion  on  the  cause  of  death  frequently  exists  among 
medical  witnesses. 

Accidental  suffocation  is  not  unfrequent ;  and  there  are  various  condi- 
tions under  which  a  person  may  die  suffocated,  only  discoverable  after 
death.  1.  Diseases  about  the  tongue,  larynx,  or  throat  may  have  ad- 
vanced to  such  an  extent  as  effectually  to  prevent  breathing-.  2.  The  de- 
ceased may  hat^e  fallen,  and  the  mouth  become  covered  with  dust,  ashes, 
mud,  or  other  substances;  and,  if  helpless,  as  in  the  case  of  an  infant  or 
an  aged  person,  or  of  one  who  is  intoxicated,  death  may  thus  easily  take 
place.  A  child  was  found  dead  in  a  room,  with  its  face  in  the  ashes  under 
a  grate ;  it  had  fallen  during  the  absence  of  the  mother,  and,  from  its  help- 
less condition,  had  speedily  become  suffocated.  Some  of  the  ashes  were 
found  in  the  windpipe.  (Lend.  Med.  Gaz.,  vol.  xvii.  p.  642.)  In  1878  a 
boy  died  from  suffocation  under  the  following  circumstances:  He  was 
playing  in  a  corn-loft  with  some  companions,  when,  in  order  to  hide  him- 
self, he  got  into  a  wheat-bin  about  eight  feet  deep.  He  was  drawn  through 
the  wheat  towards  the  machine,  and  was  thus  buried  in  the  corn.  Although 
extricated  in  a  few  minutes,  he  was  quite  dead.  In  trials  for  murder  or 
manslaughter,  a  medical  opinion  respecting  the  accidental  suffocation  of  a 
drunken  person  under  similar  circumstances  is  occasionally  required. 
These  persons,  it  must  be  remembered,  are  generally  as  helpless  as  chil- 
dren ;  if  they  fall  in  a  position  so  that  the  mouth  is  covered,  they  may  be- 
so  powerless  from  intoxication  as  not  to  be  able  to  escape.  A  case  was 
brought  into  Guy's  Hospital  in  1870,  in  which  a  man  sulDJect  to  epileptic 
fits  had  lost  his  life  by  accidental  suffocation.  He  was  found  dead,  lying 
with  his  face  in  a  quantity  of  mud.  On  a  post-mortem  examination,  the 
teeth  and  nostrils  had  liquid  mud  adhering  to  them,  and  the  tongue  was 
thickly  coated  with  it.  The  right  side  of  the  heart  was  full  of  blood,  and 
there  was  a  large  quantity  on  the  left  side  extending  into  the  aorta.  The 
blood,  as  is  frequently  the  case  in  sudden  death,  was  liquid.  There  were 
a  few  gritty  particles  in  the  windpipe,  but  no  froth.  There  was  no  doubt 
that  the  man  had  died  from  asphyxia,  as  a  result  of  accidental  suffocation 
during  a  fit.  (Lancet,  1870,  ii.  p.  82.)  In  1877  an  inquest  was  held,  in 
which  it  was  proved  that  the  deceased  was  found  dead  in  bed,  lying  with 
his  face  downwards  and  one  arm  under  his  head.  The  medical  evidence 
showed  that  the  cause  of  death  was  suffocation,  by  reason  of  the  deceased 
having  turned  with  his  face  to  the  pillow  and  so  covered  his  mouth  and 
nostrils.  3.  A  portion  of  food  may  have  remained  fixed  in  the  larynx  or 
throat.  Children  are  sometimes  accidentally  suffocated  by  drinking  boil- 
ing water  from  a  tea-kettle.  The  parts  about  the  larynx  then  become 
swollen  from  the  action  of  the  hot  water,  and  breathing  cannot  take  place. 
4.  Accidental  suffocation  is  not  uncommon  among  infants  when  thev  .sleep 
with  adult  persons  (overlaying).  A  child  maybe  in  this  way  speedily 
destroyed.  Even  the  close  wrapping  of  a  child's  head  in  a  shawl,  to 
protect  it  from  cold,  may  effectually  kill  it,  without  any  convulsive  strug- 
gles to  indicate  the  danger  to  which  it  is  exposed  (p.  48.5,  poM).  Con- 
vulsions by  no  means  necessarily  attend  on  death  from  suflbcation. 

Those  instances  of  accidental  suffocation  which  depend  on  disease  or  on 
the  impaction  of  food,  are  easily  known  by  a  careful  examination  of  the 
parts  about  the  throat ;  and  generally  they  present  no  difficulty.  In  other 
instances,  when  a  child  or  a  drunken  person  is  presumed  to  have  been 
suffocated  owing  to  the  position  in  which  he  has  fallen,  evidence  as  to  the 
position  of  the  body,  or  even  the  actual  sight  of  the  bodv,  is  necessary 
before  forming  an  opinion.  The  following  questions  may  here  arise  :  Was. 
28 


43-4  HOMICIDAL    SUFFOCATION. 

the  position  such  as  to  be  explicable  on  the  supposition  of  accident  ?  Was 
it  not  such  a  position  as  might  have  been  given  to  it  by  a  murderer? 
Could  not  the  deceased  have  had  strength  or  presence  of  mind  to  escape? 
Could  he  have  been  actually  suffocated  in  the  position  in  which  his  body 
was  discovered?  A  little  reflection  upon  the  circumstances — for  here 
something  more  than  medical  facts  will  be  required — may  enable  us  to 
give  satisfactory  answers  to  these  questions. 

Some  singular  cases  are  on  record  in  which  persons  have  wilfully  de- 
stroyed themselves  by  blocking  up  the  throat  mechanically.  An  instance 
of  this  form  of  suicide  is  reported.  (Edin.  Med.  and  Surg.  Jour., 1842, 
p.  391.)  A  woman  confined  in  prison  forced  a  hard  cotton  plug  into  the 
back  of  her  throat.  The  cavities  of  the  chest  and  abdomen  had  been 
alread}'^  examined,  and  a  medical  certificate  given  that  the  deceased  had 
died  of  apoplexy.  The  body  was  sent  to  one  of  the  anatomical  schools, 
and  on  reinspection  it  was  accidentally  found  that  the  throat  was  firmly 
blocked  up  with  a  plug  of  spindle-cotton. 

Homicide  by  suffocation  is  not  very  common,  although  it  is  a  ready 
means  of  perpetrating  murder.  Hitherto  the  cases  which  have  come 
before  our  courts  have  generally  been  those  either  of  infants,  or  of  the 
aged  and  infirm,  or  of  persons  enfeebled  by  illness  (see,  however,  Reg,  v. 
Kerr,  p.  449).  In  regard  to  the  latter,  the  rigorous  administration  of  the 
law  has  succeeded  in  putting  a  check  to  this  crime ;  but  with  respect  to 
children,  it  probably  yet  continues.  Death  by  suffocation  is  most  difficult 
to  detect;  and,  unless  the  assailant  has  cmploj'ed  an  unnecessary  degree 
of  violence,  it  is  probable  that  the  crime  may  pass  altogether  unsuspected. 
Homicide  by  suffocation  would  not  ho  attempted  on  healthy  adult  persons, 
unless  they  were  in  a  state  of  intoxication,  and  thereby  rendered  defence- 
less. It  is  certain  that  most  individuals  would  have  it  in  their  power, 
unless  greatly  incapacitated  by  disease  or  intoxication,  to  offer  such  a  de- 
gree of  resistance  as  would  leave  upon  their  bodies  indubitable  evidence 
of  murderous  violence.  Death  from  suffocation  may  be  considered  as  pre- 
sumptive of  homicide  unless  the  facts  are  clearly  referable  to  accident. 
Accidental  suffocation  is,  however,  so  palpable,  from  the  position  of  the 
body  and  other  circumstances,  that  when  death  is  clearly  traced  to  this 
cause  it  is  not  easy  to  conceive  a  case  in  which  it  would  be  difficult  to 
distinguish  it  from  one  of  actual  murder.  In  some  instances,  the  very 
means  that  have  been  adopted  to  produce  suflbcation  may  forbid  the  sup- 
position of  accident  and  clearly  establish  the  fact  of  homicide. 

The  suffocation  of  newborn  children,  by  the  introduction  of  substances 
into  the  mouth,  is  not  unfrequent.  The  unnecessary  force  employed 
generally  leaves  traces  of  violence,  which  may  be  easily  discovered  by  a 
careful  examination,  even  should  it  happen  that  the  substance  used  for  the 
murderous  purpose  has  been  removed.  A  child,  one  year  old,  after  it  had 
been  fed  with  a  bottle,  was  put  to  bed  at  six  o'clock,  and  died  at  midnight 
with  signs  of  dyspnoea.  On  inspection  ten  hours  after  death,  the  lower 
lobes  of  the  lungs  were  found  softened,  of  a  grayish  color,  and  apparently 
pulpy.  Curdled  milk  was  found  in  the  windpipe  and  bronchi.  There  was 
no  doubt  that  the  milk  had  been  vomited  after  the  child  was  put  to  bed, 
and,  on  account  of  the  horizontal  position,  a  portion  of  it  had  been  drawn 
bv  aspiration  into  the  air-passages  and  had  caused  suffocation.  (Lancet, 
1873,  i.  p.  6G9.) 

It  is  necessary  to  point  out  a  dangerous  practice  common  among  igno- 
rant nurses,  which,  without  exfiting  suspicion  on  the  part  of  a  coroner  or 
medical  witness,  may  be  an  occasional  cause  of  death  in  infants.  In  order 
to  quiet  a  child,  and  to  enable  a  nurse  to  sleep  without  disturbance,  a  bag 


DEATH    FROM    SMOTHERING.  435 

made  of  wash-leather  or  vi\<i;  containing  sugar  is  thrust  into  the  child's 
mouth.  It  is  thus  completely  gagged,  and  the  child  soon  becomes  quiet, 
respiring  chiefly  througli  the  nostrils.  If  these  by  any  accident  become 
obstructed,  or  by  the  act  of  aspiration  the  bag  should  fall  to  the  back  of 
the  throat,  death  from  suffocation  results,  the  infant  being  helpless.  The 
suspension  of  breathing  may  be  so  gradual  that  the  child  may  die  without 
crying  or  convulsions.  The  removal  of  the  bag  from  the  mouth,  as  no 
violence  has  been  used,  will  remove  ever}^  trace  of  the  cause  of  death  ; 
and,  in  order  to  exculpate  herself,  the  guilty  person  may  ascribe  death  to 
"  fits."  In  one  instance,  an  infant  was  timely  saved  by  the  mother 
having  discovered,  while  the  nurse  was  sleeping,  a  mass  of  wash-leather 
projecting  from  its  mouth.  The  woman  awoke  and  attempted  to  remove 
and  conceal  the  leather,  but  she  was  discovered  in  the  act.  The  detection 
of  this  dangerous  practice  can  only  be  a  matter  of  accident ;  hence  a  fatal 
case  can  be  rarely  the  subject  of  a  coroner's  inquest,  and  even  then  medi- 
cal evidence  may  fail  to  throw  any  light  upon  the  cause  of  death.  In  one 
instance  only  have  we  known  it  to  give  rise  to  a  criminal  charge.  (Reg. 
V.  Cox,  AVarwick  Lent  Ass.,  1848.)  The  mother,  a  pauper,  was  tried  for 
the  attempt  to  suffocate  her  infant,  eleven  days  old.  The  child  was  dis- 
covered by  another  person  with  a  piece  of  rag  hanging  from  its  mouth. 
It  was  livid  in  the  face,  but  when  the  rag  was  removed  it  made  a  violent 
gasp  and  recovered  its  breath.  There  was  no  malice  on  the  part  of  the 
prisoner,  but  it  was  made  a  strong  point  in  her  favor  that  instances  had 
occurred  in  the  workhouse,  in  which  women  had  with  impunitv  put  rags 
with  sugar  into  the  mouths  of  infants  in  order  to  soothe  and  keep  them 
quiet.  She  was  acquitted.  The  admitted  practice  of  infantile  suffocation 
appears  to  have  passed  without  reprimand  or  even  comment,  although 
this  plan  of  soothing  infants  is  just  as  likely  to  be  fatal  to  them  as  that 
of  encircling  their  necks  with  tight  ligatures. 

Smothering. — Smothering  is  a  variety  of  suffocation,  and  consists  in  the 
mere  covering  of  the  mouth  and  nostrils  in  any  way  so  as  to  prevent  the 
free  -ingress  and  egress  of  air.  Like  drowning,  hanging,  or  strangulation, 
it  produces  death  by  asphyxia.  In  newborn  infants  it  is  not  an  unusual 
occurrence,  sometimes  originating  in  accident,  and  at  others  in  criminal 
design.  An  infant  may  be  speedily  destroyed  by  smothering.  If  the 
mouth  be  only  lightly  covered  with  clothing  or  sliij-htly  compressed,  so 
that  respiration  is  interrupted,  as  in  the  act  of  carrying  a  child  in  the  arras, 
this  will  suffice  to  cause  death ;  and,  as  it  has  been  already  remarked,  death 
may  take  place  without  being  preceded  by  convulsions  or  other  striking 
symptoms.  Smothering  is  not  often  resorted  to  as  a  means  of  perpetrat- 
ing murder,  except  in  infants  or  in  debilitated  and  infirm  adults.  In  a 
case  which  occurred  at  Ayr,  a  woman  was  charged  with  the  murder  of 
her  child  by  smothering  it  in  her  shawl.  She  was  travelling  in  a  steam- 
boat ;  it  was  a  cold,  stormy  day,  and  she  had  wrapped  the  shaw^l  closely 
round  the  head  of  the  child.  There  could  be  no  doubt,  from  the  moral 
circumstances,  that  she  had  intended  to  kill  it ;  but  the  defence  was  that 
she  had  merely  intended  to  protect  the  child  from  the  cold,  and  it  was 
suffocated  before  she  was  aw^are  of  it.  There  were  no  facts  to  exclude  this 
defence,  and  the  woman  was  acquitted.  But  children  may  be  thus  acci- 
dentally destroyed  through  the  ignorance  of  persons  w^ho  nurse  them. 

According  to  Wakel}^  infants  are  frequently  found  dead  owing  to  their 
being  suckled  at  night  while  the  woman  is  in  bed.  The  child's  face  is 
pressed  on  the  breast ;  mother  and  child  fall  fast  asleep  ;  the  head  slips 
beneath  the  clothes,  and  the  child  is  then  quietly  suffocated.  There  is  no 
mark  of  pressure  or  violence  on  the  body.     (Lancet,  1858,  i.  p.  70.)    This 


436  POST-MORTEM    APPEARANCES. 

statement  is  strongly  confirmed  by  the  annual  returns  of  the  Registrar- 
General.  A  child  (five  days  old)  died  quietly  on  its  mother's  arm  while 
lying  in  bed.  There  was  much  lividity  about  the  head,  neck,  and  back  ; 
but  there  were  no  marks  of  violence.  The  bronchial  tubes  of  the  right  lung 
contained  bright  florid  blood.  The  left  lung  was  gorged  with  blood,  but 
none  had  escaped.  The  heart  was  firmly  contracted,  and  there  was  only 
a  small  quantity  of  blood  in  its  right  cavities.  According,  to  the  return 
of  the  Registrar-General,  suffocation  in  bed  from  "  overlaying"  is  a  fre- 
quent cause  of  violent  death  among  infants.  Infants  are  readily  smothered 
by  the  bed-clothes  accidentally  covering  the  mouth  and  nostrils,  and  they 
have  not  the  power  to  change  their  position. 

The  appearances  met  with  in  the  bodies  of  three  children  who  had  died 
under  these  circumstances  are  thus  described  by  Canton.  Externally  : 
features  placid  ;  lips  congested;  eyes  not  unduly  prominent ;  conjunctivae 
rather  reddened  ;  hands  clenched  ;  no  patches  of  ecchymosis  found  on  the 
skin.  Internally:  head — patches  of  effused  blood  here  and  there  beneath 
the  pericranium  ;  great  congestion  of  thepia  mater,  accompanied  b}^  numer- 
ous effusions  of  blood,  varying  in  size  from  a  pin's  point  to  a  silver  penny 
{hic)  in  superficial  extent ;  a  little  clear  fluid  in  the  ventricles  ;  some  frothy 
mucus  in  the  windpipe  and  bronchi,  with  redness  of  their  lining  mem- 
brane. The  lungs  were  much  congested  and  crepitant,  whilst  beneath  the 
pleurse  blood  was  effused,  presenting  numerous  small  bright-red  patches 
and  fine  points  (punctiform  ecchymoses).  The  pericardium  contained 
some  serum  and  was  spotted  in  its  whole  extent  in  the  manner  described  ; 
the  vasa  vasorum  of  the  heart's  great  vessels  and  thoracic  aorta  were 
minutely  injected.  The  right  cavities  of  the  heart  in  all  the  cases  con- 
tained dark  liquid  blood  ;  the  left  cavities  were  nearly  empty  ;  the  tissue 
of  the  organ  was  free  from  effused  blood.  The  surface  only  of  the  thymus 
gland  was  mottled  like  the  heart. 

There  is  a  prevalent  notion  that  congestion  of  the  lungs  is  an  invariable 
accompaniment  of  death  from  suffocation,  and  where  this  was  not  found  it 
has  been  hastily  assumed  that  death  had  taken  place  from  some  other 
cause.  Some  remarks  on  tiiis  post-mortem  appearance  have  been  made  in 
the  chapter  on  Drowning;  and  it  is  desirable,  in  reference  to  future  cases, 
to  point  out  the  fallacy  involved  in  the  assuiuption  that  congestion  of  the 
lungs  is  necessarily  present  in  death  from  suffocation.  Watson  observed 
that  the  gorged  state  of  the  right  side  of  the  heart  and  lungs  is  greatest 
where  the  act  of  suffocation  (asphyxia)  has  been  slow  and  gradual  by  the 
access  of  air  to  the  lungs  not  having  been  completely  prevented.  When, 
on  the  other  hand,  death  has  taken  place  quickly  or  suddenly  from  this 
cause,  there  is  little  or  no  unusual  congestion  of  blood  in  the  lungs  or 
heart.  (On  Homicide,  p.  115.)  At  p.  118  he  describes  a  case  of  death 
from  suffocation  in  which  the  lungs  were  natural;  and  in  the  case  of 
Campbell,  for  whose  murder  by  suffocation  Burke  was  convicted  and  exe- 
cuted in  1828-9,  Christison  and  Newbigging  found  the  organs  within  the 
chest  perfectly  natural,  the  lungg  remarkably  so,  and  unusually  free  from 
infiltration.  The  blood  in  the  heart  and  great  vessels,  as  well  as  through- 
out the  body,  was  fluid  and  black.  (Edin.  Med.  and  Surg.  "Jour.,  vol. 
xxxi.  p.  239.)  Again,  in  the  case  of  Carlo  Ferrari,  for  the  murder  of 
whom  Bishop  and  Williams  were  convicted  in  London  in  1831,  the  lungs 
were  quite  healthy,  and  not  congested  ;  the  heart  was  rather  small,  con- 
tracted, and  its  four  cavities  were  perfectly  empty.  The  prisoners  in  this 
case  confessed  that  they  had  destroyed  the  deceased  by  suffocation.  From 
these  facts  it  will  be  perceived  that  the  actual  state  of  the  lungs  and  heart 
in  the  bodies  of  those  who  had  been  notoriously  murdered  by  suffocation, 


BURKING MEDICAL    EVIDENCE.  437 

is  that  which   has  been  wrongly  pronounced  to   be   inconsistent  with  this 
mode  of  death. 

Certain  trials  which  toolc  place  many  years  since  clearly  proved  that 
persons  in  a  state  of  intoxication  or  infirmity  bad  been  murdered  by 
smothering  for  the  sake  of  the  money  derived  from  the  sale  of  the  dead 
bodies.  The  victims  were  commonl}'  destroyed  by  the  assailant  resting- 
with  his  whole  weight  upon  the  chest,  so  as  to  prevent  the  motion  of  the 
ribs,  and  at  the  same  time  forcibly  compressing  the  mouth  and  nostrils 
with  his  hands,  to  prevent  the  entrance  of  air.  A  case  of  this  kind  was 
referred  to  the  author  for  examination  in  1831.  (Rex  v.  Elizabeth  Ross, 
C.  C.  C,  Dec.  1831.)  It  was  remarkable  for  the  fact  that  the  prisoner 
was  convicted  of  homicidal  suffocation,  although  the  body  of  the  deceased 
was  never  discovered.  (Lond.  Med.  Gaz.,  vol.  xxxvii.  p.  481.)  In  Reg. 
V.  Norman,  C.  C.  C,  July,  1871,  the  prisoner,  a  girl,  cet.  15,  was  indicted 
for  murder  bv  suffocation.  She  was  a  nursery-maid,  and  had  had  the  care 
of  three  children;  the  deceased,  one  of  these  children,  being  fifteen  months 
old.  There  were  three  other  charges  of  murder  by  suffocation  against  her, 
and  one  of  an  attempt  to  murder.  There  were  suspicious  marks  of  vio- 
lence on  the  lower  lip  of  the  deceased,  as  if  produced  by  pressure  of  the 
mouth  against  some  hard  substance.  The  medical  witnesses  attributed 
death  to  suffocation  by  pressure  on  the  mouth,  but  admitted  that  the 
marks  might  have  been  accidental.  On  this  admission  the  prisoner  was 
acquitted.  On  the  trial  for  the  attempt  to  murder,  the  girl  was  convicted, 
and  the  evidence  given  in  this  case  threw  a  light  upon  the  mode  in  which 
she  might  have  perpetrated  the  four  murders  with  which  she  was  charged. 
A  little  boy,  i"et.  10,  was  heard  to  give  an  alarm  while  in  bed;  it  was  a 
stifled  cry.  The  prisoner  was  caught  in  the  act  of  getting  oft'  the  bed. 
The  boy  was  in  great  agitation,  and  said  that  the  prisoner  had  tried  to 
strangle  him  while  he  was  sleeping.  He  was  awoke  by  feeling  a  hand  on 
his  mouth  and  throat.  He  tried  to  make  a  noise,  upon  which  the  prisoner, 
who  was  lying  upon  him,  gave  him  a  sweetmeat,  and  told  him  not  to  cry. 
His  lips  and  throat  were  very  sore.  The  prisoner  was  convicted  and 
sentenced  to  ten  years'  penal  servitude.  There  can  be  no  doubt  that  the 
four  murders  were  all  perpetrated  in  a  similar  manner,  by  burking — the 
children  being  helpless,  and  unable  to  give  an  alarm.  The  conviction  of 
the  prisoner  on  the  attempt  simply  arose  from  this  child  being  older  and 
better  able  to  resist.  The  facts  show  that  medical  science  in  many  of 
these  cases  is  powerless  to  aid  the  law.  It  is  not  always  possible  to  dis- 
tinguish murder  by  smotherino:  or  suffocation  from  accident. 

In  reference  to  the  case  of  Campbell,  Christison  observes  "that  the  con- 
viction in  the  public  mind,  that  a  well-informed  medical  man  should  alwavs 
be  able  to  detect  death  by  suffocation  simply  by  an  inspection  of  the  bodv 
and  without  a  knowledge  of  collateral  circumstances,  is  erroneous,  and 
may  have  the  pernicious  tendency  of  throwing  inspectors  off  their  guard, 
by  leading  them  to  expect  strongly  marked  appearances  in  every  case  of 
death  from  suffocation.  That  such  appearances  are  very  far  from  being 
ahvays  present  ought  to  be  distinctly  understood  by  every  medical  man 
who  is  required  to  inspect  a  body  and  give  an  opinion  of  the  cause  of 
death."  At  the  same  time,  in  the  absence  of  marked  appearances  to  indi- 
cate violent  death,  due  caution  should  be  used  by  a  medical  witness  in 
expressing  an  opinion.  At  the  trial  of  the  prisoner  Burke,  Christison 
restricted  his  opinion  by  stating  that  death  by  violence  was,  from  the 
medical  circumstances  alone,  veri/  probable — a  degree  of  caution  which, 
on  similar  occasions,  it  will  be  desiraljle  for  a  medical  witness  to  imitate. 
It  is  not  possible  to  carry  medical  evidence  further  than  this.     There  is 


438  SUFFOCATIOX    OR    POISONING    BY    GASES. 

nothing  in  the  act  of  suffocation,  as  there  is  in  wounds,  poisoning,  hanff- 
ing,  or  strangulation,  by  which  the  hand  of  a  criminal  can  be  clearly  and 
unequivocally  traced. 

As  an  accident,  smothering  may  be  conceived  to  take  place  when  a 
person  falls,  in  a  state  of  intoxication  and  debility,  so  that  his  mouth  is  in 
any  way  covered,  or  the  access  of  air  to  the  mouth  or  nostrils  is  inter- 
rupted. On  an  inspection  of  the  body,  the  appearances  elsewhere  described 
will  be  met  with  in  the  lungs  and  heart.  If  the  person  has  been  able  to 
struggle,  it  is  probable  that  slight  marks  of  violence  in  the  shape  of 
scratches  or  bruises  may  be  found  about  the  mouth  and  nostrils,  with 
bruises  or  marks  of  pressure  on  the  chest,  legs,  or  arms,  and  redness  of  the 
mucous  membrane,  with  a  bloody  mucous  froth  as  well  as  foreign  sub- 
stances in  the  air-passages.  The  marks  of  violence  may  be  slij^ht,  or  even 
entirely  absent.  In  a  case  of  suspected  murder,  a  medical  jurist  should 
look  for  the  special  indications  of  suffocation  in  the  lungs,  the  circumstances 
under  which  the  body  or  bodies  are  found,  the  evidence  of  sudden  death 
in  the  presence  of  food  in  the  stomach,  and  lastly  the  absence  of  any  other 
cause  to  account  for  death.  All  these  sources  of  evidence  may  fail;  and 
as  the  means  by  which  homicidal  smothering  was  accomplished  are  not 
likely  to  be  found  with  the  body,  a  medical  opinion  on  the  case  may  be- 
come little  more  than  a  conjecture.  Still,  this  may  suffice  when  the  evi- 
dence from  extraneous  circumstances  is  strong. 


CHAPTER     XLII. 

GASEOUS      POISOXS. CAEBOXIC       ACID. SYMPTOMS. APPEAEAXCES. ANALYSIS. EFFECTS 

OF    CHAKCOAL-VAPOR. CAKBOXIC    OXIDE. COAL    A>D    CCKE    VAPOR. SCLPHCEOL'S  ACID. 

VAPORS  OF  LIME,  CEMEXT,  AXD  BKICK-KILSS. CONFIXED  AIR. COAL-GAS. WATER- 
GAS. —  CARBCRETTED  HYDROGEX. XITKOUS  OXIDE. SCLPHCEETTED  HYDEOGEX. ^EFFLU- 
VIA   OF    DEAIXS    AND    SEWERS. 

3Iode  of  Action  of  Gaseous  Poisons. — In  following  common  language, 
a  medical  jurist  is  compelled  to  apply  the  term  "  suffocation"  to  another 
variety  of  death — viz.,  to  that  of  poisoning  by  gases.  Physiological 
accuracy  mu.«t  here  be  sacrificed,  in  order  that  we  may  make  ourselves 
generally  intelligible.  Thus,  if  a  person  die  from  the  effects  of  carbonic 
acid,  of  confined  air,  of  sulphuretted  hydrogen,  or  of  other  noxious  gases, 
he  is  commonly  said  to  die  suffocated.  Strictly  speaking,  he  dies  poisoned 
— as  much  so  as  if  he  had  taken  oxalic  or  hydrocyanic  acid.  The  only 
differences  are :  (1)  that  the  poison,  instead  of  being  liquid  or  solid,  is 
gaseous  ;  and  (2)  instead  of  being  applied  to  the  mucous  membrane  of  the 
stomach,  it  affects  that  of  the  air-cells  of  the  lungs.  In  the  action  of 
arsenetted  hydrogen  we  have  a  clear  instance  of  poisoning  by  a  gas,  and 
in  the  respiration  of  the  narcotic  vapors  of  chloroform  and  ether  we  have 
also  illustrations  of  this  form  of  poisoning.  Owing  to  the  fact  that  the 
poisonous  material  is  in  a  finely  divided  state  of  vapor,  and  that  in  the 
air-cells  of  the  lungs  it  meets  at  once  with  a  large  absorbing  surface  aod 
instantly  enters  the  blood,  the  effects  are  more  rapid  and  more  strongly 
marked.  It  has  been  observed,  too,  that  some  (and  probably  all)  of  these 
aerial  poisons  have  an  accumulative  action — i.  e.  their  effects  continue  to 
increase  for  a  short  period,  even  after  a  person  has  ceased  to  breathe  them. 


THE    CAUSE    OF    DEATH    MISTAKEN".  439 

The  remarks  made  respecting-  the  action  of  gases  on  the  lungs  apply- 
equally  to  the  effects  produced  by  the  vapors  of  alcohol,  ether,  chloroform, 
and  bichloride  of  methylene.  The  specific  action  of  some  of  these  vapors 
has  been  elsewhere  noticed  {ante,  pp.  197,  199).  A  person  dies  not  only 
from  the  privation  of  oxygen,  but  from  the  absorption  of  the  poisonous 
vapor  into  the  blood  through  the  pulmonary  membrane.  Although  often 
described  as  cases  of  suffocation,  they  are  not  to  be  regarded  as  such. 
Hydrogen  and  nitrogen  have  been  considered  to  be  the  only  two  gases 
which  operate  as  negative  agents,  i.  e.  by  simply  excluding  oxygen;  but 
hydrogen  breathed  with  oxygen  in  atmospheric  proportions  has  been 
found  to  produce  narcotism. 

Norris  has  endeavored  to  determine  experimentally  the  relative  periods 
of  time  within  which  some  of  these  vapors  and  gases  may  prove  fatal. 
He  employed  a  chamber  filled  with  common  air  in  which  a  rat  could  live 
without  inconvenience  for  a  period  of  three  hours.  When  pure  hydrogen 
was  substituted  for  air  the  animal  lived  for  nine  minutes.  This  was  taken 
to  represent  death  from  the  privation  of  air  or  oxygen,  and  assuming  this 
as  a  standard  the  following  table  shows  the  time  in  which  death  occurred 
with  different  gases  and  vapors  : — 

Pure  hydrogen  gas  in    . 

Common  air  saturated  with  ether 

"  "  with  chloroform 

"  "  wjth  bichloride  of  methylene 

Pure  nitrous  oxide  gas  ..... 

Oxygen  gas  saturated  with  ether  .... 
"  "  with  chloroform 

"  "  with  bichloride  of  methylene 

Pure  carbonic  acid  gas  ...... 

(Brit.  Med.  Jour.,  1873,  ii.  p.  401.)  In  the  experiments  on  dogs  per- 
formed by  the  Committee  of  the  Med.-Chir.  Society  it  was  found  that, 
under  complete  deprivation  of  air,  the  heart's  action  continued  for  a  period 
of  eight  minutes  and  twenty  seconds.  This  very  nearly  corresponds  to 
the  time  at  which  life  ceases  in  pure  hydrogen.  These  results  show  that 
the  gases  and  vapors  are  directly  poisonous  agents,  and  that  they  do  not 
produce  their  effects  merely  by  excluding  oxygen  or  air. 

The  Cause  of  Death  Mistaken. — The  greater  number  of  the  poisonous 
gases  are  chiefly  complex  products  of  art,  and  are  never  likel}'  to  be  met 
with  in  the  atmosphere  so  abundantly  as  to  produce  injurious  conse- 
quences ;  hence  fatal  accidents  arising  from  their  inhalation  most  com- 
monly occur  under  circumstances  which  can  leave  no  doubt  respecting  the 
real  cause  of  death.  The  peculiar  effects  of  all  of  these  it  will  not  be 
necessary  to  describe  in  this  place ;  but  there  are  three,  a  knowledge  of 
the  properties  and  operation  of  which  may,  on  certain  occasions,  be  re- 
quired of  a  medical  jurist ;  these  are  the  carbonic  acid,  carbonic  oxide, 
and  sidphurelted  hydrogen  gases.  Agents  of  this  description  can  rarely 
be  employed  with  any  certainty  as  instruments  of  murder  ;  and,  if  they 
were  so  employed,  the  fact  could  be  established  only  by  circumstantial 
evidence.  One  alleged  instance  of  murder  by  carbonic  acid  is,  how^ever, 
reported  by  Devergie.  (Ann.  d'Hyg.,  1837,  t.  1,  p.  201.)  Death,  when 
arising  from  the  breathing  of  any  of  the  gases,  is  generally  attributable 
to  suicide  or  accident.  In  France  it  is  by  no  means  uncommon  for  a  per- 
son to  commit  self-destruction  by  sleeping  in  a  closed  apartment  in  which 
charcoal  has  been  suffered  to  burn :  while  in  England  accidental  deaths 


Min. 

Sec. 

9 

0 

5 

0 

I 

30 

0 

20 

0 

25 

8 

30 

0 

25 

1 

45 

0 

8 

4i0  ACTION    OF    CARBOXIC    ACID. 

are  sometimes  heard  of  where  coal  or  coke  has  been  employed  as  fuel  in 
small  and  ill-ventilated  rooms.  On  such  occasions  a  person  may  be  found 
dead  without  any  apparent  cause  to  the  casual  observer.  The  face  may 
appear  pale  or  livid,  and  the  skin  may  be  covered  with  patches  of  lividity. 
The  discovery  of  a  body  under  these  circumstances  may  be  sufficient,  in 
the  eyes  of  the  vulgar,  to  create  a  suspicion  of  murder;  and  some  person 
with  whom  the  deceased  may  have  been  at  that  period  on  bad  terms  will 
perhaps  be  pointed  out  as  the  murderer.  In  such  a  case  it  is  obvious  that 
the  establishment  of  the  innocence  of  the  accused  uill  depend  entirely  on 
the  discrimination  and  judirment  of  a  medical  practitioner.  An  instance, 
illustrative  of  the  consequences  of  this  popular  prejudice,  occurred  in  Lon- 
don in  1823.  Six  persons  were  lodgino-  in  the  same  apartment,  where 
they  were  all  in  the  habit  of  sleeping.  One  morning  an  alarm  was  given 
by  one  of  them,  a  woman,  who  stated  that,  on  rising,  she  found  her  com- 
panions dead.  Four  were  discovered  to  be  really  dead,  but  the  fifth,  a 
married  man,  whose  wife  was  one  of  the  victims,  was  recovering.  He 
was  known  to  have  been  on  intimate  terms  v/ith  the  woman  who  gave 
the  alarm,  and  it  was  supposed  that  these  two  had  conspired  to  destroy 
the  whole  party  in  order  to  get  rid  of  the  wife.  The  woman  who  was 
accused  of  the  crime  was  imprisoned,  and  an  account  of  the  supposed  bar- 
barous murder  was  soon  printed  and  circulated  in  the  metropolis.  Manv 
articles  of  food  about  the  house  were  analyzed  in  order  to  discover  whether 
they  contained  poison,  when  all  the  circumstances  were  explained  by  the 
man  stating  that  he  had  placed  a  pan  of  burning  coals  betu'een  the  two 
beds  before  going  to  sleep,  and  that  the  doors  and  windows  of  the  apart- 
ment were  kept  closed.  (Christison,  p.  583.)  Cases  of  a  similar  kind,  in 
which  there  was  at  first  a  strong  suspicion  of  poisoning,  have  been  re- 
ported. (Lond.  Med.  Gaz.,  vol.  xxxvi.  p.  937  ;  Ann.  d'Hvg.,  1843,  t.  2, 
p.  56 ;  Med.  Chron.,  voL  ii.  pp.  80,  84.) 

Cabbonic  Acid. 

This  gas  is  freely  liberated  in  respiration,  combustion,  and  fermenta- 
tion ;  it  is  also  produced  in  the  calcination  of  chalk  or  limestone,  and  is 
sometimes  diffused  through  the  shafts  and  galleries  of  coal-mines,  where 
it  is  one  constituent  of  what  is  commonly  called  "  choke-damp."  Car- 
bonic acid  gas  is  likewise  met  with  in  wells,  cellars,  and  other  excavations 
in  the  earth,  In  these  cases  it  is  generally  found  most  abundantly  on  the 
soil,  or  at  the  lower  part  of  the  well ;  and  it  appears  to  proceed  from  the 
decomposition  of  animal  and  vegetable  matters  confined  in  such  situations. 
The  slow  evaporation  of  water  strongly  charged  with  the  gas,  while  trick- 
ling over  the  sides  of  these  excavations,  may  likewise  assist  in  contaminat- 
ing the  air.  Damp  sawdust,  straw,  and  decayed  leaves  slowly  absorb 
oxygen  from  a  confined  atmosphere,  and  set  free  carbonic  acid. 

H.  Davy  believed  that  carbonic  acid  in  a  perfectly  pure  state  did  not 
pass  into  the  windpipe  when  an  attempt  was  made  to  breathe  it ;  the 
glottis  seemed  to  close  spasmodically  at  the  moment  that  the  gas  came 
in  contact  with  it.  On  diluting  the  carbonic  acid  with  about  twice  its 
volume  of  air,  he  found  that  he  could  breathe  it ;  but  it  soon  produced 
symptoms  of  giddiness  and  somnolency.  In  a  diluted  state  there  is  no 
doubt  that  it  penetrates  into  the  lungs,  and  that  it  is  absorbed  and  circu- 
lated with  the  blood.  In  estimating  the  effects  of  this  gas  when  mixed 
with  air  a  distinction  must  be  made.  The  gas  may  either  be  simply  added 
to  the  air,  or  it  may  be  produced  at  the  expense  of  the  oxygen  in  the 
enclosed  space  or  apartment.     In  the  latter  case,  it  must  be  remembered 


POISONOUS    PROPORTIONS.  441 

that  every  volume  of  carbonic  acid  thus  produced  represents  an  equal 
volume  of  oxygen  removed.  Such  an  atmosphere  is,  therefore,  more 
destructive  than  another  in  which  the  air  and  gas  are  in  simple  admixture. 
If  we  assume  that  in  each  case  the  noxious  atmosphere  contains  10  per 
cent,  of  carbonic  acid,  then  in  one  instance  there  will  be  8  per  cent,  more 
of  oxygen  and  8  per  cent,  less  of  nitrogen  than  in  the  other,  since  the 
production  of  10  parts  of  carbonic  acid  as  a  result  of  combustion  implies 
the  loss  of  10  parts  of  oxygen.  This  difference  in  the  proportions  may 
not  be,  practically  speaking,  correct,  because  there  is  no  apartment  suffi- 
ciently closed  to  prevent  air  rushing  in  from  the  exterior  while  combustion 
is  going  on  within  it;  but,  nevertheless,  the  above  statement  may  be  taken 
as  an  approximation  to  the  truth.  The  air  in  small  apartments  is  rapidly 
vitiated  by  combustion,  especially  when  the  room  is  not  properly  venti- 
lated by  the  door,  window,  or  fireplace  In  1874,  a  man  and  his  wife- 
were  found  dead  in  their  bedroom  at  Bristol,  in  the  attitude  of  making 
their  escape.  A  paraffin  lamp  was  still  burning  on  the  table.  The  noxious 
vapor  from  this  lamp,  in  a  small  ill-ventilated  room,  had  sufficed  to  cause 
death. 

The  statements  made  by  chemists  and  physiologists  respecting  the  pro- 
portion of  carbonic  acid  in  air  required  to  produce  noxious  or  fatal  effects 
on  human  beings  are  very  conflicting.  Small  animals,  such  as  birds  and 
mice,  have  been  generally  made  the  subjects  of  experiment,  but  the  results 
thus  obtained  cannot  be  satisfactorily  applied  to  show  the  relative  action 
of  carbonic  acid  on  man.  Berzelius  stated  that  a  proportion  of  5  per 
cent,  in  air  was  not  injurious,  and  that  such  a  mixture  might  be  usefully 
employed  in  the  treatment  of  consumption.  Allen  and  Pepys  inferred 
from  their  experiments  on  guinea-pigs  that  10  per  cent,  of  the  gas  would 
prove  fatal  to  man.  In  the  more  recent  experiments  of  Bernard,  this 
inference  is  corroborated  by  the  fact  that  a  bird  died  in  two  hours  and  a 
half  in  an  atmosphere  consisting  (in  100  parts)  of  9.5  of  carbonic  acid, 
28  of  oxygen,  and  62.5  of  nitrogen.  (Les  Sub.  Toxiques,  1857,  p.  135.) 
In  this  case  the  proportion  was  less  than  10  per  cent.,  while  the  propor- 
tion of  oxygen  was  7  per  cent,  more  than  that  existing  in  the  atmosphere. 
On  the  other  hand,  Demarquay  says  that  one  part  of  carbonic  acid  (25 
per  cent.)  and  three  parts  of  air  produced  in  man  but  slight  discomfort 
after  being  breathed  for  some  titne.  According  to  this  writer,  most  of 
the  accidents  caused  bv  charcoal-vapor,  confined  air,  and  gases  in  ferment- 
ing vats,  are  wrongly  ascribed  to  carbonic  acid,  and  should  be  attributed 
to  carbonic  oxide,  sulphuretted  hydrogen,  alcoholic  vapors,  or  other  gases 
not  yet  understood.  (Chem.  News,  Aug.  4,  1865.)  Those  who  have 
employed  mixtures  of  carbonic  acid  and  air  for  aneesthetic  purposes  have 
stated  that  air  containing  20  per  cent,  of  carbonic  acid  may  be  breathed 
without  any  injurious  effects.  Such  a  mixture  would  be  composed  (in 
100  parts)  of  20  of  carbonic  acid,  16  of  oxygen,  and  64  of  nitrogen.  In 
'this  mixture,  if  carefully  made,  oxy-combustion  cannot  be  maintained  ; 
hence,  if  there  was  no  error  in  the  above  proportions,  it  follows  that  a  man 
can  breathe  with  safety  and  live  in  air  in  which  a  candle  will  not  burn. 
Bernard's  carefully  performed  experiments  are  adverse  to  these  statements. 
He  found  that  animals  died  in  atmospheres  in  which  the  proportion  of 
carbonic  acid  varied  from  12  to  18  per  cent. .while  the  amount  of  oxygen 
varied  from  5  to  30  per  cent.  (Les  Sub.  Toxiques,  p.  140.)  When  it  is 
asserted  that  a  person  can  thus  breathe  with  impunity  proportions  which 
are  fatal  to  life,  it  would  be  desirable  to  know  how  such  mixtures  were 
made,  and  whether  proper  care  had  been  taken  to  prevent  the  breathing 
of  air  by  the  mouth  and  nostrils,  while  the  supposed  poisonous  mixture 


412  CARBONIC  ACID — SYMPTOMS. 

was  being  inbaled.  Lives  are  sometimes  successively  lost  in  wells  charged 
with  carbonic  acid,  and  in  brewer's  vats,  in  consequence  of  one  person 
after  another  entering,  in  the  foolish  expectation  of  at  least  being  able  to 
attach  a  rope  to  the  body  of  an  asphyxiated  person.  The  moment  that 
the  mouth  comes  within  the  level  of  the  invisible  dense  stratum  of  gas, 
muscular  power  is  lost,  and  the  person  commonly  sinks  lifeless. 

Symptoms. — The  symptoms  of  poisoning  by  carbonic  acid  vary  accord- 
ing to  the  proportion  contained  in  the  air  which  is  breathed.  In  a  con- 
centrated state  there  is  sadden  insensibility,  followed  by  death,  unless  the 
person  is  immediately  removed  into  pure  air.  When  the  air  is  gradually 
poisoned  so  as  to  acquire  its  lowest  poisonous  proportion,  insensibility 
comes  on  more  slowly  ;  and,  as  in  ordinary  narcotic  poisoning,  it  is  pre- 
ceded by  giddiness,  somnolency,  and  loss  of  muscular  power.  When  the 
gas  is  in  a  fatal  proportion,  the  symptoms  commonly  observed  are  as 
follows :  A  sensation  of  great  weight  in  the  head  and  of  pressure  in 
the  temples,  singing  in  the  ears,  a  pungent  sensation  in  the  nose,  a  strong 
tendency  to  sleep,  accompanied  by  giddiness,  and  so  great  a  loss  of  mus- 
cular power  that,  if  the  person  be  at  the  time  in  an  erect  po.sture,  he  in- 
stantly falls  to  the  ground  as  if  struck.  The  breathing,  which  is  observed 
to  be  at  first  difficult  and  stertorous  (snoring),  becomes  suspended.  The 
action  of  the  heart,  which  on  the  first  accession  of  the  symptoms  is  very 
violent,  soon  ceases;  sensibility  is  lost,  and  the  person  now  falls  into  a 
profound  coma  or  state  of  apparent  death.  The  warmth  of  the  body  still 
continues;  the  limbs  are  relaxed  and  flexible,  but  they  have  been  observed 
in  some  instances  to  become  rigid,  or  even  occasionally  convulsed.  The 
countenance  is  livid  or  of  a  leaden  color,  especially  about  the  eyelids  and 
lips,  but  on  some  occasions  it  has  been  pale  and  placid.  The  access  of 
these  symptoms  is  stated  to  have  been  sometimes  accompanied  by  a 
pleasing  sensation  of  delirium,  while  at  others  the  most  acute  pains  have 
been  suffered.  In  some  instances  there  appears  to  have  been  irritability 
of  the  stomach,  for  the  affected  person  has  vomited  the  contents  of  his 
stomach  in  a  semi-digested  state.  Those  who  have  been  resuscitated 
have  felt  pain  in  the  head,  or  pain  and  soreness  over  the  body  for  several 
days;  while,  in  a  few  severe  cases,  paralysis  of  the  muscles  of  the  face 
has  supervened  on  recovery. 

An  old  woman  occupied  a  room  under  one  in  which  there  was  a  quan- 
tity of  nitric  acid  kept  in  store.  Owing  to  some  accident,  a  carboy  was 
broken  ;  the  acid  ran  through  the  ceiling  into  the  room  below,  acting 
upon  and  corroding  the  bed-coverings  of  the  deceased's  bed.  As  the  room 
was  quite  (illed  with  the  nitric  acid  fumes,  a  chemist  was  consulted,  and 
he  advised  that  whitinir  should  be  freely  used  for  the  purpose  of  neutral- 
izing the  acid.  This  advice  was  followed,  and  several  persons,  who  were 
in  the  room  witnessing  the  operation  felt  oppressed  and  were  obliged  to 
leave  it;  thev  were  observed  to  stagger,  as  if  intoxicated,  on  reaching  the 
street.  The  room  was  then  completely  closed,  and  the  whiting  allowed 
to  remain  in  contact  with  the  acid.  The  deceased  had  suffered  from  diar- 
rhoea for  a  few  days  previously,  and  was  obliged  to  resort  to  a  night- 
chair,  which  was  in  the  room  in  which  the  accident  had  occurred.  As  she 
remained  absent  half  an  hour,  some  persons  entered  the  apartment  and 
found  her  in  a  chair  unable  to  move.  She  was  taken  into  another  room, 
and  on  a  medical  man  being  called  to  her  he  found  her  sleepy  and  coma- 
tose and  her  mind  confu.sed;  there  was  great  difficulty  of  breathing, 
extreme  lividity  of  the  face  and  lips  ;  the  arms  and  legs  were  cold,  and  the 
pulse  was  full.  In  spite  of  efforts  made  to  save  her,  she  died  in  about  an 
hour  from  the  time  at  which  she  had  entered  the  room.     Those  who  found 


POST-MORTEM    APPEARANCES ANALYSIS,  443 

her  in  the  apartment  do  not  a])pear  to  have  suffered.  This  was  a  case  of 
slow  poisonin,^-  by  carbonic  acid,  for  no  carbonic  oxide  could  have  been 
evolved  from  the  action  of  the  acid  on  chalk.  Ag-e  and  debility  from  pre- 
vious illness  may  account  for  the  unusual  circumstance  that  the  deceased 
did  not  recover  on  being  removed  into  a  pure  atmosphere. 

Post-morlem  Appearances. — In  some  instances  the  face  has  been  found 
livid  and  swollen,  and  the  features  distorted  ;  but  more  generally  it  has 
been  pale  and  placid,  as  if  the  person  had  died  without  a  struggle  in  the 
position  in  which  his  body  was  found.  The  skin  is  sometimes  livid,  or 
presents  patches  of  lividity,  and  the  limbs  are  quite  flaccid.  The  pupils 
have  been  found  dilated.  Internally  the  veins  are  filled  with  liquid  blood 
of  a  dark  color.  In  death  from  carbonic  acid  as  a  result  of  combustion, 
the  blood  has  sometimes  had  a  light-red  color  (?  from  carbonic  oxide — 
Ed.).  The  vessels  of  the  lungs  and  brain  are  observed  to  be  especially  in 
a  state  of  congestion.  The  tongue  appears  swollen,  and  sometimes  the 
mucous  membrane  of  the  intestinal  canal  presents  dark  ecchymosed 
patches.  The  following  appearances  were  met  with  thirty  hours  after 
death  in  the  bodies  of  two  adults,  male  and  female,  who  died  from  the 
accidental  introduction  of  carbonic  acid  into  their  bedroom  from  burning 
ashes.  Externally  there  was  nothing  unnatural,  excepting  a  few  slight 
discolorations  on  the  back  of  the  man  ;  internally  there  was  congestion  of 
the  membranes  and  great  vessels  of  the  brain.  Each  lateral  ventricle 
contained  about  half  an  ounce  of  clear  serum  ;  the  lungs  were  gorged  with 
dark  blood,  and  the  lining  membrane  of  the  air-tubes  (bronchi)  was 
slightly  reddened.  The  left  side  of  each  heart  was  nearly  empty ;  the 
right  contained  a  quantity  of  dark  half-coagulated  blood.  The  stomachs 
were  healthy.  The  bodies  were  found  on  the  floor  of  the  bedroom  in 
easy  positions.  The  deceased  persons  had  had  the  power  to  get  out  of 
bed,  but  were  unable  to  escape  from  the  chamber.  It  will  be  perceived 
from  this  description  that  there  is  nothing  very  characteristic  in  the  ap- 
pearances, and  thus  it  is  always  easy  to  ascribe  death  to  apoplexy  or  some 
other  cause ;  but  it  should  be  remembered  that  carbonic  acid  itself  is  a 
narcotic  poison,  inducing  cerebral  congestion  and  apoplexy. 

Anali/His. — Sometimes  a  medical  jurist  may  be  required  to  state  the 
nature  of  the  gaseous  mixture  in  which  a  person  may  have  died.  There 
will  be  no  difficulty  in  determining  whether  carbonic  acid  is  or  is  not  the 
deleterious  agent  in  such  a  mixture.  When  it  exists  in  a  confined  atmos- 
phere, its  presence  may  be  identified,  if  previously  collected  in  a  proper 
vessel,  by  the  following  characters:  1.  It  extinguishes  a  taper  if  the  pro- 
portion be  above  12  or  15  per  cent.  2.  Lime-water  or  baryta-water  is 
instantly  precipitated  white  when  poured  into  a  jar  of  the  gas ;  and  the 
precipitate  thus  formed  may  be  collected  by  filtration,  and  proved  to  pos- 
sess the  well-known  properties  of  carbonate  of  calcium  or  barium.  Air 
containing  only  one  per  cent,  of  carbonic  acid  affects  lime-water;  if  it 
amounts  to  two  per  cent.,  a  few  cubic  inches  will  suffice  to  show  its 
presence  by  the  lime-water  test.  The  proportion  in  which  carbonic  acid 
exists  in  a  mixture  may  be  determined  by  introducing  into  a  measured 
quantity,  in  a  graduated  tube  over  mercury,  a  strong  solution  of  potash. 
AI)sorption  will  take  place  after  a  certain  time,  and  the  degree  of  absorp- 
tion will  indicate  the  proportion  of  carbonic  acid  present.  Carbonic  acid 
in  a  well  may  be  collected  for  the  purpose  of  testing,  by  lowering  a  bottle 
filled  with  fine  sand,  by  means  of  a  string  attached  to  the  neck,  and 
guiding  the  bottle  by  another  string  attached  to  its  base.  When  the  bottle 
is  within  the  stratum,  it  should  be  turned  with  its  mouth  downwards;  and 
when  the  sand  has  fallen  out  the  bottle  may  be  rapidly  raised,  with  its 


444  DIFFUSION    OF    CARBONIC    ACID, 

mouth  upwards,  by  piillin^:^-  the  string  att-ached  to  the  neck.  It  should  be 
immediately  stopped  and  the  contents  examined. 

Combustion  in  Mixtures  containing  Carbonic  Acid. — In  reference  to 
suiTocation  by  carbonic  acid,  there  is  one  circumstance  which  requires 
attention.  It  is  a  matter  of  popular  belief — and,  in  fact,  it  is  asserted  by 
some  writers  on  asphyxia — that  the  burning  of  a  candle  in  a  suspected 
mixture  of  carbonic  acid  and  air  is  a  satisfactory  proof  that  it  may  be 
breathed  with  safety.  The  results  of  some  experiments  on  this  subject  led 
the  author  to  the  conclusion  that  a  candle  will  burn  in  air  which  is  com- 
bined with  even  10  or  12  per  cent,  of  its  volume  of  carbonic  acid  gas; 
and  although  such  mixtures  might  not  prove  immediately  fatal  to  man, 
yet  they  would  soon  give  rise  to  giddiness,  insensibility,  and  ultimately 
death,  in  those  who,  after  having  been  once  immersed  in  them,  did  not 
hasten  to  quit  the  spot.  In  air  containing  a  smaller  proportion  than  this 
(5  or  6  per  cent.),  a  candle  will  readily  burn,  but  it  is  probable  that  such 
a  mixture  could  not  be  long  respired  without  causing  serious  symptoms ; 
hence  the  burning  of  a  candle  can  be  vo  criterion  of  safety  against  the 
effect  of  carbonic  acid.  It  is  true  that  it  would  not  be  safe  to  venture  into 
a  gaseous  mixture  in  which  a  candle  is  extinguished ;  but  the  converse  of 
this  proposition  is  not  true — nameh^,  that  a  mixture  in  which  a  candle 
burns  may  be  always  breathed  with  safety.  It  has  been  observed  on  several 
occasions  that  the  combustion  of  charcoal  has  been  maintained  in  a  room 
in  which  persons  have  been  found  in  a  state  of  insensibility  from  breathing 
the  vapors. 

Diffusion  of  Carbonic  Acid. — Some  important  medico-legal  questions 
have  arisen  relatire  to  the  diffusion  of  this  gas  in  air,  when  produced  by 
combustion.  It  was  formerl}^  supposed  that,  owing  to  its  great  density 
(1.53),  it  would  collect  on  the  floor  of  an  apartment,  would  gradually  rise 
upwards  and  suffocate  persons  at  different  times,  according  to  the  level 
on  which  they  might  happen  to  be  placed.  Questions  on  this  subject  have 
been  variously  answered,  and  a  great  difference  of  opinion  has  arisen 
among  witnesses.  There  are  two  important  points  on  which  a  correct 
answer  to  this  inquiry  must  be  based  :  First,  the  law  of  the  diffusion  of 
gases ;  and  second,  the  effect  of  heat  in  greatly  diminishing  the  specific 
gravity  of  a  gas  naturally  heavier  than  air.  There  is  no  doubt  that,  in  a 
narrow  or  confined  vessel  exposed  to  air,  carbonic  acid  is  slow  in  escaping  ; 
nevertheless,  it  mixes  with  air  and  passes  off  rapidly  in  proportion  to  the 
surface  exposed.  In  the  course  of  an  hour  or  two,  in  spite  of  its  great 
specific  gravity,  none  will  be  contained  within  the  vessel.  The  well- 
known  Grotta  del  Cane  at  Pozzuoli,  near  Naples,  has  been  referred  to  by 
those  who  hold  that  carbonic  acid  always  tends  to  remain  on  the  lowest 
level ;  but  it  has  been  forgotten  that,  in  this  and  similar  excavations,  car- 
bonic acid  is  continually  issuing  from  crevices  in  the  soil,  so  that  that  which 
is  lost  by  diffusion  is  continually  replaced:  hence  the  illustration  proves 
nothing.  It  may  suffice  to  state  that  air  and  carbonic  acid  mix  readily  on 
contact  in  all  proportions,  although  they  enter  into  no  chemical  union. 
Thus  then,  at  common  temperature,  carbonic  acid  has  no  tendency  to 
remain  on  the  floor  or  soil,  when  there  is  a  free  access  of  air  or  contact 
with  other  gases.  The  combustion  diminishes  the  specific  gravity  of  the 
gas,  and  the  carbonic  acid  therefore  ascends  with  the  heated  current  of  air, 
and  diffuses  itself  in  the  upper  part  of  an  apartment  when  there  are  no 
means  of  carrvin"'  it  ofl'. 


CARBONIC    OXIDE.  445 


Carbonic  Oxide. 


The  noxious  effects  of  the  vapor  of  burning  charcoal  are  considered  to 
be  partly  due  to  the  presence  of  carbonic  oxide,  which  appears  to  be  chiefly- 
extricated  under  a  low  or  smouldering  combustion  of  any  kind  of  woody 
fibre.  It  is  fatal  to  man  and  all  animals.  The  action  of  this  gas  upon 
animal  life  has  been  made  a  subject  of  experiment  by  Bernard.  (Les 
Sub.  Tbxiques,  ]>.  164.)  An  atmosphere  containing  from  5  to  6  (even 
1-lOth  per  cent. — Ed.)  per  cent,  of  it  will  destroy  life.  The  blood  and 
muscles  are  brightened  in  color  by  this  gas,  while  they  are  darkened  by 
carbonic  acid.  Bernard  has  observed  that  this  bright  color  has  been  re- 
tained for  three  weeks  (the  editor  has  observed  it  after  seventeen  months) ; 
and  he  considers  the  mode  of  action  of  this  gaseous  poison  such  that  it 
prevents  the  arterial  blood  of  the  body  from  becoming  venous,  while  car- 
bonic acid  operates  by  preventing  the  venous  blood  from  becoming  arterial. 
(Op.  eit.  pp.  182,  195.)  Carbonic  oxide  kills  by  combining  with  the  red 
IMgnient  of  the  blood,  and  rendering  it  insusceptible  of  taking  up  oxygen 
and  exchanging  this  in  the  tissues  for  effete  carbonic  acid. 

This  condition  of  the  blood,  as  the  result  of  the  action  of  carbonic  oxide, 
may  occasion  some  doubt  of  the  cause  of  death  in  cases  of  suffocation  by 
fire.  In  1858,  an  inquiry  took  place  into  the  cause  of  death  of  fourteen 
persons,  owing  to  a  fire  in  a  house  at  Bloomsbury.  The  medical  witness, 
on  examining  the  bodies,  found  a  redness  of  the  muscles  and  a  redness  of 
the  blood.  He  therefore  thought  that  death  was  not  caused  by  suffocation 
but  from  the  inhalation  of  arsenical  vapors,  owing  to  some  minerals  con- 
taining arsenic  having  been  partially  consumed  during  the  fire.  But  there 
was  a  total  want  of  evidence  to  show  that  the  vaj)ors  of  arsenic,  when 
breathed,  Avould  cause  death  so  speedily  as  the  noxious  gases  evolved  by 
fire,  or  that  they  would  redden  the  blood  and  muscles.  On  the  other  hand, 
the  respiration  of  carbonic  oxide  would  explain  these  facts.  It  is  worthy 
of  remark  that,  in  many  of  the  observed  cases  of  death  from  charcoal- 
vapor,  the  blood  has  had  a  darker  color  than  natural ;  the  greater  solubility 
of  carbonic  acid  and  the  larger  proportion  in  which  it  is  produced  may 
account  for  this  effect. 

The  action  of  corbonic  oxide  on  the  body  is  that  of  a  narcotic  poison. 
Tourdes  has  ascertained  that  rabbits  died  in  twenty-three,  minutes  when 
kept  in  an  atmosiihere  containing  1-I5th  of  its  volume  of  pure  carbonic 
oxide;  when  the  proportion  was  l-30th  they  died  in  thirty-seven  minutes, 
and  when  1-Sth  in  seven  minutes.  Letheby  states  that  in  his  experiments 
a  mixture  of  one-half  per  cent,  killed  small  birds  in  three  minutes,  and  of 
1^  per  cent,  in  about  half  this  time.  The  animals  showed  no  signs  of 
pain  :  they  fell  in  a  state  of  insensibility,  and  either  died  at  once  without 
convulsions  or  they  graduall}^  passed  into  a  state  of  profound  coma.  He 
found,  on  inspection,  that  the  blood  was  redder  than  usual,  that  the 
muscles  of  the  heart  were  somewhat  gorged,  and  that  the  brain  was 
congested.  (Lancet,  1862,  i.  p.  219.)  Hoppe-Seyler  states  that  animals 
which  had  been  made  to  breathe  carbonic  oxide  were  restored  by  artificial 
respiration  continued  for  some  time,  and  under  these  circumstances  the 
gas  was  expired  as  carbonic  acid,  having  undergone  further  oxidation 
in  the  blood.  It  may  be  detected  in  the  blood  by  the  spectroscope.  Ac- 
cording to  some  observations,  carbonic  oxide  is  eliminated  from  the  lungs 
as  such  without  being  converted  into  carbonic  acid.  (Lancet,  1873,  i.  p. 
141.) 

It  is  a  remarkable  fact  that  with  the  bright-red  color  of  the  blood  seen 
in  this  form  of  poisoning,  two  absorption-bands  similar  to  those  of  oxy- 


446         CHARCOAL-VAPOR.       SYMPTOMS    AND    APPEARANCES. 

hsemoglobin  appear,  and  nearly  in  the  same  situation.  They  are,  how- 
ever, more  reirangible  than  these,  and  are  more  in  the  greenish-yellow 
rays.  A  reducing-  agent  (sulphide  of  ammonium)  does  not  afl'ect  these 
bands  as  it  does  those  of  oxidized  blood.  Hence,  if  the  person  breathes 
for  only  a  short  time,  the  carbonic  oxide  is  expelled.  In  poisoning  by 
coal-gas,  carbonic  oxide  appears  to  be  sometimes  the  cause  of  death.  It 
is  always  a  constituent  of  this  gas,  but  in  variable  proportions  (see  p.  453). 

C  HARCO  AL-V  APOR. 

The  vapor  given  off  during  the  combustion  of  charcoal  is  not  pure  car- 
bonic acid,  but  a  mixture  of  gases.  It  operates  fatally  when  breathed, 
partly  in  consequence  of  the  carbonic  acid  contained  in  it,  and  partl^y  from 
the  presence  of  a  variable  proportion  of  carbonic  oxide.  The  proportions 
of  these  gases,  however,  are  subject  to  variation,  according  to  whether  the 
combustion  is  vivid  or  not.  When  the  charcoal  was  burning  vividly,  the 
quantity  of  carbonic  acid  was  found  by  Orfila  to  be  less  than  when  it  was 
either  nearly  extinguished  or  beginning  to  burn.  In  the  former  case  the 
carbonic  acid  was  in  the  i>roportion  of  about  11  per  cent,  by  volume,  in 
the  latter  the  proportion  amounted  to  about  14  per  cent.  Leblanc  found 
that  charcoal  burning  in  the  open  air  produced  about  one-half  per  cent,  of 
carbonic  oxide.  There  is  no  doubt  that  a  low  or  imperfect  combustion  is 
more  favorable  to  the  production  of  this  gas,  and  it  is  considered  to  oper- 
ate more  powerfully  on  the  body  than  carbonic  acid.  According  to  Le- 
blanc, a  bird  was  killed  instantly  by  breathing  air  containing  4  or  5  per 
cent,  of  carbonic  oxide  ;  1  per  cent,  only  sufficed  to  cause  death  in  two 
minutes.  Charcoal-vapor  may  be  regarded  as  a  mixture  of  carbonic  acid, 
carbonic  oxide,  aqueous  vapor,  and  air  partially  deoxidized.  The  fatal 
effects  produced  by  the  vapor  are  owing  to  the  action  of  carbonic  acid  and 
carbonic  oxide,  and,  according  to  Bernard,  a  mixture  of  the  two  is  more 
destructive  than  either  gas  separately.  (Les  Sub.  Toxiques,  p.  212.) 
Leblanc  endeavored  to  determine  the  proportion  of  the  gases  in  charcoal- 
vapor  when  this  was  in  such  a  condition  as  to  prove  fatal  to  animal  life. 
The  vapor  was  conducted  from  some  fully  ignited  fuel  into  an  enclosed 
space  in  which  there  was  a  middle-sized  dog,  Avhose  condition  could  be 
watched.  In  ten  minutes  the  animal  fell  exhausted,  and  in  twenty  min- 
utes it  died,  after  some  hard  breathing.  A  candle  burnt  with  its  usual 
brightness  in  the  closed  room,  and  it  was  only  ten  minutes  after  the  death 
of  the  dog  that  the  flame  of  the  candle,  after  becoming  paler  and  paler, 
was  extinguished.  The  air  of  the  chamber  was  at  this  time  collected  and 
analyzed.  It  contained,  in  100  parts — carbonic  acid,  4.61  ;  carbonic  oxide, 
0.54;  carburetted  hydrogen,  0.04;  oxygen,  19.19;  and  nitrogen,  15.62. 
It  would  thus  appear  that  less  than  5  per  cent,  of  carbonic  acid  is  fatal  to 
life  when  so  little  as  one-half  per  cent,  of  carbonic  oxide  is  mixed  with  it. 
(Bernard,  op.  cit.,  p.  159.)  The  burning  of  a  candle  under  the  circum- 
stances will  also  show  that  oxy-combustion  may  be  maintained  in  a  mix- 
ture by  Avhich  an  animal  is  killed,  and  therefore  that  combustion  can  fur- 
nish no  criterion  of  safety  in  apartments  in  which  charcoal  has  been  burnt. 
Biefel  and  Poleck  have  shown  that  charcoal  fumes  contain  on  an  average 
carbonic  acid  and  carbonic  oxide  in  the  relative  proportions  of  twenty  to 
one  ;  and  that  carbonic  oxide  is  the  chief  poisonous  agent.  (Zeitschr.  fiir 
Biologic,  Bd.  xvi.  p.  279.) 

Si/mpfoma  and  Appearances  after  Death. — The  following  case,  illus- 
trating the  effects  of  charcoal-vapor,  occurred  to  Collambell.  (Lond.  Med. 
Gaz.,  Vol.  xxvii.  p.  693.)     A  man  was  engaged  to  clean  the  windows   of 


FATAL    CASES.  447 

three  small  rooms  on  the  basement-floor  of  a  house.  The  first  room  had 
a  door  opening  into  a  courtyard;  the  others  merely  communicated  with 
each  othei"  by  a  central  door,  and  there  was  no  fireplace  in  any  one  of 
them.  A  brazier  of  burning  charcoal  had  been  placed  in  the  outer  room 
for  the  purpose  of  drying  it,  but  it  appeared  that  the  deceased  had  shut 
the  outer  door,  and  had  removed  the  brazier  into  the  inner  room  of  the. 
three,  leaving  the  communicating  doors  open.  In  two  hours  the  man  was 
found  quite  dead,  lying  on  the  floor  of  the  middle  room.  The  countenance 
was  pale,  as  well  as  the  whole  of  the  skin;  the  eyes  were  bright  and 
staring,  the  pupils  widely  dilated,  the  lips  bloodless,  the  jaws  firmly  fixed, 
the  tongue  protruding;  and  the  face  and  the  limbs  were  cold.  Some 
frothy  mucus  had  escaped  from  the  mouth.  The  person  who  discovered 
the  deceased  found  the  ashes  in  the  brazier  still  burning,  and  he  ex- 
perienced great  oppression  in  breathing.  An  inquest  was  held,  but  with- 
out an  inspection  of  the  body,  and  a  verdict  of  "accidental  death"  re- 
turned. The  body  was  afterwards  privately  inspected  by  Collambell.  On 
opening  the  head  the  vessels  on  the  surface  of  the  brain  were  found  much 
distended  with  dark  liquid  blood  ;  the  pia  mater  was  bedewed  with  serum. 
The  brain  was  of  unusually  firm  consistenc}^,  and  numerous  bloody  points 
appeared  on  making  a  section  of  it.  The  lateral  ventricles  were  distended 
with  about  an  ounce  and  a  half  of  pale  serum,  and  the  vessels  of  the 
choroid  plexus  were  much  congested.  The  cerebellum  was  firm,  and  pre- 
sented on  section  numerous  bloodv  points.  About  two  ounces  of  serum, 
tinged  with  blood,  were  collected  from  the  base  of  the  skull.  The  lungs 
had  a  slate  color.  On  the  left  side  of  the  chest  there  were  eight  ounces  of 
serum  tinged  with  blood,  and  nearly  an  equal  quantity  on  the  right  side. 
On  cutting  into  the  organs,  a  large  quantity  of  serous  fluid,  mixed  with 
blood,  escaped.  The  bronchial  tubes  were  filled  with  a  frothy  fluid  tinged 
with  blood.  The  pericardium  contained  an  ounce  of  pale  serum  ;  the  heart 
was  enlarged — its  cavities  contained  no  blood  ;  the  liver  and  kidneys  were, 
however,  much  gorged.  There  was  no  doubt  that  the  cause  of  death  was 
the  inhalation  of  charcoal-vapor  ;  and  it  is  probable  that  the  man  died  from 
respiring  but  a  comparatively  small  proportion.  The  capacity  of  the 
chambers  must  have  reached  nearly  two  thousand  cubic  feet ;  the  deceased 
had  been  there  only  two  hours,  and  when  the  person  who  discovered  him 
entered  the  rooms  the  air  was  not  so  vitiated  but  that  he  could  breathe, 
although  with  some  oppression.  The  fuel  was  then  in  a  state  of  com- 
bustion. 

In  a  case  of  death  from  charcoal-vapor  that  was  referred  to  the  author 
for  examination  in  1851  there  was  a  considerable  effusion  of  blood  in  the 
submucous  tissue  of  the  stomach.  This  appearance  led  to  a  strong  sus- 
picion of  irritant  poisoning.  A  full  investigation  of  the  circumstances, 
however,  showed  that  the  suspicion  was  unfounded.  The  vapor  had  de- 
scended through  a  flue  communicating  with  the  bedroom  in  which  the 
deceased  slept  with  her  husband  ;  it  destroyed  the  wife,  and  nearly  killed 
the  husband.  A  stove  with  burning  charcoal  had  been  placed  in  the  room 
above  that  in  which  the  couple  slept,  and  an  iron  pipe  conveyed  the  prod- 
ucts of  combustion  into  a  flue,  whence  they  had  descended  into  the  bedroom 
and  caused  the  fatal  accident.  It  is  sometimes  difficult  to  account  for  the 
mode  by  which  these  gaseous  matters  find  their  way  into  an  apartment. 
In  the  above-mentioned  case  we  had  great  difficulty  in  procuring  correct 
information.  Th^re  was  no  fire  in  the  bedroom,  nor  any  source  of  com- 
bustion, and  this  at  first  strengthened  the  suspicion  that  the  husband  must 
have  poisoned  the  wife  at  their  supper  on  the  previous  night.  Devergie 
relates  a  somewhat  similar  case,  in  which  the  wife  was  found  dead  in  bed, 


448  VAPOR    FROM    BURNING    WOOD. 

while  the  husband,  lying  by  her  side,  was  in  a  state  of  unconsciousness, 
from  which  he  did  not  recover  until  the  next  day.  In  this  case  there  was 
neither  stove  nor  fire,  nor  any  source  of  combustion  in  the  room.  The 
noxious  gases  must  have  leaked  into  the  room  through  fissures  in  a  chim- 
ney adjoining  it.  (Ann.  d'Hyg.,  1871,  t.  2,  p.  441.)  A  mother  and 
daughter  went  to  bed.  In  the  morning  the  daughter  was  found  on  her 
face,  dead — the  face  livid,  and  there  had  been  copious  bleeding  from  the 
nose.  The  mother  was  insensible,  and  recovered  only  after  many  hours 
under  ti'eatment.  The  cause  of  the  accident  was  traced  to  an  imperfect 
joint  in  a  furnace-flue,  which  passed  through  the  bedroom  to  a  chimney. 
This  adjoined  their  bed,  and  the  leakage  took  place  directly  upon  them. 
The  door  was  shut,  and  the  smell,  perceived  at  first  was  supposed  to  come 
in  from  the  outside.  (Lond.  Med.  Gaz.,  vol.  xlvii.  p.  412.)  In  the  case 
of  a  youth,  set.  17,  Gudrard  found  the  mouth  and  nostrils  filled  with  froth. 
The  "liver  and  spleen  were  gorged  with  dark  liquid  blood;  the  heart  was 
collapsed  and  its  cavities  were  empty,  but  liquid  and  dark-colored  blood 
flowed  from  the  large  vessels.  The  windpipe  and  bronchi  had  a  red  color, 
and  were  filled  with  frothy  mucus.  The  membranes  of  the  brain  were 
congested,  and  the  sinuses  gorged  with  fluid  blood.  The  face  was  pale, 
the  evelids  M-ere  closed,  and  the  pupils  natural.  There  were  livid  patches 
over  the  body.     (Ann.  d'Hyg.,  1843,  t.  2.  p.  57.) 

It  often  excites  surprise  on  these  occasions  that  no  exertion  has  been 
made  to  escape,  when  it  would  apparently  require  but  slight  efforts  on  the 
part  of  the  person  affected.  The  action  of  this  vapor  is  very  insidious  : 
one  of  its  first  effects  is  to  create  an  utter  prostration  of  strength,  so  that 
even  on  a  person  awake  and  active  the  gas  may  .«peedily  produce  a  perfect 
inability  to  move  or  to  call  for  assistance.  (For  a  case  illustrative  of  the 
dangerous  effects  of  the  diluted  vapor  see  Edin.  Med.  and  Surg.  Jour., 
vol.  i.  p.  541.)  In  this  instance  a  charcoal-brazier  was  left,  only  for  a 
short  time,  in  the  cell  of  a  prison.  It  was  removed,  and  the  prisoners 
went  to  sleep.  They  experienced  no  particular  effects  at  first,  but  after 
some  hours  two  were  I'ound  dead.  Thus,  then,  an  atmosphere  which  can 
be  breathed  for  a  short  time  with  impunity  may  ultimately  destroy  life. 
Leudet  has  shown  that  in  some  persons  the  first  effect  of  the  inhalation  of 
charcoal  fumes  is  to  induce  a  state  of  unconsciousness.  (Jour,  de  Med., 
Oct.  1883,  p.  472.) 

Devergie  first  showed  that  the  smothered  combustion  of  wood  may  lead 
to  the  evolution  of  carbonic  oxide  and  give  rise  to  dangerous  conse- 
quences. (Ann.  d'Hyg.,  1835,  t.  1,  p.  442.)  His  remarks  have  been  con- 
firmed by  two  cases  published  by  Bayard  and  Tardieu.  A  man  and  his 
wife  were  found  dead  in  bed.  There  was  a  smoky  vapor  in  the  apart- 
ment, but  no  fire  had  been  lighted  in  the  grate,  and  the  chimney  was 
blocked  up.  The  planks  of  the  floor  were  widely  separated,  and  there 
was  a  large  hole  in  the  boards  at  the  foot  of  the  bed  communicating  with 
the  apartment  below.  It  was  found,  on  examination,  that  some  joists, 
connected  with  the  flue  of  an  iron  plate  which  had  been  heated  for  making 
confectionery  the  previous  day  were  in  a  smouldering  state;  that  the 
vapor  had  entered  the  bedroom  of  the  deceased  through  the  crevices  in  the 
floor,  and,  not  finding  a  vent  by  the  chimney,  had  led  to  these  fatal  results. 
It  is  remarkable  that  the  source  of  combustion  was  nearly  nine  yards  dis- 
tant, and  one  person  who  slept  nearer  to  the  flue  of  the  iron  plate  entirely 
escaped.  In  the  body  of  the  husband  the  skin  was  of  a  reddish  tint,  the 
blood  liquid,  the  cavities  of  the  heart  empty,  the  lungs  gorged,  and  there 
was  no  subpleural  ecchyraosis.  In  the  body  of  the  wife  there  was  less 
redness  of  the  skin,  the  blood  was  coagulated  in  the  cavities  of  the  heart, 


VAPOR    FROM    BURNING    WOOD.  449 

principally  on  the  right  side  extending  to  the  vessels ;  less  engorgement 
of  the  lungs,  and  a  great  number  of  subpleural  ecchymoses,  indicating 
that  strong  efforts  had  been  made  to  respire.  There  was  at  first  a  rumor 
of  poisoning,  which  was  only  removed  by  a  close  examination  of  the 
.locality.     (Ann.  d'Hyg.,  1845,  t.  1,  p.  369.) 

Schauenburg  has  published  the  cases  of  two  children  who  were  de- 
stroyed in  an  hour  by  the  vapor  of  burning  wood.  The  mother  had  acci- 
dentally shut  them  up  in  a  room,  into  which  the  vapor  leaked  from  the 
wood  employed  to  heat  an  oven.  In  each  case  the  brain  and  its  mem- 
branes were  found  highly  congested,  while  the  lungs  were  collapsed,  and 
contained  no  more  blood  than  is  usually  found  in  them.  (Vierteljahrsschr. 
fiir  Gerichtl.  Med.,  1872,  1,  p.  40.)  It  may  be  observed,  in  reference  to 
this  vapor,  that  when  produced  from  burning  charcoal  or  wood — in  spite 
of  the  great  density  of  carbonic  acid,  the  noxious  gas  is  diffused  rapidly- 
throughout  the  whole  of  an  apartment.  This  is  owing  partly  to  the  effect 
of  the  heated  current  of  air,  and  partly  to  the  diffusion  of  gases,  whereby 
heavy  and  light  gases  are  soon  uniformly  intermixed. 

Bugnion  and  De  la  Harpe  relate  the  following  case,  in  which  the  effects 
were  referable  to  carbonic  oxide.     The  latter  was  called  at  one  P.M.  to  see 
a  child  which  had  just  died.     On  his  arrival  he  found  the  dead  body  of  a 
healthy-looking  boy,  aged  five  years,  lying  with  dilated  pupils  on  a  bed  in 
the  natural  attitude  of  sleep.     The  body  was  still  warm  ;  rigor  mortis  had 
invaded  the  arms  ;  and  there  was  some  opacity  of  the  cornea.     On  the  under 
surface  of  the  limbs,  and  on  that  side  of  the  face  on  which  the  head  rested 
there  were  patches  of  cadaveric  lividity.     The  mother  did  not  know  when 
death  had  taken  place,  having  supposed  the  child  to  be  asleep  when  she  went 
to  her  work  in  the  morning.     By  the  side  of  the  dead  body  of  the  child  lay 
the  father,  who  was   unable  to  answer  questions  distinctly,  laughed  at 
whatever  was  said  to  him,  and  could  give  no  information  as  to  the  death 
of  his  son.     His  face  was  suffused  ;  there  w^as  foam  on  his  lips  ;  his  breath- 
ing was  very  difficult ;  and  his  pulse  was  full  and  rapid.     On  another  bed 
in  the  same  room  lay  a  boy  of  ten,  pale,  motionless,  with  cold  clammy  skin, 
thready  pulse,  and,  in  short,  in  a  state  of  collapse.     He  recovered,  and 
was  out  of  danger  in  the  evening.     The  mother,  who  slept  in  the  same 
room,  had,  at  first,   felt   scarcely  any  ill   effects.      In  the  course  of  the 
morning  she  felt  unwell  and  returned  home  from  her  work.     The  illness 
and  the  death  were  traced  to  the  use  of  a  charcoal-stove  in  the  room 
Avhere  all  slept.     The  condition  of  the  father  agrees  with  a  case  referred 
to  by  Casper,  in  which  temporary  mania  was  induced  by  charcoal-vapors; 
and  with  a  case  to  be  presently  reported.     In  the  case  of  the  boy,  Bu"-nion 
and  De  la  Harpe  found  the  following  appearances  forty-eight  hours  after 
death.     The  tip  of  the  tongue  lay  beneath  the  teeth  ;  the  inner  surface  of 
the  lips  was  bright  red  and  parchmented  ;  the  rosy  color  of  the  lungs  was 
very  noticeable,  and  these  organs  were  gorged  with  blood,  forming  a  striking 
contrast  to  the  pale  anaemic  intestines.     Only  two  small  subpleural  ecch  va- 
moses were  found.     The  surface  of  the  lung  was  uneven  and  bosselated 
the  depressed  portions  being  of  a  deep  violet  hue,  and  containing  a  smaller 
quantity  of  air  than  the  raised  portions,  which  were  rosy-red  and  emphy- 
sematous.    On  section,  the  tissue  of  the  lung  was  found  decidedly  hyper- 
semic  and  of  a  scarlet  color.     The  whole  of  the  mucous  membrane  from 
the  epiglottis  to  the  small  bronchi  was  of  a  uniform  vermilion  tint.     On 
pressure,  thick    mucus,  untinted  with  blood,  exuded   from  the  bronchi. 
The  heart  was  pale  and  soft.     The  blood  throughout  the  body  was  fluid 
and  of  a  brighter  color  than  usual.     No  petechias  were  found  in  the  oro-ans 
except  the  left  kidney.     The   brain  was  deeply  congested.     The  autopsy 
29 


450  COAL    AND    COKE    VAPORS. 

is  thus  summarized:  intense  general  bronchitis;  pulmonary  congestion, 
with  partial  atelectasis  ;  hyperemia  of  the  upper  portion  of  the  body,  with 
anaemia  of  the  abdominal  viscera;  fluidity  and  universal  bright  color  of 
the  blood.     (Med.  Chron.,  vol.  ii.  p.  84.) 

Vapor  of  Gunpowder. — The  vapor  of  exploded  gunpowder  is  chiefly  a 
mixture  of  nitrogen  with  carbonic  acid,  C3^anogen  compounds,  and  the 
vapor  of  sulphide  of  potassium.  When  fired  in  a  close  place  where  there 
is  no  ventilation,  gunpowder  expels  the  air  containing  oxygen  and  sub- 
stitutes for  it  a  mixture  of  gases  not  fitted  to  support  life.  The  effect  of 
such  a  mixture  when  breathed  may  be  gathered  from  the  following  cases, 
communicated  in  1813  by  Smith,  of  Shepton  Mallet.  A  bo}'-,  get.  14,  went 
down  a  well  immediately  after  a  considerable  charge  of  powder  had  been 
exploded  in  it.  He  dropped  suddenly  to  the  bottom  of  the  well,  and  a 
man  who  followed  him  also  dropped  apparently  lifeless.  They  were  both 
drawn  up  as  soon  as  possible.  The  man  appeared  stupefied,  but  speedily 
recovered.  The  boy  was  quite  unconscious,  was  blue  about  the  lips, 
almost  pulseless,  had  epileptic  convulsions  and  appeared  to  be  dying.  He 
vomited  much  biliary  and  mucous  fluid  and  became  worse  after  removal 
from  the  open  air  to  the  hospital  ward.  His  breathing  was  loud,  but  ait 
entered  the  lungs  freely.  The  pupils  were  natural.  Artificial  respiration 
was  used  and  warm- water  baths  were  applied  to  the  feet,  but  he  did  not 
recover  until  after  thirty-six  hours. 

Coal  and  Coke  Vapors.     Sulphurous  Acid. 

Products  from  Burning  Coal  and  Coke. — The  gases  extricated  in  the 
smothered  combustion  of  coal  or  coke,  in  addition  to  carbonic  acid,  contain 
carbonic  oxide  and  tarry  vapors.  AVe  may  expect  to  find  in  the  atmos- 
phere of  a  close  room  in  which  a  combustion  has  been  going  on,  sulphur- 
ous ACID  GAS ;  and  from  coal,  in  addition  to  this  sulphuretted  and  car- 
buretted  h3^drogen  gases.  These  emanations  are  fatal  to  life  ;  but  in  con- 
sequence of  their  very  irritating  properties,  they  give  warning  of  their 
presence  and  are  therefore  less  liable  to  occasion  fatal  accidents.  From 
an  accident  which  occurred  at  Colchester,  in  which  two  children  lost  their 
lives,  it  would  appear  that  some  persons  are  so  ignorant  as  to  believe  that 
the  vapor  of  coke  is  less  fatal  than  the  vapor  of  charcoal.  The  sulphurous 
acid  gas,  when  existing  in  a  small  proportion  in  air,  has  the  effect  of  irri- 
tating the  air-passages  so  violently  that,  if  accidentally  breathed,  it  would 
commonly  compel  the  person  to  leave  the  spot  before  the  vapors  had 
become  sufficientl}'  concentrated  to  destroy  life.  Nevertheless,  accidents 
from  the  combustion  of  coal  and  coke  sometimes  occur. 

Symptoms  and  Appearances. — The  following  cases  will  convey  a 
knowledge  of  the  symptoms  and  appearances  w4iich  may  be  met  with  on 
these  occasions.  Four  persons  were  brought  into  Guy's  Hospital  in  a 
state  of  asphyxia.  It  appeared  that  on  the  previous  evening  they  had 
shut  themselves  up  in  the  forecastle  of  a  coal-brig  and  had  made  a  fire. 
About  six  or  seven  o'clock  on  the  same  evening,  some  of  the  crew  acci- 
dentally placed  a  covering  over  the  flue  on  the  outside,  and  thus  stopped 
the  escape  of  smoke  from  the  fire,  which  was  made  of  a  kind  of  coal  con- 
taining much  sulphur.  Early  in  the  morning  one  of  the  crew,  on  opening 
the  hatches,  observed  three  of  the  inmates  lying  on  the  floor  unconscious 
and  frothing  at  the  mouth  and  the  fourth  in  his  crib  in  a  similar  condition. 
The  air  in  the  place  was  most  offensive.  After  the  men  were  brought  on 
deck,  one  of  them,  aged  twenty-one,  began  to  recover,  and  when  brought 
to  the  hospital  he  seemed  only  giddy,  as  if  intoxicated :    he  soon  com- 


SULPHUROUS    ACID.  451 

pletely  recovered.  Another,  aged  forty,  after  breathing  oxygen  gas  and 
having  brandy  and  ammonia  administered  to  him,  showed  no  symptoms 
of  recovery,  but  died  in  a  few  hours.  A  third,  aged  seventeen,  soon 
began  to  rally,  and  in  a  short  time  he  was  able  to  answer  questions  :  he 
declared  that  at  the  time  of  the  accident  he  felt  no  pain,  sense  of  oppres- 
sion, or  weight,  either  in  his  head  or  chest.  The  fourth  aged  fifteen,  died 
the  following  day,  having  shown  no  s3^mptoms  of  rallying.  Stimulants 
were  administered  and  warm  fomentations  were  used,  but  all  efforts  to 
produce  reaction  failed.  The  appearances  presented  by  these  persons  when 
brought  in  were  as  follows:  the  lips  were  purple,  the  countenance  livid, 
and  the  surface  of  the  body  cold  ;  the  hands  and  nails  were  purple  ;  the 
breathing  was  quick  and  short ;  the  pulse  small,  quick,  and  feeble ;  the 
pupils  were  fixed,  and  there  was  total  insensibility.  The  body  of  the 
man  aged  forty  was  inspected  four  hours  after  death.  The  membranes  of- 
the  brain  were  congested,  and  there  was  a  large  quantity  of  fluid  under 
the  arachnoid  membrane;  the  sinuses  were  gorged  with  blood;  the  lungs 
were  greatly  congested,  as  were  also  the  right'  cavities  of  the  heart.  It 
was  remarked  that,  in  its  congested  condition,  this  body  was  similar  in 
appearance  to  that  of  a  hanged  culprit.  The  body  of  the  lad  aged  fifteen 
was  inspected  about  thirty-three  hours  after  death.  Under  the  pia  mater 
or  inner  membrane  of  the  brain  was  observed  one  small  ecchyniosed  spot; 
in  the  substance  of  the  brain  there  were  more  bloody  points  than  usual ;  a 
small  quantity  of  fluid  was  found  under  the  arachnoid  membrane  and  the 
sinuses  were  full  of  coagulated  blood.  The  lungs  showed  no  congestion, 
but  the  right  cavities  of  the  heart  were  much  distended  with  blood.  (For 
a  report  of  cases  of  recovery  from  the  effects  of  coal-vapor,  see  London 
Med.  Gaz.,  vol.  ix.  p.  935,  vol.  xliii.  p.  937  ;  also  Dub.  Med.  Press  Jan  31 
1849,  p.  69.) 

A  case  showing  the  fatal  effects  of  coal-vapor  occurred  to  Davidson.  A 
man  lost  his  life  from  sleeping  in  a  closed  room  with  a  fire  to  which  there 
was  no  flue.  The  lungs  were  found  gorged  with  blood,  and  the  windpipe 
and  bronchi  were  filled  with  a  frothy  muco-sanguineous  fluid;  the  mucous 
membrane  beneath  was  slightly  injected  ;  there  was  a  small  effusion  in 
each  pleural  cavity  ;  the  right  side  of  the  heart  was  full  of  dark  liquid 
blood;  the  dura  mater  was  much  injected;  the  sinuses  of  the  brain  and 
the  veins  of  the  pia  mater  were  congested  ;  and  there  was  subarachnoid 
effusion.  The  substance  of  the  brain,  when  cut,  presented  numerous 
bloody  points.  (Edin.  Month.  Jour.,  1847,  p.  763.)  Other  cases  are  re- 
ported in  the  medical  journals,  which  do  not  materially  differ.  As  the 
persons  are  usually  found  dead,  the  post-mortem  appearances  only  can  be 
described.  In  one  instance,  a  man,  set.  30,  and  a  cat,  wore  found  dead  in 
a  room  in  which  coal  was  burnt  in  a  stove  provided  with  an  iron  pipe  to 
carry  off  the  products  of  combustion.  It  was  observed,  after  the  fatal 
event,  that  the  pipe  was  defective.  It  had  a  hole  in  it  from  corrosion  just 
before  passing  through  the  wall.  Sufficient  coal-vapor  had  escaped  through 
this  to  cause  death  in  a  few  hours.  (Brit.  Med.  Jour.,  1876,  1.  p.  444.) 
In  the  Med.  Times  and  Gaz.,  1852,  i.  p.  353,  the  reader  will  find  an  account 
of  three  cases  of  recovery  from  the  effects  of  coal-vapor.  (See  also,  for 
other  cases  which  proved  fatal,  the  same  journal,  1860,  i.  p.  323.) 

The  fatal  effect  of  the  vapor  of  burning  coke  are  strongly  illustrated  by 
the  deaths  of  a  mother  and  six  childi-en,  varying  in  age  from  ei"-ht  to 
eighteen  years,  in  Toxteth  Park,  Liverpool,  in  1878.  The  mother,  Ann 
Cameron,  ast.  41,  was  last  seen  alive  at  eleven  o'clock  at  night.  Early 
on  the  following  morning,  when  the  small  room  in  which  they  slept  was 
entered,  she  and  her  children  were  found  lying  dead  on  the  floor;  and 


452  VAPOKS    OF    LIME    AND    BRICK    KILNS. 

from  the  appearance  of  the  bodies  it  was  inferred  that  they  had  been  dead 
for  some  hours.  There  \\  as  a  strong  smell  of  burning  coke  in  the  room  ; 
there  was  an  iron  bucket  containing  burnt  coke  in  the  middle  of  the  room, 
and  the  door  and  windows  had  been  closed,  so  that  there  were  no  means 
of  ventilation.  There  was  at  first  a  suspicion  of  suicide,  and  then  of 
murder,  but  the  circumstances  proved  that  the  deaths  had  resulted  from 
accidental  sufl'ocation  by  coke-vapor.  Owing  to  the  smallness  of  the  room, 
which  had  a  capacity  of  only  512  cubic  feet,  the  noxious  effects  of  the 
vapor  must  have  been  greatly  accelerated. 

In  another  case,  which  occurred  to  Bury  and  Cullingworth,  a  woman, 
residing  with  her  parents,  gave  the  alarm  at  five  P.  M.,  that  her  father 
and  mother  were  lying  dead  in  the  chamber,  having  gone  to  bed  in  their 
usual  health  the  previous  night.  She  staggered  and  seemed  so  excited  that 
she  was  charged  with  being  drunk  by  the  police,  and  was  subsequently 
charged  with  causing  the  deaths.  The  dead  bodies  of  an  elderly  man  and 
woman  were  found  lying  on  the  bed  in  the  room — the  man  on  his  back  ; 
the  woman  resting  on  her  knees  with  her  face  buried  in  the  man's  thigh, 
and,  on  turning  her  body  on  to  its  back,  it  was  observed  that  the  nose 
had  been  bleeding.  It  transpired  that  the  deaths  had  been  caused  by  the 
fumes  of  coke,  burning  in  the  fire  all  night.  In  the  morning  the  surviving 
woman  awoke,  and  found  her  father  dead  and  cold  ;  and  her  mother  said 
she  was  dying  from  suffocation,  and  she  did  die  shortly  afterwards.  The 
daughter  was  unable  to  rise  from  the  bed,  or  to  disentangle  herself  from 
her  "dead  father  until  late  in  the  day.  She  screamed;  but  it  was  not  till 
five  P.  M.  that  she  was  able  to  walk  downstairs  and  give  the  alarm.  On 
post-mortem  examination  next  day,  the  body  of  the  man  was  found  lying 
on  the  right  side  in  a  composed  attitude.  On  the  right  thigh  were  two 
patches  of  dried  blood,  and  one  on  the  right  wrist,  which  lay  close  to  the 
thigh.  There  were  several  bruises  on  the  body.  The  heart-cavities  con- 
tained small  clots  and  a  little  dark  blood.  The  body  of  the  woman  had 
the  skin  of  the  face  and  the  front  of  the  body  of  a  purplish  hue,  and  the 
nose  and  lips  were  swollen  as  if  from  a  blow.  The  internal  organs  were 
healthy.  The  heart  contained  some  thin  fluid  blood,  but  no  clots.  The 
blood  of  the  man  was  examined,  and  found  to  contain  distinct  traces  of 
carbonic  oxide  gas.     (Med.  Chron.,  vol.  ii.  p.  80.) 

Full  details  of  the  post-mortem  appearances  met  with  in  poisoning  by 
coke-fumes  and  the  vapors  of  burning  charcoal,  are  given  by  La  Harpe 
(Rev.  Med.  de  la  Suisse  Rom.,  1885,  p.  101),  and  by  Cullingworth  (Med. 
Chron.,  ii.  p.  80). 

Analysis. — Sulphurous  acid  is  immediately  known  by  its  powerful  and 
suffocating  odor,  which  resembles  that  of  burning  sulphur.  The  best  test 
for  its  presence  is  a  mixture  of  iodic  acid  and  starch,  which  speedily 
acquires  a  blue  color  when  exposed  to  the  vapor. 

Yapors  of  Lime,  Brick,  and  Cement  Kilns. 
Gaseous  Products  from  Lime-hurving. — In  the  burning  of  lime,  car- 
bonic acid  is  given  out  abundantly  ;  but  owing  to  the  nature  of  the  fuel 
used,  carbonic  oxide  and  sul|)hurous  acid  are  mixed  with  it.  Persons  who 
have  incautiously  slept  in  the  neighborhood  of  a  burning  lime-kiln  during 
a  winter's  night  have  been  destroyed  by  the  respiration  of  these  vapors. 
The  discovery  of  a  dead  body  in  such  a  situation  would  commonly  suffice 
to  indicate  the  real  cause  of  death;  but  a  practitioner  ought  not  to  be  the 
less  prepared  to  show  that  there  existed  no  other  apparent  cause  of  death 
about  the  person.  It  is  obvious  that  a  person  might  be  murdered,  and 
the  body  placed  subsoquently  near  a  kiln  by  the  murderer  in  order  to 


COAL-GAS.       SYMPTOMS    AND    APPEARANCES.  453 

avert  suspicion.  If  there  are  no  marks  of  external  violence,  the  stomach 
should  be  carefully  examined  for  poison.  In  the  absence  of  all  external 
and  internal  injuries,  medical  evidence  will  avail  but  little ;  for  a  person 
mig-ht  be  criminally  suffocated,  and  his  body,  if  found  under  the  circum- 
stances above  stated,  would  present  scarcely  any  appearances  upon  which 
a  medical  opinion  could  be  securely  based.  The  vapors  of  brick-kilns  are 
equally  deleterious,  the  principal  agent  being  carbonic  acid  mixed  with 
carbonic  oxide;  although,  according  to  the  stage  of  combustion  of  the 
fuel,  ammonia,  hydrochloric  acid,  sulphuretted  hydrogen,  and  sulphurous 
acid  may  be  evolved.  In  1842,  two  boys  were  found  dead  on  a  brick-kiln 
near  London,  whither  they  had  gone  for  the  purpose  of  roasting  potatoes. 
Although  the  cause  of  death  in  both  cases  was  clearly  suffocation,  in  one 
instance  the  body  was  extremely  livid,  while  in  the  other  there  was  no 
lividity  whatever.  Such  accidents  are  frequent.  In  1878,  an  inquest  was- 
held  at  Islington  on  the  body  of  a  man  who  was  found  dead  on  a  brick- 
kiln. There  were  no  burns  on  the  body.  A  post-mortem  examination 
showed  that  he  had  died  from  suffocation  by  the  noxious  gases  evolved 
from  the  kiln. 

The  vapors  of  cement-kilns  are  as  noxious  as  those  of  brick-kilns:  car- 
bonic and  sulphurous  acids  predominate  in  them. 

Coal-gas. 

Coal-gas  is  a  compound  which  acts  directly  as  a  poison  when  respired. 
Many  fatal  accidents  have  occurred  from  the  respiration  of  air  contami- 
nated with  it.  Its  composition  is  subject  to  much  variation,  according  to 
circumstances.  An  analysis  of  coal-gas  as  supplied  to  London  showed 
that  it  contained  per  cent. — of  hydrogen,  46.43  ;  of  light  carburetted 
hydrogen,  38.93;  carbonic  oxide,  5.62;  olefiant  gas,  3.86;  watery  vapor, 
2.48;  nitrogen,  2.22;  carbonic  acid,  0.46.  The  differences  in  composition 
depend  on  the  heat  to  which  the  gas  has  been  submitted.  Poleck  found,  in 
four  series  of  experiments  in  which  death  was  caused  in  rabbits  by  the  gase- 
ous products  of  combustion  of  pit-coal,  that  the  air  of  the  chamber  had  a  mean 
composition  in  100  parts  of  6.56  carbonic  acid,  0.46  carbonic  oxide,  13.4 
oxygen,  and  T9.58  nitrogen.  In  experiments  made  with  coal-gas  the 
gaseous  mixture  which  caused  the  death  of  the  animal  was  always  found 
explosive.  He  agrees  with  many  others  that  carbonic  oxide  is  the  poison- 
ous agent  in  coal-gas,  except  in  those  cases  in  which  it  is  largely  contami- 
nated with  sulphuretted  hydrogen  gas.  In  poisoning  by  charcoal-vapor 
the  effects  are  due  to  carbonic  acid,  carbonic  oxide,  and  the  diminution  of 
oxygen.  There  is  no  doubt  that  the  hydrocarbons  also  have  a  specially 
noxious  influence,  although  the  use  of  the  safety-lamp  in  mines  proves 
that  a  mixture  of  marsh-gas  with  air  in  an  explosive  proportion  may  be 
breathed  for  a  certain  time  without  producing  serious  effects. 

Symptoms  and  Appearances  after  Death. — The  symptoms  produced 
by  coal-gas,  when  mixed  in  a  large  proportion  with  air,  are — giddiness, 
headache,  nausea  with  vomiting,  confusion  of  intellect,  loss  of  conscious- 
ness, general  weakness  and  depression,  partial  paralysis,  convulsions,  and 
the  usual  phenomena  of  asphyxia.  The  appearances  after  death  will  be 
understood  from  the  following  cases.  A  family  residing  at  Strasburg 
breathed  for  forty  hours  an  atmosphere  contaminated  with  coal-gas,  which 
had  escaped  from  a  pipe  passing  near  the  cellar  of  the  house  in  which  they 
lodged.  On  the  discovery  of  the  accident,  four  of  the  family  were  found 
dead.  The  father  and  mother  still  breathed.  In  spite  of  treatment,  the 
father  died  in  twenty-four  hours ;  but  the  mother  recovered.     When  the 


454  POISONING    BY    COAL-GAS. 

five  bodies  were  inspected,  there  was  a  great  difi"erence  ia  the  appearances ; 
but  the  principal  changes  observed  were  congestion  of  the  brain  and  its 
membranes — the  pia  mater  being  gorged  with  blood,  and  the  whole  sur- 
face of  the  brain  intensely  red.  In  three  of  the  cases  there  was  an  elTusion 
of  coagulated  blood  on  the  dura  mater  and  in  the  spinal  canal.  The  lining 
membrane  of  the  air-passages  was  strongly  injected,  and  there  was  spread 
over  it  a  thick  viscid  froth,  tinged  with  blood  ;  the  substance  of  the  lungs 
was  of  a  bright-red  color  and  the  blood  in  the  vessels  was  coagulated. 
(Ann.  d'Hyg.,  Jan.  1842.)  In  two  cases  communicated  by  Teale  (Guy's 
Hosp.  Rep.,  1839,  p.  106),  there  was  found  congestion  of  the  brain  and  its 
membranes,  with  injection  of  the  lining  membrane  of  the  air-pasir^ages ; 
and  the  blood  was  remarkably  liquid.  An  aged  woman  and  her  grand- 
daughter, who  had  been  annoyed  by  the  escape  of  gas  during  the  day, 
retired  to  bed,  and  they  were  found  dead  about  twelve  hours  afterwards. 
In  1873,  four  members  of  a  family  were  found  dead  in  their  bedroom  at 
Dundee.  The  mother,  father,  and  two  children  had  retired  to  rest  quite 
well.  There  was  a  strong  smell  of  coal-gas  on  entering  the  room,  and 
they  had  undoubtedly  died  from  the  effects  of  this  gas  while  sleeping. 
Gas  had  been  formerly  supplied  to  the  house,  but  it  had  been  carelessly 
cut  off,  and  some  still  leaked  into  the  room.  These  facts  show  that  life 
may  be  insidiously  destroyed  by  the  breathing  of  this  gas  without  giving 
the  slightest  warning. 

In  the  cases  above  related,  the  effects  produced  by  coal-gas  were  owing 
to  the  long-continued  breathing  of  it  in  a  diluted  state.  The  quantity  con- 
tained in  the  air  of  the  rooms  must  have  been  very  small :  in  the  first  case 
it  was  probably  not  more  than  8  or  9  per  cent.,  because  at  a  little  above 
this  proportion  the  mixture  with  air  becomes  explosive ;  and  there  had 
been  no  explosion  in  this  case,  although  in  the  apartments  in  which  the 
persons  were  found  dead,  a  stove  had  been  for  a  long  time  in  active  com- 
bustion, and  a  candle  had  been  completely  burnt  out.  In  Teale's  cases 
those  who  first  entered  the  house  perceived  a  strong  smell  of  coal-gas,  but 
still  the  air  could  be  breathed. 

The  body  of  a  gasfitter  was  found  supported  in  a  sitting  posture  on  the 
floor.  The  man  had  accidentally  breathed  coal-gas  mixed  with  air  while 
connecting  a  tube  with  a  meter.  The  skin  was  cold,  the  cornea  glazed, 
and  the  face  pale  and  placid ;  there  was  some  froth  about  the  mouth,  the 
pupils  were  rather  dilated,  and  the  limbs  supple.  There  was  a  strong 
smell  of  gas  in  the  place.  He  was  working  in  a  closet,  and  was  found 
on  the  top  of  a  pair  of  steps  in  a  sitting  posture — his  head  on  one  side, 
his  arms  hanging  down,  and  his  back  leaning  against  the  wall,  in  the 
attitude  in  which  he  had  been  engaged  at  his  work.  He  had  evidently 
died  quietly  and  placidly  on  his  seat,  and  had  made  no  attempt  to  descend 
the  steps.  He  was  last  seen  alive  an  hour  before  he  was  found,  and  he 
no  doubt  died  rapidly  from  the  inhalation  of  the  gas.  An  inspection  of 
the  body  was  made  about  twenty-four  hours  after  death.  The  skin  of 
the  face  and  upper  part  of  the  body  was  pale,  rigidity  was  well  marked, 
and  there  was  general  lividity  of  the  back  of  the  body  as  well  as  of  the 
limbs.  The  blood  was  everywhere  fluid.  The  brain  and  its  membranes 
were  not  congested,  but  were  rather  pale  than  otherwise ;  the  ventricles 
contained  a  pale  serum.  There  was  a  strong  odor  of  coal-gas  on  exposing 
the  brain.  The  lungs  were  of  a  dark-red  color,  and  did  not  collapse  on 
raising  the  chest-bone;  they  were  dark  at  the  back  of  the  lobes  from 
gravitation  of  blood;  their  structure  was  healthy.  The  windpipe  and 
Ijronchi  contained  frothy  mucus  in  some  quantity.  A  powerful  odor  of 
gas  was  perceived  on  compressing  the  lungs.     The  heart  was  healthy ; 


POISONING    BY    COAL-GAS.  455 

the  risfht  cavities  were  disteaded  with  blood,  and  the  left  were  nearly 
empty  ;  the  blood  was  everywhere  dark-colored.  There  was  cono-estion 
of  the  abdominal  viscera,  but  no  other  unusual  appearance.  (Med.-Chir. 
Trans.,  1862,  vol.  45,  p.  103.)  In  general  the  smell  of  gas  may  be  per- 
ceived in  the  breath  for  some  time  after  the  person  has  been  removed 
from  the  noxious  atmosphere.  In  the  Chantrelle  trial  at  Edinburgh, 
May,  1878,  the  time  for  the  disappearance  of  the  odor  in  a  person  sdli 
living  was  an  important  question  (p.  184).  There  are  but  few  facts 
recorded  on  this  subject.  In  one  case,  where  sensibility  was  completelv 
lost,  the  smell  of  the  gas  had  entirely  disappeared  from  the  breath  in  two 
hours  and  a  half  after  the  man's  recovery.      (Lancet,  1878,  i.  p.  786.) 

Coal-gas,  like  other  aerial  poisons,  may  destroy  life  if  long  breathed, 
although  so  diluted  as  not  to  produce  any  serious  effects  in  the  first  in- 
stance. This  gas  owes  its  peculiar  odor  to  the  vapor  of  naphtha ;  the- 
odor  begins  to  be  perceptible  in  air  when  the  gas  forms  only  the  1 000th 
part ;  it  is  easily  perceived  when  forming  the  700th  part,  but  the  odor  is 
strongly  marked' when  it  forms  the  150th  part.  In  most  houses  in  which 
gas  is  burnt  the  odor  due  to  leakage  is  plainly  perceived ;  and  it  is  a 
serious  question  whether  health  and  life  may  not  often  be  affected  by  the 
long-continued  breathing  of  an  atmosphere  containing  but  a  small  pro- 
portion. The  odor  will  always  convey  a  sufficient  warning  against  its 
poisonous  effects.  It  siiould  be  known  that  this  gas  will  penetrate  into 
dwellings  in  an  insidious  manner.  In  Teale's  cases  (see  p.  454,  ante), 
the  pipe  from  which  tiie  gas  had  escaped  was  situated  about  ten  feet  from 
the  wall  of  the  bedroom  where  the  women  slept;  the  gas  had  permeated 
through  the  loose  earth  and  rubbish,  and  had  entered  the  apartment 
through  the  floor.  We  have  notes  of  several  other  cases  in  which  coal- 
gas  has  thus  destroyed  life  by  slow  leakage  into  bedrooms.  In  one  of 
these  a  gas-pipe  passing  under  the  floor  had  been  left  imperfectly  stopped 
during  repairs.  This  led  to  the  death  of  two  ladies  sleeping  in  the  room 
above  with  closed  doors  and  windows.  In  another,  the  leakage  was  owing 
to  a  carpenter  hammering  nails  through  the  floor.  Some  of  these  had 
penetrated  a  concealed  gas-pipe,  and  led  to  an  escape  sufficient  to  prove 
fatal  to  a  person  sleeping  in  the  room.  In  a  third  case,  a  leakage  had 
been  caused  by  rats  gnawing  a  hole  in  the  thin  pipe  in  which  gas  is 
conveyed  in  houses.  Four  persons  suffered  severely  by  this  accident, 
and  barely  escaped  with  their  lives. 

There  is  another  cause  of  leakage  which  may  lead  to  accident.  When 
gas  is  burnt  during  the  night  in  a  closed  bedroom  the  flame  may  be  ex- 
tinguished by  a  current  of  air.  This  would  lead  to  a  subsequent  escape, 
which  might  prove  fatal.  The  action  of  this  gas  on  the  brain  and  nervous 
system  is  so  insidious  that  a  person  is  rendered  powerless  before  he  is 
conscious  of  danger. 

Coal-gas  is  the  agent  now  employed  for  the  destruction  of  stray  dogs 
in  Paris.  Patenko  has  examined  the  bodies  of  animals  thus  destroved. 
The  appearances  met  with  are  generally  those  of  suffocation  (q.v.) ;  and 
the  blood,  more  especially  in  the  liver,  is  of  a  rosy  hue,  as  in  poisoning 
by  carbonic  oxide.     (Ann.  d'Hyg.,  1885,  t.  1,  p.  209.) 

It  is  impossible  to  determine  exactly  what  proportion  of  this  gas  in  air 
will  prove  fatal.  An  atmosphere  containing  from  7  to  12  per  cent,  has 
been  found  to  destroy  dogs  and  rabbits  in  a  few  minutes ;  when  the  pro- 
portion was  from  1^  to  2  per  cent,  it  had  little  or  no  effect.  With  respect 
to  man,  it  may  destroy  life  if  long  respired  when  forming  about  9  per 
cent. ;  i.e.  when  it  is  in  less  than  an  explosive  proportion.  (See  Brit,  and 
For.  Med.  Rev.,  vol.  20,  p.  253  ;  also  Ann.  d'Hvg.,  1830,  t.  1,  p.  457  ; 


456  WATER-GAS. 

and  Edin.  Med.  Jour.,  Ju\j,  1874,  p.  23.)  Aldis  observed  in  his  experi- 
ments that  in  ordinary  coal-gas  mixed  with  air  rats  were  rendered  in- 
sensible in  half  a  minute,  and  died  in  a  minute  and  a  half  to  two  minutes. 
There  was  before  death  a  spasmodic  action  of  the  diaphragm.  The  gas 
was  allowed  to  enter  slowly  into  a  bell-jar  of  air  in  which  the  animals 
were  placed.     (Med.-Chir.  Trans.,  1862,  vol.  45,  p.  100.) 

A  person  may  die  from  respiring  a  mixture  of  unburnt  gas,  as  well  as 
of  the  products  of  its  combustion.  It  is  not  unusual  to  find  the  gas  burn- 
ing in  a  room  in  which  a  person  has  been  asphyxiated.  A  youth,  set.  18, 
went  to  bed  in  a  small  room  without  a  fireplace  or  a  means  of  ventilation, 
in  which  was  a  sliding  gasalier  with  two  jets.  He  was  found  in  the 
morning  insensible;  the  sliding  gasalier  had  been  drawn  down  as  far  as 
possible,  and  one  of  the  jets  was  burning  with  the  cock  turned  on  full. 
There  was  a  strong  smell  of  unburnt  gas  in  the  room,  which  had  escaped 
from  the  sliding  tube.  When  seen  he  was  completely  comatose,  breathing 
irregularly;  the  face  was  livid,  the  pupils  natural  and  sensible  to  light; 
body  temperature  102°  F,  The  pillow  w^as  stained  with  a  brownish  fluid 
issuing  from  the  mouth.  In  spite  of  treatment  he  continued  in  much  the 
same  state  for  nearly  three  days,  when  his  temperature  rose  to  106°. 
The  pulse  was  imperceptible,  the  pupils  dilated  and  insensible.  Death 
took  place  .^ixty-eight  hours  after  he  was  found.  On  inspection  the  vessels 
of  the  surface  of  the  brain  were  full  of  blood;  small  clots  appeared  on 
making  a  section  of  it.  The  right  auricle  of  the  heart  was  full  of  dark 
blood,  fluid  and  coagulated.  The  surface  of  the  lungs  was  of  a  dark 
claret  color,  mottled  with  pink  spots.  The  lungs  were  full  of  dark  blood, 
and  sections  of  them  presented  a  mottled  appearance,  like  the  pleural 
surface.  The  bronchial  tubes  were  free — the  inner  surface  was  of  a  dark 
purple  color.  The  kidneys  were  congested.  (Brit.  Med.  Jour.,  18T5,  ii. 
p.  392.) 

Water-gas. 

Recent  successful  attempts  to  introduce  water-gas  into  this  country  and 
into  the  United  States  of  America,  as  a  heating  and  illuminating  agent, 
have  given  rise  to  serious  accidents.  Water-gas,  made  by  passing  steam 
over  hot  coke,  is  essentially  a  mixture  of  hydrogen  and  carbonic  oxide 
gases,  and  contains  about  40  per  cent,  of  the  latter  gas.  It  is  odorless 
and  highly  poisonous.  Many  fatal  accidents  have  occurred  in  the  United 
States  .of  America  from  its  escape  into  the  air  of  rooms. 

On  Noven:iber  20,  1839,  two  forgemen,  French  and  Fenwick,  occupied 
a  cabin  in  which  there  was  a  cooking  stove  heated  by  water-gas.  By  an 
accident  the  gas  was  extinguished,  the  tap  being  left  partially  turned  on. 
In  the  course  of  the  day  they  were  found  dead,  as  if  asleep.  Two  days 
later  the  bodies  were  examined  by  several  medical  men  in  a  room  of 
39,000  cubic  feet  capacity,  and  receiving  perhaps  1000  cubic  feet  of  fresh 
air  per  minute.  Before  the  bodies  were  well  opened,  several  of  those 
engaged  were  affected  by  the  gas,  which  was  escaping  into  the  room,  and 
one  seriously.  All  recovered.  Two  days  after  this,  and  four  days  after 
the  deaths  occurred,  the  editor  assisted  at  the  post-mortem  examinations, 
which  had  been  abandoned  on  the  previous  occasion.  The  appearances 
were  typical  of  those  from  carbonic  oxide  poisoning,  viz.,  a  rosy  hue  of  the 
viscera  and  of  the  post-mortem  hypostases  (ecchymoses),  a  fresh  appear-- 
ance  of  the  viscera,  an  exudation  of  rosy  blood-stained  fluid  into  the 
stomach,  bladder,  and  cranial  cavity.  The  rosy  hue  of  portions  of  the 
viscera  was  clearly  visible  seventeen  months  later,  though  the  organs 
were  simply  kept  in  glass-stoppered  bottles.     The  blood  also  retained  its 


CONFINED    AIR.  457 

rosy  hue  for  many  weeks,  and  throughout  this  time  showed  the  two 
absorption   bands  of  carbonic   oxide  hasmoglobin.     (Guy's  Hosp.   Rep. 
1889,  p.  228.) 

Confined  Air. 

Symptoms  and  Effects. — An  animal  confined  within  a  certain  quantity 
of  air,  which  it  is  compelled  to  breathe,  will  soon  die.  A  human  being  in 
the  same  way  may  be  suffocated,  if  confined  in  a  close  apartment  where 
the  air  is  not  subject  to  change  or  renewal,  while  the  products  of  respira- 
tion are  accumulated;  and  the  effects  are  hastened  when  a  number  of  per- 
sons are  crowded  together  in  a  small  space.  The  change  which  air,  thus 
contaminated  by  breathing,  undergoes  may  be  very  simply  stated.  The 
quantity  of  nitrogen  in  100  parts  will  remain  nearly  the  same;  the  quan- 
tity of  oxygen  will  probably  vary  from  8  to  12  per  cent.,  while  the  re- 
mainder will  be  made  up  chiefly  of  carbonic  acid.  If  many  persons  are 
crowded  together  the  air  will  acquire  a  high  temperature,  and  it  will  be 
saturated  with  aqueous  vapor  which  contains  decomposing  animal  matter 
derived  from  the  lungs  and  skin.  From  this  statement  it  is  evident  that 
air  which  has  been  contaminated  by  continued  breathing  will  operate 
fatally  on  the  human  bodv,  partly  in  consequence  of  its  being  deficient  in 
oxygen,  and  partly  from  the  noxious  effects  of  the  carbonic  acid  and  other 
substances  contained  in  it.  The  proportion  in  which  carbonic  acid  exists 
in  respired  air  is  subject  to  variation :  according  to  the  experiments  of 
Allen  and  Pepys,  it  never  exceeds  10  per  cent,  by  volume  of  the  mixture, 
how  frequently  soever  it  may  have  been  received  into  and  expelled  from 
the  lungs.  The  influence  of  respiration  on  air  may  be  thus  stated:  An 
adult  consumes  from  one  (277  cubic  inches)  to  two  gallons  of  air  per 
minute,  and  the  air  expired  contains  from  4  to  5  per  cent,  of  carbonic 
acid  ;  but  when  a  person  continues  to  breathe  the  same  air,  the  proportion 
of  carbonic  acid  expelled  is  reduced  at  each  successive  expiration.  When 
the  amount  in  air  has  reached  10  or  12  per  cent.,  no  more  is  thrown  off  by 
the  lungs,  and  the  blood  is  no  longer  depurated.  For  healthy  existence 
an  adult  consumes  20  cubic  feet,  or  125  gallons,  of  air  per  hour.  A 
common  candle  will  consume  as  much  as  two  gallons  of  air  per  minute. 

These  facts  are  of  importance  in  reference  to  the  size  of  bedrooms  occu- 
pied by  the  poorer  classes.  The  rooms  are  often  small,  without  ventilation 
by  door,  window,  or  chimney,  and  fatal  accidents,  especially  to  children, 
are  likely  to  arise  from  a  number  sleeping  in  the  same  room.  Parkes  cal- 
culated in  reference  to  sleeping-rooms  that  the  minimum  cubic  space 
required  for  boys  and  girls  from  fourteen  to  sixteen  years  of  age  should 
not  be  less  than  500  cubic  feet,  and  above  that  age  from  600  to  800  cubic 
feet  should  be  allowed  per  head.  In  1878  a  woman  and  six  children  were 
found  dead  in  their  bedroom  at  Liverpool.  The  whole  capacity  of  the 
room  was  only  equal  to  512  cubic  feet,  i.  e.  about  sufficient  for  one  person. 
In  this  case  a  bucket  with  burning  coke  (see  p.  451)  had  been  placed  in 
the  centre  of  the  room,  the  door  and  windows  closed,  and  there  was  no 
flue  to  carry  off  the  coke-vapor.  This  was,  perhaps,  the  principal  cause  of 
death,  as  the  coke  must  have  rapidly  exhausted  the  small  quantity  of  air 
in  the  room. 

Dalton  found  that  the  air  in  crowded  rooms,  such  as  theatres,  contained 
one  per  cent,  of  carbonic  acid,  the  atmospheric  proportion  (l-2500th)  being 
therefore  increased  twenty-fivefold.  The  author  found  a  similar  propor- 
tion in  the  impure  air  taken  from  Cornish  mines,  at  a  depth  of  about  1400 
feet.     The   coarse  candles  used  by   miners  vitiate  as  much  air  as  the 


458  NITROUS    OXIDE. 

breathing  of  an  adult,  and  there  is  an  absence  of  any  proper  means  of 
ventilation.  It  is  certain  that  insensibility  and  death  would  ensue  in  a 
human  adult  before  the  whole  of  the  oxygen  of  the  confined  air  had  dis- 
appeared ;  but  the  opportunity  can  rarely  present  itself  of  analyzing  such 
a  contaminated  mixture,  and  hence  it  is  impossible  to  specify  the  exact 
proportion  in  which  carbonic  acid  would  exist  when  the  confined  air  proved 
fatal  to  persons  who  had  respired  it.  The  carbonic  acid  in  the  air  of  close 
rooms  does  not  gravitate  to  the  floor,  but  is  diifused  throughout.  The 
whole  mass  of  air  is  in  fact  vitiated,  and  requires  renewal.  (Lond.  Med. 
Gaz.,  vol.  xxxviii.  p.  351 ;  see  also  Report  on  Mines,  1864,  App.  B,  196; 
and  Chem.  News,  1865,  i.  p.  79.) 

Nitrous  Oxide. 

Some  cases  of  death  from  the  inhalation  of  this  gas  as  an  anaesthetic 
render  a  short  notice  of  it  necessary  in  this  place.  Davy  was  the  first  to 
show  by  experiments  on  himself  that,  under  certain  precautions,  it  might 
be  breathed  when  mixed  with  air  without  danger  to  life,  and  that  it  had 
the  eflE'ect  of  producing  an  agreeable  species  of  intoxication. 

In  1873,  it  was  administered  by  a  dentist  at  Exeter  to  a  lady,  set.  38, 
at  her  own  desire,  in  order  to  annul  pain  during  the  extraction  of  a  molar 
tooth.  A  physician  carefully  examined  her  before  the  operation,  and 
found  that  there  was  nothing  to  preclude  the  use  of  the  gas.  The  nitrous 
oxide  was  pure  ;  it  had  been  safely  used  for  other  patients  from  the  same 
condenser,  and  an  apparatus  was  so  arranged  as  to  secure  the  removal  of 
the  expired  air.  The  total  quantity  administered  was  about  six  gallons. 
This  could  not  be  regarded  as  an  overdose.  Davy  himself  breathed  with 
safety  five  gallons  in  one  of  his  early  experiments.  Soon  after  the  com- 
mencement of  the  inhalation  it  was  observed  that  the  pulse  became  rapid 
and  less  full,  indicating  an  action  on  the  heart;  the  patient  was  then 
sensible,  and  the  apparatus  was  removed.  The  operation  was  commenced, 
but  the  lady  insisted  on  having  the  gas  again.  She  took  it;  insensibility 
came  on,  and  the  operation  was  completed.  Immediately  afterwards  the 
face  became  livid,  the  features  began  to  swell,  and  the  tongue  protruded. 
In  Spite  of  every  effort  to  restore  her,  she  did  not  recover  from  the  state 
of  insensibility  ;  she  breathed  two  or  three  times,  and  the  pulse  then  ceased. 
No  inspection  of  the  body  was  made.  The  above-mentioned  facts  were 
given  in  evidence  at  the  coroner's  inquest,  and  the  medical  opinion  was 
that  death  had  been  caused  by  the  gas  in  producing  paralysis  of  respira- 
tion, and  that  in  this  case  no  forethought  could  have  prevented  the  result. 
The  jury  returned  a  verdict  of  homicide  by  misadventure.  (Lancet,  1873, 
i.  pp.  178,  245,  253.)  It  has  been  suggested  that  on  this  occasion  death 
may  have  taken  place  from  suffocation,  by  blood  entering  the  air-passages; 
but  while  there  were  no  symptoms  indicative  of  this,  all  the  facts  appear 
to  show  that  the  gas  operated  as  a  blood-poison,  and  destroyed  life. 

According  to  the  experiments  of  Joylet  and  Blanche  (Arch,  de  Physiol., 
Juillet,  1873),  this  gas,  when  breathed,  operates  fatally  by  producing  pure 
asphyxia.  The  insensibility  which  is  a  result  of  breathing  the  gas  is,  in 
their  view,  owing  to  the  non-oxygenation  of  the  blood.  It  is  dissolved 
in  the  blood  and  circulated  with  it,  the  blood  not  having  the  power  to 
separate  the  combined  oxygen  from  it.  According  to  these  physiologists, 
the  angesthetic  state  produced  by  this  gas  is  owing  to  temporary  asphyxia, 
which,  in  proportion  to  its  duration  and  the  time  for  which  air  is  cut  oif, 
may  end  in  recovery  or  death.  (Brit.  Med.  Jour.,  1873,  ii.  p.  141.) 
There  is  not  only  a  circulation  of  unaerated  blood,  but  this  liquid  contain- 


SULPHURETTED  HYDROGEN.  459 

ing  the  nitrous  oxide  in  solution  may  produce  some  direct  effect  on  the 
nerve-centres. 

[Prof.  Faneuil  D.  Weisse  read  an  admirable  paper,  entitled  "  The  Obli- 
gations and  Responsibilities  of  an  Administrator  of  an  Anaesthetic,"  before 
the  Medico-Legal  Society,  January,  1873,  which  treats  this  subject  with 
great  ability.     (Series  2,  Medico-Legal  Papers,  144.)] 

Sulphuretted  Hydrogen. 

This  gas  has  a  more  powerful  action  on  the  body  than  either  carbonic 
acid  or  charcoal-vapor.  Persons  are  sometimes  accidentally  killed  by  it ; 
but  the  very  offensive  odor  that  a  small  portion  of  it  communicates  to  a 
large  quantity  of  air  is  sufficient  to  announce  its  presence,  and  thus,  with 
due  caution,  to  prevent  any  dangerous  consequences.  Sulphuretted  hydro- 
gen gas,  when  breathed  in  its  pure  state,  is  instantaneously  fatal.  It 
e.Kerts  equally  deleterious  effects  upon  all  animals,  and  through  all  the 
textures  of  the  body,  but  especially  through  the  lungs. 

St/mpfoms. — The  symptoms  produced  by  sulphuretted  hydrogen  on  the 
human  body  vary  according  to  the  degree  of  concentration  in  which  it  is 
breathed.  When  in  a  moderately  diluted  state,  the  person  speedily  falls 
inanimate.  An  immediate  removal  to  pure  air,  and  the  application  of 
stimulants,  with  cold  effusion,  may,  however,  suffice  to  restore  life.  Ac- 
cording to  the  account  given  by  those  who  have  recovered,  this  state  of 
inanimation  is  preceded  by  a  sense  of  weight  in  the  stomach  and  in  the 
temples;  also  by  giddiness,  nausea,  sudden  weakness,  and  loss  of  motion 
and  sensation.  If  the  gas  in  a  still  less  concentrated  state  be  respired  for 
some  time,  coma,  insensibility,  or  tetanus  with  delirium,  supervenes,  pre- 
ceded by  convulsions,  or  pain  and  weakness  over  the  whole  of  the  body. 
T^'he  skin  in  such  cases  is  commoaly  cold,  the  pulse  irregular,  and  the 
breathing  labored.  When  the  air  is  but  slightly  contaminated  with  the 
gas,  it  may  be  breathed  for  a  long  time  without  producing  any  serious 
symptoms ;  sometimes  there  is  a  feeling  of  nausea  or  sickness  accom- 
panied with  pain  in  the  head  or  diffused  pains  in  the  abdomen.  These 
symptoms  are  often  observed  to  affect  those  who  are  engaged  in  chemical 
manipulations  with  this  gas.  Sulphuretted  hydrogen  appears  to  act  like 
a  narcotic  poison  when  highly  concentrated,  but  like  a  narcotico-irritant 
when  much  diluted  with  air.  It  is  absorbed  into  the  blood,  deoxidizing  it 
and  giving  it  a  brownish-black  color,  in  which  state  it  is  circulated  through- 
out the  body.  In  all  cases  a  noxious  atmosphere  containing  this  gas  is 
indicated  by  an  offensive  smell  producing  nausea  and  sickness.  (For  a 
case  of  poisoning  by  it,  in  which  the  person  recovered,  see  Lond.  Med. 
Gaz.,  vol.  xliii.  p.  871.) 

Appearances  after  Death. — On  examining  the  bodies  of  persons  who 
have  died  from  the  effects  of  sulphuretted  hydrogen,  when  breathed  in  a 
concentrated  form,  and  the  inspection  is  recent,  the  following  appearances 
have  been  observed  :  The  mucous  membrane  of  the  nose  and  throat  is 
commonly  covered  with  a  brownish  viscid  fluid.  An  offensive  odor  is 
exhaled  from  all  the  cavities  and  soft  parts  of  the  body.  These  exhalations, 
if  received  into  the  lungs  of  those  engaged  in  making  the  inspection,  some- 
times give  rise  to  nausea  and  other  unpleasant  symptoms,  and  may  even 
cause  syncope  or  asphyxia.  The  muscles  of  the  body  are  of  a  dark  color, 
and  are  not  susceptible  of  the  electric  stimulus.  The  lungs,  liver,  and  the 
soft  organs  generally  are  distended  with  black  liquid  blood.  There  is  also 
great  congestion  about  the  right  side  of  the  heart,  and  the  blood  has  been 
found  everywhere  liquid  and  dark-colored;  the  body  rapidly  undergoes 


460  APPEARANCES    AFTER    DEATH. 

putrefaction.  When  death  has  occurred  from  the  breathing  of  this  gas  in 
a  more  diluted  form,  the  appearances  are  less  marked.  There  is  then 
general  congestion  of  the  internal  organs,  with  a  dark  and  liquid  state  of 
the  blood.  In  fact,  in  such  cases  the  appearances  can  scarce!}^  be  dis- 
tinguished from  those  produced  by  carbonic  acid.  Four  men  lost  their 
lives  in  the  Fleet  Lane  Sewer  in  1861 ;  they  were  found  dead,  and  there 
was  no  doubt  that  sulphuretted  hydrogen  was  the  cause  of  death.  The 
eyes  and  mouth  were  open,  the  lips  and  tongue  livid,  the  pupils  widely 
dilated,  the  blood  black  and  fluid,  the  lungs  congested,  the  heart  full  of 
black  fluid  blood,  the  right  side  gorged,  and  there  was  a  bloody  froth  in 
the  windpipe.  In  the  brain  the  large  vessels  of  the  dura  mater  were  full 
of  black  fluid  blood.     (Lancet,  1861,  i.  p.  187.) 

In  185T,  six  persons  lost  their  lives  at  Cleator  Moor,  near  Whitehaven, 
by  breathing  sulphuretted  hydrogen  in  a  diluted  form,  by  reason  of  their 
having  slept  in  small,  close,  ill-ventilated  rooms,  into  which  the  gas  had 
penetrated.  Three  of  the  deceased  persons — a  husband,  wife,  and  child, 
of  one  family  (Armstrong) — had  retired  to  rest,  in  their  usual  health,  on 
the  night  of  June  9th.  Two  of  them  were  found  the  next  morning  dead 
in  bed,  and  a  third  (the  child)  was  found  in  a  state  of  insensibility,  and 
lingered  until  the  afternoon  of  the  same  day,  when  she  died.  The  fourth, 
a  healthy  adult,  retired  to  sleep  in  his  bed  with  his  door  closed,  and  he 
was  found  dead  in  aii  hour.  The  fifth,  a  child,  was  taken  ill  on  the 
morning  of  the  11th,  and  died  the  same  day.  The  sixth  was  taken  ill  on 
the  morning  of  the  10th,  and  died  on  June  12th.  The  symptoms  com- 
plained of  by  some  who  recovered  w^ere  nausea,  sickness,  giddiness,  and 
insensibility.  In  the  body  of  one  child,  the  pupils  were  found  dilated ; 
viscid  mucus  escaped  from  the  nostrils  ;  there  was  congestion  of  the  lungs 
and  kidneys,  as  well  as  of  the  membranes  of  the  brain.  In  the  adult  who 
died  in  an  hour,  the  pupils  were  natural,  the  jaws  firmly  clenched,  the 
fingers  contracted,  and  the  nails  blue ;  there  was  great  cadaveric  lividity, 
and  a  quantity  of  fluid  with  frothy  mucus  issued  from  the  nostrils  and 
mouth.  The  lungs  were  much  congested,  and  serum  was  eflTused  in  the 
cavity  of  the  chest.  The  heart  contained  a  little  fluid  blood,  and  was 
somewhat  flaccid.  The  mucous  membrane  of  the  windpipe  and  gullet  was 
redder  than  natural,  and  in  the  former  there  was  frothy  mucus.  The 
stomach,  as  well  as  the  large  and  small  intestines,  was  highly  congested, 
but  otherwise  healthy.  The  brain  and  its  membranes  were  greatly 
engorged  with  blood,  which,  as  in  the  body  generally,  was  very  dark  and 
fluid.  The  cottages  in  which  the  accidents  had  occurred  were  built  upon 
a  heap  of  iron-slag,  which  also  abutted  on  the  premises  behind.  The  slag 
contained,  among  other  matters,  sulphide  of  iron  and  sulphide  of  calcium. 
A  foul  smell,  compared  to  that  of  cinders  extinguished  by  water,  had  for 
some  time  been  perceived  about  the  rooms,  chiefly  at  night  when  the  doors 
and  windows  were  closed  ;  and  the  day  before  the  occurrence  a  heavy 
storm  of  rain  had  washed  through  the  slag-heap,  and  aggravated  the 
effects.  The  heap  of  slag  was  burning  in  certain  parts,  and  sulphuretted 
hvdrogen  was  evolved  in  large  quantities  at  a  depth  of  a  few  feet  below. 
A  fortnight  after  the  deaths,  on  removing  the  stone  pavement  in  the  lower 
rooms,  the  slag  below  was  found  damp,  and  sulphuretted  hydrogen  was 
still  issuing  from  it.  The  white-lead  paint  in  the  closets  was  partly  con- 
verted into  black  sulphide,  and  this  chemical  change  was  found  in  patches 
on  the  chamber-door  of  one  small  room  in  which  two  persons  had  died. 
The  symptoms,  so  far  as  they  were  observed  in  the  living,  the  appearances 
in  the  dead  bodies,  and  the  chemical  nature  of  the  wet  slag  beneath  the 
foundation,  left  no  reasonable  doubt  that  during  the  night,  with  the  doors 


EFFLUVIA    OF    DRAINS    AND    SEWERS.  4Gi 

and  windows  closed,  sulphuretted  hydrogen  had  escaped  in  sufficient 
quantity  to  poison  the  air  and  destroy  life,  and  a  verdict  was  returned  to 
this  eliect.  A  suggestion  was  made  that  carbonic  acid  might  have  caused 
the  symptoms  and  death,  but  there  was  no  source  of  carbonic  acid  but  the 
breath  ;  and  there  is  no  instance  known  of  au}^  adult  having  breathed 
himself  to  death  in  an  hour  in  a  room  containing  600  cubic  feet  of 
air — not  to  mention  that  persons  had  slept  in  similar  rooms  in  the  same 
row  of  cottages,  at  a  distance  from  the  slag-heap,  without  perishing  from 
such  a  cause.  Another  theory  was  put  forward,  to  the  effect  that  carbonic 
oxide  in  the  vapors  of  some  blast-furnaces  had  found  its  way  into  the 
rooms  where  these  persons  had  died ;  but  the  nature  of  the  locality  and 
the  distance  of  the  furnaces  rendered  this  impossible.  Persons  who  had 
left  their  windows  open,  whereby  these  vapors  might  have  entered,  escaped, 
while  the  deaths  occurred  only  in  those  houses  in  which  the  doors  and 
windows  were  completely  closed.  It  is  highly  probable  that  the  sulphur- 
etted hydrogen  was  mixed  with  other  gases  and  vapors,  as  it  is  never 
found  pure  except  in  a  chemical  laboratory  ;  but  the  circumstances  proved 
left  no  doubt  that  this  gas  was  the  principal  agent  of  death.  This  seems 
to  have  been  clearly  established  by  the  fact  that,  after  a  channel  for  drain- 
age had  been  cut  through  the  slag-heap  and  the  slag  removed,  no  further 
casualty  took  place. 

As  in  reference  to  carbonic  acid  an  atmosphere  which  may  be  breathed 
for  a  short  time  with  impunity  will  ultimately  destroy  life.  Sulphuretted 
hydrogen  in  a  fatal  proportion,  hoivever  diluted  or  mixed  with  other 
vapors,  would  always  be  indicated  by  a  disagreeable  smell;  although 
from  habit,  as  well  as  probably  from  the  effects  of  the  gas  on  the  nervous 
system,  this  offensive  smell  might  not  be  perceived  when  a  person  had  re- 
mained for  a  short  time  in  the  poisoned  atmosphere.  In  the  cases  of  the 
Halls,  which  occurred  at  Sheffield  in  1 852,  there  is  reason  to  believe  that 
the  deaths  of  two  persons  were  caused  by  the  smouldering  of  ashes  in  a 
cesspool.  (Assoc.  Med.  Jour.,  April,  1853,  p.  280.)  Haywood  consid- 
ered that  carbonic  acid  was  the  agent  in  this  case,  although  it  is  probable, 
from  the  nature  of  the  materials  in  which  combustion  was  going  on,  that 
sulphuretted  hydrogen  and  other  gases  and  vapors  were  simultaneously 
evolved. 

Effluvia  of  Drains  and  Sewers. — The  most  common  form  of  accidental 
poisoning  by  sulphuretted  hydrogen  (for  it  is  rare,  that  a  case  occurs 
which  is  not  purely  accidental)  is  witnessed  among  nightmen  and  others 
who  are  engaged  in  cleaning  out  drains  and  sewei's,  or  in  the  removal  of 
nightsoil.  According  to  Thenard,  there  are  two  kinds  of  mechanical  mix- 
tures of  gases  which  are  commonly  met  with  in  the  exhalations  of  privies. 
The  first  compound  consists  of  a  large  proportion  of  atmospheric  air,  hold- 
ing diffused  through  it  sulphide  of  ammonium  in  the  form  of  vapor.  The 
sulphide  is  contained  abundantly  in  the  water  of  the  soil,  and  is  constantly 
rising  from  it  in  vapor,  and  diffusing  itself  in  the  surrounding  atmosphere. 
It  is  this  vapor  which  gives  the  unpleasant  and  pungent  odor  to  the  efflu- 
via, and  causes  an  increased  secretion  of  tears  "in  those  w^ho  unguardedly 
expose  themselves  to  such  exhalations.  The  symptoms  produced  by  the 
respiration  of  this  gaseous  mixture,  when  in  a  concentrated  state,  bear  a 
close  resemblance  to  those  which  result  from  the  action  of  sulphuretted 
hydrogen  gas.  If  a  person  is  but  slightly  affected  he  will  probably  complain 
of  nausea  and  sickness  ;  his  skin  will  be  cold,  his  respiration  free",  but  irreg- 
ular ;  the  pulse  is  commonly  frequent,  and  the  voluntary  muscles,  especially 
those  of  the  chest,  are  affected  by  spasmodic  twitchings. .  If  more  strongly 
affected,  he  loses  all  power  of  sense  and  motion  ;  the  skin  becomes  cold, 


462  ANALYSIS    OF    SEWER    GASES. 

the  lips  and  face  assume  a  violet  hue,  the  mouth  is  covered  by  a  bloodj 
and  frothy  mucus ;  the  pulse  is  small,  fi-equent,  and  irregular  ;  the  breath- 
ing hurried,  laborious,  and  convulsive;  and  the  limbs  and  trunk  are  in  a 
state  of  general  relaxation.  If  still  more  severely  affected,  death  may  take 
place  immediately  ;  or,  should  the  person  survive  a  few  hours,  in  addition 
to  the  above  symptoms  there  will  be  short  but  violent  spasmodic  twitch- 
ings  of  the  muscles,  sometimes  even  accompanied  by  tetanic  spasms, 
(Ann.  d'Hyg.,  1829,  t.  2,  p.  70.)  If  the  person  is  sensible  he  will  com- 
monly suS'er  severe  pain,  and  the  pulse  may  become  so  quick  and  irregu- 
lar that  it  cannot  be  counted.  When  the  symptoms  are  of  such  a  formi- 
dable nature  it  is  rare  that  a  recovery  takes  place.  The  appearances  met 
with  on  making  an  examination  of  the  body  are  similar  to  those  observed 
in  death  from  sulphuretted  hydrogen.  The  inspection  should  be  made 
with  caution,  for  a  too-frequent  respiration  of  the  poisonous  exhalations 
may  serioush'  affect  those  who  undertake  it.  (Ann.  d'Hvg.,  18T2,  t.  2, 
p.  73.)  The  admixture  of  any  mineral  acid  with  the  sewage  liquid  con- 
taining sulphide  of  ammonium  produces  an  immediate  escape  of  sulphur- 
etted hydrogen  in  fatal  proportion.  This  operates  more  speedily  than  the 
mere  agitation  of  the  liquid.  In  1876  a  man  lost  his  life  in  a  London 
sewer  owing  to  the  sudden  influx  of  refuse  acid  liquid  from  a  factory, 
which  caused  a  sudden  escape  of  the  poisonous  gas.  The  editor  has  on 
several  occasions  found  that  men  working  in  sewers  were  rendered  insen- 
sible, comatose,  and  blue  and  livid  on  the  surface  of  the  body,  owing  to 
the  discharge  of  acid  liquids  from  soda-water  factories  into  the  sewers. 
The  acid  liberates  a  mixture  of  carbonic  acid  and  sulphuretted  hydrogen 
from  the  deposits  in  the  sewer  ;  and  these  gases  overpower  the  workmen 
who  are  exposed  to  their  influence. 

Analysis. — The  recognition  of  these  gases  and  vapors  is  a  simple  oper- 
ation. The  odor  which  they  possess  is  sufficient  to  determine  their  pres- 
ence, even  when  they  are  diluted  with  a  large  quantity  of  atmospheric  air. 
Sulplruretted  hydrogen  gas  is  at  once  identified  by  its  action  on  paper 
previously  dipped  in  a  solution  of  a  salt  of  lead:  if  present,  even  in  very 
small  proportion  (the  1-100, 000th  part),  the  moistened  paper  speedily 
acquires  a  brownish-black  stain  from  the  production  of  sulphide  of  'lead. 
It  must  not  be  supposed  that  sulphuretted  hydrogen,  when  it  has  proved 
fatal  in  a  diluted  iorm,  can  be  detected  in  the  lungs,  stomach,  or  blood  of 
a  dead  body.  When  the  body  is  recently  removed  from  a  drain  or  sewer, 
the  gas  may  be  found  pervading  the  whole  of  the  tissues ;  but  in  other 
cases  it  will  be  as  useless  to  look  for  it  as  for  carbonic  acid  in  poisoning 
by  this  gas.  !N^oxious  gases  are  not  long  retained  by  the  tissues  ;  a  short 
exposure  will  suffice  to  remove  all  traces  of  them.  The  examination  of 
the  locality  can  alone  throw  a  light  upon  the  cause  of  death.  The  propor- 
tion of  the  gas  found  in  an  apartment  will,  however,  rarelv  be  a  criterion 
of  the  actual  quantity  which  has  destroyed  life.  A  person  going  into  a 
room  where  the  deceased  bodies  are  lying  may  notice  only  a  disagreeable 
or  stifling  smell,  but  he  may  be  able  to  breathe  for  a  longer  or  a  shorter 
period  with  the  door  or  window  open.  It  is  not  the  respiration  of  a  few 
minutes,  but  the  breathing  of  the  diluted  noxious  atmosphere  for  hours 
that  really  destroys  life.  The  best  method  of  detecting  sulphuretted 
hydrogen  when  present  in  a  dead  body  (not  putrefied)  is  to  place  a  slip  of 
card  glazed  with  lead  in  the  muscles  or  soft  organs  :  it  will  sooner  or  later 
be  tarnished  and  acquire  a  brown  color  if  the  gas  is  present. 

Sulphuretted  hvdrogen  may  be  proved  to  exist  by  the  lead-test  in  the 
vapor  of  st'lphide  of  ammonium  when  mixed  with  air,  while  the  presence 
of  ammonia  in  the  compound  is  indicated  by  its  alkaline  reaction  to  test- 


DETECTION    OF    SULPHURETTED    HYUROttEN.  463 

paper — also  by  holding,  in  a  vessel  containing  the  vapor  recently  col- 
lected, a  rod  dipped  in  strong  hydrochloric  acid ;  the  production  of  dense 
white  fumes  announces  the  formation  of  chloride  of  ammonium.  The 
presence  of  this  compound  vapor  in  any  mixture  is  at  once  indicated  by 
introducing  paper  wetted  with  a  solution  of  nitro-prusside  of  sodium.  The 
sulphide  produces  with  it  a  rich  crimson  color  ;  if  sulphuretted  hydrogen 
alone  is  present  the  nitro-prusside  paper  undergoes  no  change.  It  is  a 
fact  which  cannot  be  too  universally  known  that  a  candle  will  readily 
burn  in  a  mixture  of  either  of  these  gases  with  air  which,  if  breathed, 
would  suffice  to  destroy  life.  The  candle-test  should  be  applied  with 
caution  in  places  where  these  effluvia  are  collected  and  confined  in  sewers 
or  close  cesspools.  AVhen  sulphuretted  hydrogen  is  diffused  in  a  propor- 
tion of  about  7  per  cent,  with  air  it  forms  a  dangerously  explosive  mix- 
ture. 

It  is  worthy  of  remark  that  the  air  of  a  cesspool  may  be  often  breathed 
with  safety  until  the  workmen  commence  removing  the  soil,  when  a  large 
quantity  of  mephitic  vapor  may  suddenly  escape,  which  will  lead  to  the 
immediate  suffocation  of  all  present.  Several  persons  have  been  killed 
by  trusting  to  the  previous  burning  of  a  candle,  in  ignorance  of  this  fact. 
In  an  accident  which  occurred  in  Whitechapel,  in  1857,  three  men  died 
speedily  from  breathing  the  vapor  of  an  old  sewer,  and  two  others  nearly 
lost  their  lives  in  attempting  to  assist  them.  According  to  Parent- 
Duchatelet,  men  can  work  for  a  time  in  an  atmosphere  containing  from 
2  to  3  per  cent,  of  sulphuretted  hydrogen.  The  air  of  one  of  the  prin- 
cipal sewers  of  Paris  gave  the  following  results  on  analysis,  in  100  parts: 
Oxygen,  13.79  ;  nitrogen,  81.21 ;  carbonic  acid,  2.01 ;  sulphuretted  hydro- 
gen, 2.99. 

Another  gaseous  mixture,  in  the  form  of  deoxidized  air,  was  found  by 
Theuard  in  the  sewers  of  Paris  :  it  was  composed,  in  100  parts,  of  nitrogen 
94,  of  oxygen  2,  and  of  carbonic  acid  4.  Sometimes  the  carbonic  acid  is 
combined  with  ammonia,  and  then  it  may  be  regarded  chiefly  as  a  mixture 
of  nitrogen  holding  diffused  through  it  the  vapor  of  carbonate  of  ammo- 
nium, which  is  sufficient  to  render  it  highly  irritating  to  the  mucous  mem- 
brane of  the  eyes  and  nose.  Its  action  on  the  human  body  when  breathed 
will  be  readily  understood  from  its  chemical  composition.  In  its  opera- 
tion it  is  essentially  negative,  and  destroys  life  by  cutting  off  the  access 
of  oxygen.  The  small  proportion  of  carbonic  acid  or  of  carbonate  of 
ammonium  existing  in  it  could  not  give  rise  to  the  asphyxia  which  so 
rapidly  followed  its  inhalation.  The  chances  of  recovery  are  much 
greater  in  persons  who  become  asphyxiated  from  the  inspiration  of  this 
compound  than  in  those  who  are  exposed  to  the  influence  of  the  preced- 
ing. Commonly  the  immediate  removal  to  a  current  of  pure  air  is  suffi- 
cient to  bring  about  a  recovery.  Should  death  take  place  it  will  be  found 
on  inspection  that  the  internal  appearances  are  the  same  as  those  which 
are  met  with  in  death  from  suffocation. 

This  mixture  has  no  offensive  smell ;  it  extinguishes  a  lighted  candle ; 
the  carbonic  acid  contained  in  it  may  be  removed  by  caustic  potash,  and 
then  it  will  be  seen  that  the  great  bulk  of  the  mixture  is  formed  of  nitro- 
gen— a  gas  which  by  its  negative  properties  cannot  be  easily  confounded 
with  any  other.  In  a  mixed  atmosphere  of  carbonic  acid  and  sulphuretted 
hydrogen  the  two  gases  may  be  separated  by  agitating  the  mixture  with 
a  solution  of  acetate  of  lead,  and  treating  the  precipitate  with  acetic  acid, 
which  dissolves  the  carbonate  and  leaves  sulphide  of  lead. 


46-i  LIGHTNING    AND    ELECTRICITY. 


LIGHTNING.    COLD.    HEAT.    STARVATION. 


CHAPTER     XLIII. 

EFFECTS    OF    ELECTRICITY. POST-MORTEM    APPEARANCES. COLD    AN    OCCASIONAL    CAUSE    OF 

DEATH. SYMPTOMS. CIRCL'JISTAXCES    WHICH    ACCELERATE    DEATH. POST-MORTEM    AP- 
PEARANCES.— EFFECT    OF  HEAT. STARVATION  A  RARE    CAUSE    OF    DEATH. SYMPTOMS. 

APPEARANCES    AFTER    DEATH. LEGAL    RELATIONS. 

Lightning  and  Electricity. 

Deaths  from  lightning  are  more  common  than  is  generally  supposed. 
Although  they  usually  occur  under  circumstances  in  which  the  facts  are 
known,  vet  cases  may  present  themselves  in  which  the  marks  of  violence 
left  upon  the  dead  bodies  may  be  suggestive  of  homicide.  Few  or  no 
statistics  of  these  deaths  have  been  published  in  England;  but  in  France 
the  facts  collected  by  Boudin  show  the  following  results.  In  twenty-eight 
years — from  1835  to  18G3 — 2238  persons  were  killed  by  lightning.  From 
18.54  to  1864  inclusive,  967  persons  were  killed,  698  being  males  and  269 
females.  In  the  year  1864  alone  there  were  87  killed,  61  males  and  26 
females.  Of  34  persons  killed  by  lightning  in  the  open  fields  during  the 
year  1853,  15  were  struck  while  taking  shelter  under  trees;  and  of  107 
persons  killed  by  lightning  between  1841  and  1853,  21  are  reported  to 
have  been  killed  under  trees.  Children  appear  to  escape  this  mode  of 
death  more  than  adults.  (Chem.  jS'ews,  1865,  July  7  and  Dec.  8.)  In 
the  Registrar-General's  reports  the  number  of  deaths  from  lightnin'g  in 
England  and  Wales  for  nine  years  (1869-1878)  was  182,  of  which  147 
were  males.  In  1880  the  number  was  26.  These  returns  do  not  show 
the  actual  number  of  deaths.  In  Prussia  registration  is  compulsory,  and 
in  that  country  during  the  same  period  819  persons  were  reported  to  have 
been  killed  by  lightninsr.     (Brit.  Assoc.  Rep.,  Aug.  1878.) 

Cause  of' Death. — Electricity  appears  to  act  fatally  by  producing  a 
violent  shock  to  the  brain  and  nervous  system.  In  general  there  is  no 
sense  of  pain  ;  the  individual  falls  at  once  into  a  state  of  unconscious- 
ne.ss.  In  a  case  which  did  not  prove  fatal  the  person,  who  was  seen  soon 
after  the  accident,  was  found  laboring  under  the  following  symptoms: 
Insensibility  ;  deep,  slow,  and  interrupted  respiration  ;  entire  relaxation 
of  the  muscular  sy.stem  ;  the  pulse  soft  and  slow ;  the  pupils  dilated,  but 
sensible  to  light.  (Lon.  Med.  Gaz.,  vol.  xiv.  p.  654.)  It  will  be  seen 
that  these  are  the  usual  symptoms  of  concussion  of  the  brain.  The  effect 
of  a  slight  shock  is  that  of  producing  stunning ;  and  when  persons  who 
have  been  severelv  struck  recover  they  suffer  from  noises  in  the  ears, 
paraly.sis,  and  other  symptoms  of  nervous  disorder.  (Med.  Times,  July 
]o,  1848.)  Insanity  has  even  been  known  to  follow  a  stroke  of  lightning. 
(Connolly's  Rep.  of  Hanwell,  1839.)  In  one  case  the  person  remained 
delirious  for  three  days,  and  when  he  recovered  he  had  completely  lost  his 
memory.     (Lancet,  1839,  ii.  p.  582.)     A  boy,  aet,  4,  received  a  severe 


LIGHTNING — APPEARANCES    AFTER    DEATH.  465 

shock  on  ]May  11th,  was  seized  with  tetanus  on  the  13th,  and  died  in  four 
hours.  (Med.  Times  and  Gaz.,  1855,  i.  p.  533.)  In  another  instance, 
an  old  man  who  took  shelter  under  a  tree  felt  as  if  a  vivid  flash  had 
struck  him  in  the  face  ;  he  did  not  fall,  but  he  became  almost  blind.  He 
suffered  for  some  days  from  frontal  headache,  and  loss  of  sight  super- 
vened. (Med.  Times  and  Gaz.,  1858,  ii.  p.  90.)  Under  slight  shocks 
the  principal  symptoms,  which  soon  disappear,  are  headache  and  confu- 
sion of  intellect. 

It  may  be  observed  of  the  effects  of  lightning  generally,  that  death  is 
either  immediate  or  the  individual  recovers.  A  person  may,  however, 
linger,  and  die  from  the  effects  of  severe  lacerations  or  barns  indirectly 
produced.  In  a  case  which  occurred  in  1838,  death  was  thus  caused 
indirectly  by  the  effects  of  electricity.  The  following  case  of  recovery 
illustrates  further  the  action  of  electricity.  Three  persons  were  struck  by 
lightning  at  the  same  time.  In  one,  a  healthy  man,  set.  26,  the  symptoms 
were  severe.  An  hour  and  a  half  after  the  stroke  he  lay  completely  uncon- 
scious, as  if  in  a  fit  of  apoplexy  ;  his  pulse  was  below  60,  full  and  hard ; 
respiration  snoring;  pupils  dilated  and  insensible.  There  were  frequent 
twitchings  of  the  arms  and  hands  ;  the  thumbs  were  fixed  and  immovable, 
and  the  jaws  firmly  clenched.  Severe  spasms  then  came  on,  so  that  four 
men  could  scarcely  hold  him  in  his  bed  ;  and  his  body  was  drawn  to  the 
left  side.  "When  these  symptoms  had  abated,  he  was  copiously  bled  ;  cold 
was  applied  to  the  head,  a  blister  to  the  nape  of  the  neck,  and  mustard- 
poultices  to  the  legs.  Stimulating  injections  and  opium  were  also  adminis- 
tered. In  the  course  of  twenty-four  hours  consciousness  slowly  returned, 
and  the  man  soon  completely  recovered.  The  only  external  injury  dis- 
coverable was  a  red  streak,  as  broad  as  a  finger,  which  extended  from  the 
left  temple  over  the  neck  and  chest:  this  disappeared  completely  in  a  few 
days.  (Brit,  and  For.  Med.  Rev.,  Oct.  1842.)  These  red  streaks  or 
marks  sometimes  assume  a  remarkable  disposition  over  the  skin.  (Yier- 
teljahrsschr.  fur  Gerichtl.  Med.,  1863,  p.  308.) 

Appearances  after  Death. — The  suddenness  of  death  is  such  that,  the 
body  sometimes  preserves  the  attitude  in  which  it  was  struck  (Med.  Times 
and  -Gaz.,  1860,  i.  p.  167),  and  there  may  be  no  appearances,  and  no 
physical  changes  in  the  body  or  dress,  to  indicate  the  mode  of  death.  Five 
negroes  were  simultaneously  prostrated  by  a  single  stroke  of  lightning. 
Three,  including  two  children,  were  instantaneously  killed.  The  only 
mark  of  injury  found  on  one,  an  adult  female,  was  a  burnt  spot,  the  size 
of  a  dollar,  under  the  right  axilla,  and  this  woman's  clothes  were  set  on 
fire.  (Dub.  Med.  Press,  May  14,  1845.)  Persons  involved  in  the  same 
flash  do  not  all  suffer  equally.  A  man,  a  woman,  and  a  boy  were  simulta- 
neously struck  in  an  open  field.  The  man  heard  the  thunder ;  he  felt  his 
hat  thrust  down  upon  his  head,  as  if  by  violent  pressure.  The  boy  was 
confused  and  unsteady,  but  conscious.  The  woman  was  lying  on  the 
ground,  speechless  and  moaning ;  she  soon  recovered  ;  she  had  heard  no 
thunder,  and  saw  no  lightning.  (Brit.  Med.  Jour.,  1876,  i.  p.  102.) 
Those  who  are  severely  struck  do  not  hear  the  thunder.  Generally  speak- 
ing, there  are,  externally,  marks  of  contusion  and  laceration  about  the  spot 
where  the  electric  current  has  entered  or  passed  out :  sometimes  a  severe 
lacerated  wound  has  existed  ;  on  other  occasions  there  has  been  no  wound 
or  laceration,  but  an  extensive  ecchymosis,  which,  according  to  Meyer,  is 
most  commonly  found  on  the  skin  of  the  back.  In  one  instance,  which 
occurred  in  London  in  May,  1839,  there  were  no  marks  of  external  vio- 
lence ;  and  several  similar  cases  are  quoted  from  American  journals. 
(Med.  Times,  1845,  i.  p.  82.)  The  clothes  are  in  almost  all  cases  rent 
30 


■466  LIGHTNING — ITS    EFFECT    ON    THE    BODY. 

and  torn,  and  partially  singed,  giving  rise  to  a  peculiar  burnt  odor, — some 
times  even  rolled  up  in  shreds  and  carried  to  a  distance.  They  are  occa- 
sionally found  partially  burnt,  but  this  is  not  a  frequent  occurrence. 
Metallic  substances  about  the  person  present  traces  of  fusion,  and  articles 
of  steel  have  been  observed  to  acquire  magnetic  polarit}'.  West  met  with 
the  case  of  a  boy,  set.  18,  instantly  struck  dead  by  lightning,  where  a  knife 
in  the  pocket  had  strong  magnetic  polarity.  This  case  further  shows  that 
which  has  frequently  been  noticed — namely,  that  while  much  violence  has 
been  done  to  the  dress,  the  parts  of  the  body  covered  by  it  have  escaped 
injury.  The  deceased  wore  at  the  time  of  the  accident  a  pair  of  strong 
leather  boots ;  these  were  torn  to  shreds,  probably  owing  to  the  presence 
of  iron  nails  in  the  soles,  but  the  feet  of  the  deceased  presented  no  mark 
of  injury.  An  accident  by  lightning  occurred,  in  which  a  man  was  in- 
stantaneously killed.  A  cap  which  the  man  wore  had  a  hole  through  it ; 
his  hair  was  singed,  his  shoes  were  burst  open,  and  his  trousers  torn. 
The  woodwork  of  the  building  down  which  the  electricity  passed  was 
merely  split,  and  there  was  no  mark  of  burning.  AVe  have  examined,  in 
several  instances,  the  wood  of  trees  which  have  been  struck  b_y  lightning  : 
in  each  case  it  has  presented  only  the  appearance  of  rending  by  mechanical 
force,  the  inner  bark  being  torn  from  the  alburnum. 

Wounds  and  hums  are  sometimes  met  with  on  the  body.  The  wounds 
have  commonly  been  lacerated  punctures,  like  stabs  produced  by  a  blunt 
dagger.  In  the  case  of  a  person  who  was  struck  but  not  killed,  a  deep 
wound  was  produced  in  one  thigh,  almost  laying  bare  the  femoral  artery. 
This  person  was  struck,  as  many  others  have  been,  while  in  the  act  of 
opening  an  umbrella  during  a  storm.  Fractures  of  the  bones  have  not 
been  commonly  observed ;  but  in  a  case  mentioned  by  PouUet,  the  skull 
w"as  severely  fractured  and  the  bones  were  depressed. 

In  1864.  Mackintosh  was  called  to  see  three  persons  who  had  been 
struck  by  lightning  about  twenty  viinutes  previously.  They  had  taken 
shelter  under  a  haystack,  which  had  been  set  on  fire  by  the  same  flash. 
1.  A  boy,  aet.  10,  was  then  able  to  walk,  although  unable  to  move  his  legs 
immediately  after  the  occurrence.  All  that  he  remembered  was  that  he 
saw  the  stack  on  fire,  and  called  to  his  father  ;  he  felt  dizzy  all  over,  and 
unable  to  move.  His  hair  and  clothes  were  not  singed,  and  the  metallic 
buttons  on  his  dress  showed  no  signs  of  fusion.  On  removing  his  clothes 
a  slight  odor  of  singeing  was  perceptible.  He  complained  of  pain  in  the 
lower  part  of  the  abdomen.  There  were  several  red  streaks,  of  about  a 
finger's  breadth,  running  obliquely  downwards  and  inwards  on  either  side 
of  the  chest  to  the  middle  line  in  front  of  the  abdomen ;  they  then  de- 
scended over  the  pubes,  and  were  lost  in  the  perineum.  It  does  not  ap- 
pear that  there  was  any  abrasion  of  the  skin.  This  boy  perfectly  recov- 
ered ;  the  red  streaks  disappeared  gradually,  and  could  hardly  be  traced 
four  days  after  the  injury.  2.  Another  boy,  sdt.  11,  lay  prostrate  and  un- 
conscious, with  an  expression  of  grim  terror  and  suffering ;  he  frothed  at 
the  mouth,  moaned  piteously,  and  flung  his  legs  and  arms  about  in  all 
directions.  The  breathing  was  deep,  slow,  and  laborious  ;  the  heart  palpi- 
tating, the  pulse  weak  and  very  irregular ;  the  pupils  dilated,  and  insensi- 
ble to  light.  There  were  in  this  case  several  red  streaks  converging  from 
the  neck  and  shoulders  to  the  middle  of  the  chest-bone,  and  passing  over 
the  abdomen  until  they  were  lost  on  the  pubes.  There  were  similar 
streaks  radiating  for  a  few  inches  from  the  tuber  ischii  on  each  hip  in 
different  directions,  until  they  were  lost  in  the  skin.  It  appears  that  this 
boy  was  in  a  sitting  posture  when  struck.  The  hair  on  the  back  of  his 
head  and  neck  was  singed,  and  the  peculiar  odor  of  singeing  was  per- 


LIGHTNING  —  ITS    EFFECT    ON    THE    BODY.  407 

ceived,  althou,t>-h  his  clothes  showed  no  traces  of  burning-,  nor  the  metallic 
buttons  of  fusion.  The  boy  became  conscious  in  five  hours,  and  ra})idij 
recovered.  The  red  streaks  gradually  disappeared,  leavin,f^  marks  of  a 
scaly,  glistening-,  white  appearance,  which  ultimately  left  no  trace  of  their 
existence.  3.  A  man,  tet.  46,  like  the  two  others,  was  in  a  sitting  posture, 
and  appeared  to  have  been  killed  on  the  spot;  he  had  not  moved  hand  or 
foot.  The  countenance  was  placid,  and  the  pupils  were  widely  dilated. 
There  was  a  large  lacerated  ivoimd  of  the  scalp  at  the  junction  of  the 
occipital  with  the  parietal  bones,  but  without  any  fracture.  The  electric 
current  appeared  to  have  passed  down  each  side  of  the  head,  between  the 
soft  parts  and  the  cranium.  On  the  left  side  it  had  passed  downwards  in 
front  to  the  left  ear,  and  terminated  on  the  side  of  the  neck,  rupturing 
bloodvessels  and  muscles,  and  causing  swelling  of  the  parts  with  elfusion 
of  blood.  It  presented  the  appearance  of  an  extensive  bruise  caused  ,by  . 
mechanical  violence.  On  the  right  side  the  current  had  passed  down  to 
the  space  above  the  collar-bone,  causing  lividity  and  swelling  of  the  right 
ear  as  well  as  of  the  adjacent  skin  ;  and  it  terminated  in  a  dark-blue 
mangled  patch  of  skin,  in  which  there  were  several  free  communications 
with  the  surface.  The  hair  on  the  back  of  the  head  was  slightly  singed, 
and  that  in  front  of  the  chest  was  singed  quite  close  to  the  skin  ;  but  the 
hair  which  covered  the  wound  in  the  scalp,  where  the  current  had  entered, 
w^as  uninjured.  The  clothes  were  neither  torn  nor  burnt,  and  the  metallic 
buttons  were  not  fused.  The  clothes  of  all  three  were  very  wet.  The 
hat  was  not  examined.  The  left  side-pocket  of  the  trousers  contained  several 
lucifer  matches  and  a  tin  tobacco-box,  which  were  unaffected  by  the  elec- 
tric discharge.  The  right  pocket  contained  a  knife,  which  had  acquired 
strong  magnetic  polarity.  The  body  was  placed  in  a  warm  room,  and  it 
is  worthy  of  remark  that  cadaveric  rigidity  came  on  in  fourteen  hours 
after  death.  (Lancet,  18G4,  ii.  p.  118.)  It  is  to  be  regretted  that  no  post- 
mortem examination  was  allowed.  It  is  probable  that  the  brain  sustained 
severe  injury,  causing  immediate  death.  These  cases  singularly  present 
the  effect  of  lightning  in  three  degrees — the  effect  of  a  slight  shock  in  No. 
1,  of  a  severe  shock  in  No.  2,  and  of  a  fatal  shock  in  No.  3.  There  was 
but  little  bodily  injury  in  any  case,  and  no  appearance  of  burning.  The 
marks  on  the  skin  in  Nos.  1  and  2  could  not  have  been  mistaken  for  vio- 
lence, but  the  wound  to  the  scalp  and  the  injuries  to  the  neck  in  No.  3 
might  have  been  ascribed  to  the  violence  of  another,  had  not  the  circum- 
stances been  fully  known.  The  clothes  probably  escaped  burning  or  tear- 
ing by  reason  of  their  being  wet  and  their  readily  conducting  electricity. 
The  burns  occasionally  found  on  the  bodies  of  persons  who  have  been 
struck  by  lightning  have  been  hitherto  ascribed  to  the  ignition  of  the 
clothes.  It  appears,  however,  from  the  subjoined  cases,  that  burns  even 
of  a  severe  kind  may  be  the  result  of  a  direct  agency  of  electricity  itself 
upon  the  body.  Greoghegan  met  with  the  case  of  a  girl  who  had  been 
struck  by  lightning;  there  was  burning  of  the  thigh  and  buttocks  to  the 
first  and  second  degrees,  but  the  clothes  did  not  show  any  signs  of  com- 
bustion. In  1852,  a  man,  ^t.  23,  while  engaged  in  milking  a  cow  in  a 
wooden  shed  during  a  severe  thunderstorm,  suddenly  observed  a  vivid 
flash  of  lightning,  which  killed  the  cow  instantly  and  inflicted  serious  in- 
juries upon  himself.  He  was  seen  sixteen  hours  after  the  accident,  and  a 
severe  burn  was  found  on  his  person,  extending  from  the  right  hip  to  the 
shoulder,  and  covering  a  large  portion  of  the  front  and  side  of  his  body. 
His  mind  was  then  wandering,  and  there  were  symptoms  of  inflammatory 
fever.  The  man  was  confined  to  his  bed  for  seventeen  days,  at  the  end 
of  which  time  the  injuries  had  not  perfectly  healed.     On  examining  his 


468  EFFECTS    ON    THE    NERVOUS    SYSTEM. 

dress,  the  right  sleeve  of  his  shirt  AA-as  found  burnt  to  shreds,  but  there 
was  no  material  burning  of  any  other  part  of  the  dress.  The  case  is 
singular,  inasmuch  as  it  bhows  that  the  dress  may  be  burnt  without  the 
surface  of  the  body  being  simultaneously  injured;  and  further,  that  a 
burn  may  be  produced  on  the  body,  although  the  clothes  covering  the 
part  may  have  escaped  combustion. 

Fleming  has  described  the  cases  of  eight  persons  who  were  struck  by 
lightning,  and  on  the  bodies  of  some  of  these  were  marks  of  severe  burns. 
The  dresses  were  in  parts  much  singed.  These  cases  show,  in  a  remark- 
able manner,  the  intense  heat  evolved  in  the  instantaneous  passage  of  the 
electric  current  through  the  clothes  and  body.  The  persons  struck  were 
benumbed  or  paralyzed  in  various  degrees,  but  all  ultimately  recovered; 
the  burns  were  so  severe  that  some  months  elapsed  before  they  were  en- 
tirely healed.  (Glasgow  Med.  Jour.,  Oct,  1859,  p.  257.)  A  man  was 
struck  by  lightning  in  1861.  Externally  there  was  a  burn  upon  the  nape 
of  the  neck,  where  the  metallic  watchguard  rested ;  and  from  the  point 
where  the  current  of  electricity  left  the  chain  the  skin  was  blistered  in  a 
straight  line  down  to  the  feet,  scorching  the  hair  of  the  pubes  in  its  course. 
The  man's  intellect  was  confused  and  his  general  condition  Avas  that  of 
collapse.  With  the  aid  of  stimulants  he  became  sufficiently  restored  to 
communicate  his  feelings.  There  was  paralysis  of  the  legs,  with  loss  of 
sensibility  (angesthesia)  and  retention  of  uritie.  He  was  deaf,  and  com- 
plained of  a  noise  in  his  ears  like  thunder ;  he  had  some  difficulty  in 
articulating,  and  pain  in  swallowing,  with  a  peculiar  metallic  taste  in  his 
mouth.  The  anaesthesia  passed  away  in  half  an  hour,  but  he  did  not  com- 
pletely recover  the  use  of  his  limbs  for  four  days ;  the  bladder  was  para- 
lyzed for  twenty-four  hours;  the  urine  was  high-colored  and  contained  an 
abundance  of  phosphates.  The  bowels  were  confined.  All  these  symp- 
toms gradually  disappeared,  excepting  slight  deafness,  and  the  man  was 
discharged  convalescent. 

The  following  complete  account  of  the  external  and  internal  appearances 
found  in  the  body  of  a  healthy  middle-aged  laborer,  who  was  killed  by  a 
stroke  of  lightning,  has  been  published  by  Schaffer.  The  man  was  work- 
ing in  the  fields  with  several  other  laborers,  just  after  a  thunderstorm  had 
passed  over  and  had  apparently  subsided.  He  was  endeavoring  to  kindle 
a  light  with  a  flint  and  steel,  when  the  lightning  struck  him.  For  a 
moment  after  the  shock  he  stood  still,  and  then  his  body  fell  heavily  to 
the  ground  lifeless.  The  electric  current  had  entered  at  the  upper  part  of 
his  forehead,  perforating  and  tearing  his  hat  at  that  part ;  it  seemed  then 
to  have  become  divided  into  two  currents,  which  passed  down  the  sides  of 
the  body  along  the  lower  limbs  and  out  at  the  feet.  On  the  upper  part  of 
the  forehead  was  found  a  soft  swelling,  of  a  dark-blue  color,  and  about  the 
size  of  the  palm  of  a  hand ;  the  hair  which  covered  it  was  uninjured. 
From  this  spot  two  dark-red  streaks  proceeded  in  different  directions. 
One  of  these  passed  to  the  left,  running  over  the  temple  in  front  of  the  left 
ear,  down  the  neck  to  the  surface  of  the  chest,  over  which  it  passed  be- 
tween the  left  nipple  and  the  armpit;  and  so  made  its  way  over  the  body 
to  the  left  inguinal  region,  where  it  formed  a  large,  irregular,  scorched- 
looking  patch  on  the  skin.  From  this  point  the  dark-red  streak  again 
continued  its  downward  course,  passing  over  the  great  trochanter  of  the 
femur,  then  along  the  outer  surface  of  the  left  leg  to  the  back  of  the  foot, 
where  it  terminated  in  several  small  dark-blue  spots.  The  other  streak, 
which  proceeded  from  the  ecchymosed  swelling  on  the  forehead,  passed 
directly  to  the  right  ear,  which  was  considerably  swollen  and  of  a  dark-blue 
color ;  from  the  ear  it  ran  downwards  and  backwards  along  the  neck, 


ECCHYMOSES    FROM    LIGHTNING.  469 

crossed  the  right  border  of  the  scapula,  and  eventually  reached  the  right 
groin,  where  a  scorched  patch  of  skin  similar  to  that  in  the  left  groin  was 
found.  From  this  part  the  discolored  streak  continued  down  the  outer 
side  of  the  right  leg,  to  its  termination  on  the  back  of  the  foot,  just  as  on 
the  left  side.  The  hair  on  the  forehead,  as  well  as  that  which  is  present 
in  any  part  of  the  track  taken  by  the  electric  current  down  to  the  groin, 
was  not  burnt,  yet  at  the  groin  itself,  and  at  every  part  hence  to  the  foot, 
over  which  the  electric  current  had  passed,  the  hairs  were  completely 
burnt.  The  cause  of  the  skin  and  hair  in  the  groins  being  burnt  is  prob- 
ably to  be  referred  to  the  buckles  of  a  belt  which  the  man  wore  round  his 
abdomen  at  the  time  of  the  accident  ;  the  belt  was  completely  destroyed. 
]S"othing  further  worthy  of  notice  was  observed  on  the  exterior  of  the 
body,  with  the  exception  of  the  face  being  very  red.  The  swelling  of  the 
head  was  found  to  be  due  to  the  presence  of  a  large  quantity  of  extrava-  • 
sated  blood.  The  bone  beneath  was  not  injured.  About  four  ounces  of 
blood  had  been  effused  in  other  parts  of  the  scalp  corresponding  to  the 
swollen  discolored  patches  outside.  The  vessels  of  the  cerebral  membranes 
were  greatly  congested,  and  the  brain  itself  contained  much  blood,  espe- 
cially observed  in  the  choroid  plexuses.  A  large  quantity  of  reddish 
mucus  was  found  in  the  larynx,  windpipe,  and  air-tubes.  The  lungs  were 
loaded  with  dark  blood  ;  there  was  a  great  deficiency  of  blood  in  the 
cavities  of  the  heart  and  iu  the  large  vessels.  The  bloodvessels  of  the 
stomach  and  intestines  were  more  than  usually  congested.  The  right  lobe 
of  the  liver  was  of  a  dark-red  color,  and  loaded  with  blood,  especially  the 
part  which  corresponded  to  the  burnt  patch  of  skin  at  the  lower  part 
of  the  abdomen.  The  spleen  also  was  lai'ge  and  filled  with  blood.  Much 
blood  was  found  accumulated  in  the  substance  of  the  muscles  of  the  abdo- 
men at  those  parts  which  lay  beneath  the  burnt  surfaces  outside. 
(Oesterreich.  Med.  Wochenschrift,  June  6,  1846.)  It  was  formerl}^  sup- 
posed that  the  blood  was  never  found  coagulated  in  persons  killed  by 
lightning,  and  that  the  body  did  not  become  rigid  after  death.  Experience 
has  shown,  however,  that  these  statements  are  not  in  accordance  with 
observed  facts. 

Ucchymoses  resembling  those  produced  by  mechanical  violence  and  of 
great  extent  are  sometimes  met  with.  A  short,  muscular  man  was  killed 
by  lightning.  There  was  a  strong  smell  of  burning  about  the  body.  The 
hair  was  singed  considerably  at  the  back  of  the  head,  at  the  nape  of  the 
neck  and  slightly  above  the  forehead,  at  each  corner  of  which  there  was  a 
dark  ecchymosis.  The  scalp  was  greatly  ecchymosed  at  the  top  and  at  the 
back  of  the  head.  There  was  a  large  ecchymosis  at  the  nape  of  the  neck, 
and  from  this  a  livid  band  half  an  inch  broad  curved  round  the  right  side 
of  the  neck  and  terminated  in  a  large  ecchA^nosis  at  the  sternal  end  of  the 
right  clavicle.  The  left  forearm  was  scorched  in  front,  and  along  the 
centre  of  the  scorched  surface  ran  a  dark  line  about  three  or  four  lines 
broad.  There  were  slight  ecchymoses  on  the  right  thigh  and  on  the  right 
side  of  the  scrotum.  About  half-way  down  the  right  leg  was  an  extensive 
scorch  encircling  the  leg,  and  a  line  of  about  three-quarters  of  an  inch  in 
breadth  ran  down  the  inner  side  of  the  leg  to  the  sole.  The  soles  of  both 
feet  were  extensively  blistered  and  the  cuticle  charred.  The  clothing 
corresponding  to  the  injured  parts  was  extensively  scorched,  and  large 
holes  were  burnt  in  the  soles  of  the  socks.  The  boots  were  scorched  in- 
side, but  not  injured  outside,  although  there  were  iron  nails  in  the  soles. 
E.xcepting  the  nails  in  the  boots,  there  was  no  metal  about  the  body. 
The  pupils  were  widely  dilated.  Cadaveric  rigidity  was  unusually 
marked,  requiring  great  force  to  overcome  it.     The  inner  surface  of  the 


470  DEATH    FROM    ELECTRICITY. 

scalp  was  ecchymosed.  The  brain  appeared  bloodless  and  soft,  and  there 
was  but  little  fluid  in  the  ventricles.  The  veins  and  sinuses  of  the  base 
■were  filled  with  dark  fluid  blood.  The  heart  was  flabby;  the  right  ven- 
tricle contained  a  small  quantity  of  dark  fluid  blood  ;  the  great  veins  were 
distended  with  very  dark  blood,  everywhere  perfectly  fluid.  There  w-as 
no  coagulum  or  clot  in  any  part,  and  the  blood  showed  no  tendency  to 
coagulate  after  its  escape.  The  lungs  were  \evj  soft  and  much  congested 
posteriorly.  (Med.  Times  and  Gaz.,  1865,  ii.  p.  418.)  The  external  in- 
juries in  these  cases  resemble  those  caused  by  violence,  but  the  ])eculiar 
form,  extent,  and  direction  of  the  ecchymoses,  as  well  as  the  presence  of 
marks  of  burning,  either  on  the  clothes  or  the  body,  were  sufficient  to  dis- 
tinguish them  as  injuries  produced  bv  electricity. 

For  a  description  of  the  minor  effects  of  electricity,  the  reader  is  referred 
to  the  cases  of  two  club  servants  struck  by  lightning  in  London  in 
January,  1885.  (Brit.  Med  Jour.,  1885,  i.  p.  458.)  Mackay  also  describes 
the  curious  marks  he  met  with  on  a  boy  struck  by  lightning.  (Edin.  Med. 
Jour.,  1883,  ii   p.  560.) 

Deaths  resulting  from  the  application  of  electricity  for  illuminating  pur- 
poses have,  within  the  last  few  3^ears,  occurred  with  some  frequency.  A 
case  is  recorded  where  a  young  man  at  a  theatre,  out  of  curiosity,  touched 
two  conducting  wires  from  a  dynamo-machine.  He  fell  senseless,  and 
died  in  forty  minutes.  A  sailgr  on  board  the  Imperial  Russian  yacht 
Livadia  touched  the  wires  of  the  machine,  and  was  struck  dead  almost 
immediately.  A  gardener  was  found  dead  at  Hatfield  House,  in  the 
neighborhood  of  the  conducting  wires  of  a  dynamo-machine,  and  these 
he  was  supposed  to  have  touched  accidentally.  Still  more  recently,  two 
men  perished  in  Paris  by  accidentally  coming  in  contact  with  some  con- 
ducting wires  whilst  climbing  a  wall.  In  1884  a  man  at  the  Health 
Exhibition  in  London  died  in  a  moment  from  grasping  the  two  wires  of 
a  dynamo-machine  which  he  was  engaged  in  cleaning.  The  appearances 
met  with  in  the  Parisian  cases  have  been  recorded  (Ann.  d'Hyg.,  1885,  t. 
13,  p.  53),  and  also  those  observed  on  the  man  killed  at  the  Health  Exhi- 
bition. (Brit.  Med.  Jour.,  1885,  i.  p.  550.)  In  this  latter  case,  on  the 
outer  side  of  the  left  forefinger  was  a  small  elongated  blister,  about  half 
an  inch  in  length,  which  had  the  appearance  of  a  burn  ;  but  there  was  no 
surrounding  congestion  of  the  skin,  nor  any  smell  of  charred  skin.  Some 
of  the  epidermic  cells  of  the  skin  raised  by  the  blister  appeared  as  if  fused 
together. 

Electricity  has,  singularly  enough,  been  employed  for  suicidal  pur- 
poses. In  1885,  Paul  Thiebault,  with  this  intent,  deliberately  took  hold 
of  the  conductors  of  a  dynamo-machine  at  the  works  of  M.  Chertemps, 
in  Paris,  and  was  instantaneously  killed.  (Brit.  Med.  Jour.,  1885,  i.  p. 
550.) 

In  August,  1890,  a  murderer,  Kemmler,  was  judicially  executed  by 
electricity  at  Auburn,  U.S.A.,  the  current  being  introduced  into  the  body 
at  the  shaven  scalp.  At  the  necropsy  there  was  a  well-defined  circle  at 
the  top  of  the  head  where  the  skin  had  been  scorched,  and  a  circular  spot 
four  inches  in  circumference  on  the  small  of  the  back  where  the  second 
electrode  had  been  applied.  The  body  was  much  Inirned,  and  became  rigid 
within  an  hour  of  death.  On  the  brain  and  beneath  the  spot  where  the 
electrodes  had  been  applied  the  blood  was  burnt  to  a  carbonaceous  mass. 
The  spina!  cord,  brain,  muscles,  heart,  and  abdominal  organs  were  normal. 
(Brit.  Med.  Jour.,  1890,  ii.  p.  354.) 

[The  post-mortems  made  upon  the  bodies  of  four  murderers  at  the  New 
York  State  Prison,  executed  by  electricity  under  the  new  statute  in  that 


DEATH    FROM    ELECTRICITY.  471 

State,  July  1,  1891,  will  shed  valuable  light  upon  this  subject.  I  quote 
from  the  official  post-mortem  report  made  bv  Carlos  F.  MacDonald,  M.D., 
and  S.  13.  Ward,  M.D.  :— 

"  In  all  these  cases  one  electrode  was  so  applied  as  to  cover  the  fore- 
head and  temples,  and  the  other — a  larger  one — the  calf  of  the  right  leg, 
except  in  the  case  of  Joseph  Wood,  in  which  it  was  applied  to  the  left  leg, 
in  consequence  of  the  existence  of  an  ulcer  on  the  right  one.  The  elec- 
trodes were  thoroughly  wet  with  a  solution  of  salt  and  water  before  the 
current  was  turned  on,  and  were  moistened  at  intervals,  when  the  current 
was  interrupted,  with  the  same  solution  thrown  on  them  from  a  syringe. 

"James  J.  Slocum  entered  the  execution-room  at  4:33  A.M.,  and 
passed  at  once  to  the  chair,  accompanied  by  his  priest  and  occupied  with 
his  devotions.  The  restraining  straps  and  electrodes  were  adjusted  expe- 
ditiously and  without  resistance,  and  the  electric  circuit  was  completed  for 
the  first  time  at  4:36:40.  The  first  contact  lasted  twenty-seven  seconds, 
at  the  end  of  which  time  it  was  broken  ;  but  the  pulse  was  still  found  to  be 
beating  strongly,  and,  between  one  and  two  minutes  later,  a  noisy  respira- 
tion became  established  with  considerable  regularity.  The  current  was 
immediately  re-applied,  and  continued  for  twenty-six  and  a  quarter  seconds, 
and  was  finally  broken  at  4:39.  Respiration  had  then  ceased  entirely 
and  permanently,  and  auscultation  showed  that  the  heart-beat  had  also 
ceased.  The  body  was  removed  to  the  dead-house  at  5  A.M.  Four  min- 
utes later  rigor  mortis  was  found  jfco  be  markedly  developed  in  the  right 
leg,  and  rapidly  extended  to  all  the  muscles  of  the  neck  and  trunk,  appear- 
ing last  in  the  arms. 

"  Professor  L.  H.  Laudy  reports  that  the  pressure  in  this  case  amounted 
to  1458  volts. 

"  After  the  removal  of  Slocum's  body,  consultation  among  the  medical 
gentlemen  present  seemed  to  point  to  the  unanimous  feeling  that  it  was 
quite  possible  that  the  long  continuance  of  the  current  was  not  so  im- 
portant a  factor  in  producing  rapid  cessation  of  the  heart-beat  as  the 
sudden  impact  of  making  and  breaking  the  contact,  and  for  that  reason  the 
next  execution  was  conducted  a  little  differently. 

"  Harris  A.  Smiler  entered  the  room  at  5:06:30  A.M.  The  first  contact 
was  made  at  5:08:30  A.M.,  and  continued  ten  seconds;  was  then  inter- 
rupted to  allow  of  wetting  the  sponges;  was  again  made  for  ten  seconds, 
and  again  the  sponges  were  wet ;  and  a  third  contact  was  made  for  ten 
seconds.  Three  contacts,  of  ten  seconds  each,  were  thus  made,  at  the 
end  of  which  time  there  was  no  effort  at  respiration,  but  the  pulse  was 
beating  so  firmly  and  regularly  that  it  was  deemed  expedient  to  close 
the  circuit  again  for  nineteen  seconds,  at  the  end  of  which  time  ausculta- 
tion showed  that  the  heart  had  permanently  ceased  beating.  This  obser- 
vation was  confirmed  by  Doctors  Ward,  MacDonald,  Rockwell,  Barber, 
Daniels,  Townsend,  Allison,  and  Wilson  in  succession.  The  body  was 
removed  from  the  execution-room  at  5:28  A.M.  At  5:25  rigor  mortis  was 
well  marked  in  the  right  leg,  and  proceeded  to  extend  as  in  the  previous 
case. 

"  Professor  Laudy  reported  in  this  case  a  pressure  of  1485  volts. 

"  It  will  be  noticed  in  the  first  case  the  current  was  applied  for  fifty- 
three  seconds  in  all.  At  the  end  of  that  time  respiration  and  the  heart- 
beat had  permanently  ceased.  In  the  second  case,  at  the  end  of  three 
contacts  of  ten  seconds  each,  the  heart-beat  was  still  strong,  and  at  the 
end  of  the  fourth  application,  of  nineteen  seconds  more,  had  permanently 
ceased.  It  would  appear  from  this  that  the  duration  of  the  current  was 
quite  as  important  an  item  as  the  making  and  breaking  of  the  contact. 


472  DEATH    FROM    ELECTRICITY. 

It  -^'as  therefore  determined  to  make  the  contact  in  the  next  case  a  little 
longer,  interruptions  being- necessary  to  permit  of  moistening  the  sponges. 

"Joseph  "Wood  entered  the  room  at  5:32,  and  the  electric  circuit  was 
completed  at  5:34:40.  Three  contacts  of  twenty  seconds  each  were  made, 
at  the  end  of  which  time  respiration  had  ceased  permanently :  no  pulse 
could  be  felt  at  the  wrist,  and  no  heart-beat  was  heard  on  auscultation, 
though  it  was  listened  for  by  Doctors  Ward,  MacDonald,  Rockwell,  South- 
wick,  Daniels,  Allison,  and  Barber.  An  extremely  fine,  faint  crepitation 
could  be  heard,  but  nothing  else.  At  5:53  the  body  was  removed  from 
the  room. 

"  Professor  Laudy  reported  in  this  case  a  pressure  of  1435  volts. 

"Feeling  that  perhaps  the  contacts  had  been  unnecessarily  prolonged,  it 
was  determined  to  make  them  a  little  shorter  in  the  next  case. 

"  Schichick  Jugigo  entered  the  room  at  6:00:30  A.M.  At  6:02:15  A.M. 
the  circuit  was  closed  for  the  first  time,  and  three  contacts  of  fifteen  seconds 
each  followed,  with  two  intervals  of  twenty  seconds  each.  When  the 
current  was  finally  broken  a  very  slight  fluttering  was  felt  at  the  wrist, 
Avhich  observation  was  confirmed  by  Doctors  Ward,  Daniels,  Rockwell, 
Wilson,  and  Townsend,  and  by  Ward  a  second  time. 

"  In  this  case  extreme  heat  was  noticed  in  the  region  of  the  knee  above 
the  point  where  the  lower  electrode  had  been  applied,  and  a  thermometer 
held  against  the  skin  for  only  fifteen  seconds  ran  up  to  112°,  the  highest 
point  it  registered,  while  the  sensation  conveyed  to  the  band  was  such  as 
to  render  it  probable  that  the  temperature  had  run  up  to  the  boiling-point 
of  water,  if  not  higher.  At  6:17  the  chest  was  bared  and  the  cessation  of 
the  heart-beat  was  confirmed  by  Drs.  Ward,  MacDonald,  Cortelyou,  Alli- 
son, Wilson,  and  Barber.     The  body  was  removed  from  the  room  at  6:24. 

"  The  pressure  reported  by  Professor  Laudy  in  this  case  was  1485  volts. 

"From  the  experience  had  in  these  four  cases  we  are  inclined  to  the 
belief  that,  while  unconsciousness  was  instantaneous  and  continuous  from 
the  first  moment  of  contact  in  each  case,  yet,  in  order  to  insure  that  death 
supervene  as  speedily  as  possible,  it  is  necessary  to  continue  a  current  of 
the  voltage  employed  in  these  cases  for  from  fifty  to  sixty  seconds.  In 
each  case  the  temperature  of  the  water  near  to  and  at  the  edges  of  the 
electrodes  was  raised  nearly  if  not  Ciuite,  to  the  boiling-point,  so  as  to 
blister  the  skin  more  or  less  extensively  ;  there  was  absolutely  nowhere 
any  smoking,  or  charring,  or  burning. 

"  The  autopsies  in  all  these  cases  were  made  as  soon  as  could  conve- 
niently be  done  after  the  executions.  On  account  of  his  reputation  in  this 
special  line,  they  were  intrusted  to  Dr.  Ira  T.  TanGiesen,  of  New  York. 
That  of  the  Japanese,  Schichick  Jugigo,  Avas  made  first,  at  10  A.M.,  in  the 
presence  of  Drs.  C.  F.  jVIacDonald,  S.  B.  Ward,  and  others.  In  this 
autopsy  Dr.  YanGiesen  was  assisted  by   Dr.  Daniels. 

"Tuesdav,  July  T,  1891,  10  A.M.  '  Present— Dr.';.  Ira  T.  YanGiesen, 
C.  F.  MacDonald,  A.  P.  Southwick,  C.  M.  Daniels,  H.  E.  Allison, 
Franklin  Townsend,  Jr.,  L.  Y.  Cortelvou,  Hiram  Barber,  Henry  Wilson, 
and  S.  B.  Ward. 

"  Schichick  Jugigo. — The  post-mortem  examination  in  this  case  was  con- 
ducted by  Dr.  Ira  T.  YanGiesen,  assisted  by  Dr.  Daniels,  and  was  held 
four  hours  after  death.  The  pupils  were  alike  and  moderately  contracted. 
The  body  wns  well  nourished  and  unusually  well  developed.  The  anterior 
epithelial  cells  of  the  cornea  had  desc|uamated  from  the  central  portion  by 
the  action  of  heat.  There  was  a  l)ul,i;ing  forward  of  the  sclera  of  the  left 
eye  at  the  left  sclero-corneal  junction.  Conjunctiva  anD9niic.  The  scalp 
and  skin  covering  the  neck  had  a  dull  purplish  hue.     The  skin  of  the 


DEATH    FROM    ELECTRICITY.  473 

anterior  surface  of  the  body  was  not  discolored  or  ecchymosed.  At  the 
flexure  of  both  elbows  were  a  number  of  symuietrical  linear  ecchymoses, 
which  were  more  marked  on  the  right  side.  Also  a  curved,  narrow 
ecchymotic  line  just  below  the  outside  of  the  right  nipple.  These  probably 
were  caused  by  the  straps.  At  the  posterior  surface  of  the  right  knee- 
joint,  and  on  the  posterior  and  inner  and  upper  surface  of  the  calf,  the 
epidermis  was  raised,  wrinkled,  and  folded.  At  the  flexure  of  the  knee- 
joint  the  epidermis  had  been  torn  away  to  the  extent  of  about  an  inch  in 
diameter.  Tiie  right  lower  extremity  was  flexed  and  bent  more  to  the 
median  li-ne  than  its  fellow.  There  was  a  slight  discharge  of  thin  milky 
fluid  from  the  urethra,  and  some  still  remaining  in  the  canal.  A  sample 
of  this  fluid  was  taken  for  microscopical  examination.  Post-mortem 
rigidity  well  marked  except  in  arms,  where  it  was  only  slight.  The  whole 
posterior  surface  of  neck,  trunk,  arms,  and  lower  extremities  was  of  a  dull 
purplish  hue.  There  were  a  few  slight  blisters  on  both  temples  and  both 
cheeks  and  e_velids.  There  were  raised  whitish  streaks  on  both  sides  of 
the  neck  just  below  the  anu'le  of  the  jaw. 

"  The  trunk  was  opened  by  a  straight  incision  from  the  top  of  the  ster- 
num to  the  pubes.  The  fat  was  one  inch  thick  over  the  abdomen.  Mus- 
cles red  and  firm.  Diaphragm  at  left  side  was  found  at  the  level  of  the 
sixth  intercostal  space,  and  on  the  right  side  at  the  fifth  intercostal  space. 
Portions  of  small  intestine  were  taken  for  microscopical  examination. 

"  Examination  of  heart.  Auricles  and  ventricles  flaccid  and  in  diastole, 
and  filled  with  fluid  blood.  The  larger  vessels  were  tied  and  the  heart 
removed.  The  left  ventricle  was  well  filled  with  fluid  blood,  but  no  clots. 
The  auricles  were  the  same.  The  blood  was  of  the  same  color  in  the  left 
ventricle  as  in  the  right.  Yalves  normal.  On  opening  the  vessels  a  large 
quantity  of  dark  colored  liquid  blood  escaped,  half  filling  the  pleural 
cavity.  There  were  no  pleural  adhesions.  Lungs  perfectly  healthy,  but 
slightly  congested. 

"  The  spleen  was  found  to  be  of  normal  size,  the  capsule  smooth,  pulp 
firm,  and  uniformly  filled  with  blood,  and  the  arrangement  of  the  Malpigh- 
ian  bodies  and  splenic  connective  tissue  entirely  normal.  The  pancreas 
was  perfectly  normal,  and  a  portion  removed  for  microscopical  examina- 
tion. Liver  entirel}^  normal,  and  a  portion  was  also  removed  for  micro- 
scopical examination.  The  gall-bladder  was  filled  with  bile.  Left  kidney. 
The  capsule  was  non-adherent.  It  was  rather  large,  and  the  cortex  of 
normal  thickness.  The  kidney  was  uniformly  injected,  and  the  markings 
in  the  cortex  were  normal  as  to  number  and  arrangement.  The  right 
kidney  was  the  same. 

"  The  stomach  was  empty,  the  mucous  membrane  pale,  the  rugae  were 
well  marked  and  perfectly  healthy.  The  intestines  were  healthy.  The 
small  intestine  was  filled  with  semi-fluid  feces.  The  large  intestine  was 
the  same.     The  urinary  bladder  was  normal  and  half  full. 

"  Examination  of  brain.  The  brain  was  exposed  by  a  straight  incision 
on  scalp  over  the  vortex  from  ear  to  ear,  and  saw-cuts  through  the  skull  at 
a  slight  angle  and  at  the  level  of  the  eyebrows.  The  scalp  showed  several 
old  scars,  and  was  slightly  less  adherent  under  those  portions  where  the 
electrode  was  attached.  The  skull  was  symmetrical.  The  dura  mater 
was  normal,  and  the  vessels  moderately  dilated.  The  longitudinal  sinus 
was  found  to  be  normal,  and  contained  some  fluid  blood.  The  brain  was 
removed  in  the  usual  way.  The  pia  mater  was  uniformly  thin  and  trans- 
parent; the  vessels  in  a  medium  state  of  congestion;  sulD-pial  fluid  small 
in  amount.  Blood  was  everywhere  fluid  in  the  meshes  of  the  pia  mater. 
There  was  no  apparent  difference  in  that  portion   which  the  electrode 


474  DEATH    FROM    ELECTRICITY. 

covered.  The  vessels  at  the  base  were  perfectly  normal.  The  ventricles 
contained  a  small  amount  of  clear  fluid.  The  roof  and  floor  of  the  lateral 
ventricles  were  normal.  The  ependyma  was  smooth  and  transparent. 
White  substance  firm.  Gray  matter  normal  in  every  respect.  Floor  of 
the  fourth  ventricle,  at  the  upper  half,  contained  some  dilated  vessels,  and 
on  the  left  side  there  was  a  minute,  radiating  petechial  spot  two  mm.  in 
diameter. 

"  The  spinal  cord  was  exposed  in  the  usual  manner.  The  external  ap- 
pearance of  both  cord  and  membrane  was  entirely  normal,  and  the  vessels 
crntaiiied,  if  anything,  even  less  blood  than  usual,  due  probably  to  the 
short  time  that  had  elapsed  between  the  occurrence  of  death  and  the  hold- 
ing of  the  autopsy.  Sections  half  an  inch  apart  showed  nothing  abnor- 
mal. A  portion  of  both  sciatic  nerves  was  taken  for  microscopical 
examination. 

"  Owing  to  the  greatli  length  of  time  necessary  to  make  this  autopsy  as 
completely  and  minutely  as  was  done,  and  the  subsequent  careful  micro- 
scopical examinations,  it  was  not  considered  necessary  to  examine  the  brain 
and  spinal  cord  in  the  other  cases,  especially  as  nothing  of  any  importance 
had  been  observed. 

"  Harnns  A.  Smiler. — The  same  individuals  were  present  as  at  the  last 
autopsy. 

"  Posterior  surface  of  the  body  "U'as  of  the  same  color  and  also  showed 
the  same  blisters  as  in  the  case  of  Jugigo,  The  left  leg  showed  some  con- 
traction. 

"  The  body  was  opened  by  the  long  straight  incision,  as  in  the  case  of 
Jugigo.  The  diaphragm  was  found  on  the  left  side  at  the  sixth  intercostal' 
space,  and  on  the  right  side  at  the  fifth  intercostal  space.  The  left  lung 
was  slightly  adherent  at  the  apex.  The  heart  was  rather  small.  The  left 
ventricle  was  somewhat  firmer  than  the  right,  which  latter  was  a  little 
flabby.  The  auricles  were  distended  with  fluid  blood.  The  right  ventricle 
was  empty  and  collapsed.  The  apex  of  the  left  lung  was  small  and 
shrunken  and  retracted,  and  contained  a  few  scattered,  dense  nodules, 
some  of  which  were  calcified.  Otherwise  the  lung  was  normal,  and  re- 
sembled the  preceding  case.  Right  lung  showed  the  same  sort  of  changes, 
but  not  so  marked.  Small  ecchymotic  spots  (Tardieu's  spots)  were  ob- 
served under  the  pericardium  on  the  surface  of  the  left  ventricle.  The  walls 
of  the  ventricles  were  of  normal  thickness.  There  were  signs  of  an  old 
endocarditis  below  the  aortic  valves.  All  tlie  valves  were  healthy.  The 
spleen  was  small  and  the  pulp  soft  and  normal.  The  pancreas  was  normal. 
The  liver  was  normal  both  in  size  and  texture. 

"  The  left  kidney  was  greatly  hypertrophied  and  the  capsule  non-ad- 
herent. The  cortex  was  somewhat  thickened,  and  the  markings  distinct 
and  regular;  moderately  congested.  The  right  kidney  was  small,  two 
and  a  half  by  three-quarters  of  an  inch  in  size,  and  weighed  48  grammes 
— less  than  an  ounce  and  three-quarters.  The  tissue  was  normal,  but  the 
kidney  was  apparently  couficnitally  .small.  Intestines.  Descending  colon 
was  filled  with  gas;  ascending  colon  and  small  intestine  pallid,  and  con- 
tained semi-fluid  material.  Stomach  contained  undigested  food,  potatoes, 
etc.  Mucous  membrane  pale  and  coated  with  a  thin  layer  of  slim}'- 
mucus.  Bladder  distended  with  urine.  Walls  and  mucous  membrane 
normal.  Examination  of  brain  and  cord  deemed  unnecessary.  The  blood 
was  fluid  everywhere  and  darker  than  normal. 

"Joseph  Wood. — Autopsy  held  at  1:25  P.M.  Same  individuals  were 
present  as  at  the  last  autopsy. 

"  Body  presented  same  appearance  as  in  preceding  cases.    There  was  the 


ELECTRICITY LEGAL    RELATIONS.  475 

same  contraction  of  the  legs,  and  the  same  general  appearance  as  in  the 
others.     Same  condition  of  e))itlie]ium  of  cornea. 

"Median  incision  made  as  in  other  cases.  Diaphragm  attached  to  fifth 
intercostal  space  on  both  sides.  There  were  half  a  dozen  scattered  pete- 
chial points  fonnd  under  the  pericardium,  half  a  mm.  in  diameter.  On 
the  anterior  surface  of  both  ventricles  and  on  the  posterior  surface  of  the 
left  ventricle  were  five  scattered  similar  points.  On  the  posterior  surface 
of  the  right  ventricle  Avere  three  similar  small  points,  and  one  larger,  three 
and  a  half  mm.  in  diameter. 

"Heart  normal  in  size,  and  condition  of  ventricles  the  same  as  in  the 
case  of  Smiler.  Both  lungs  were  free  from  adhesions.  The  right  lung, 
bronchi,  pulmonary  vessels,  and  lung  tissues  were  normal,  but  somewhat 
more  pigmented  than  usual.  The  substance  of  the  lung  was  dry  and  dark 
pink  in  color.  Heart  muscle  pale  and  firm  and  of  normal  thickness.  All 
the  valves  wei'e  normal. 

"  Spleen  was  normal  in  size  and  dark  red  in  color,  and  showed  two 
thickened  white  patches  on  capsule.  The  pulp  was  firm.  The  pancreas 
was  normal.  The  liver  was  normal  in,  every  respect.  Both  kidneys 
normal  in  every  respect.  K"othing. abnormal  was  found  in  the  intestines. 
The  gall-bladder  was  distended  with  normal  bile.  The  urinary  bladder 
was  of  normal  thickness,  but  the  mucous  membrane  was  considerably  con- 
gested.    The  brain  and  cord  were  not  examined. 

"James  J.  Slocum. — Autopsy  held  at  1:45  P.M.  Same  persons  present 
as  in  preceding  cases. 

"There  were  the  same  blisters  and  external  appearances  as  in  the 
others.  There  were  also  the  same  appearance  of  cornea.  Median  inci- 
sion was  made  as  in  the  other  cases. 

"  Heart.  Petechial  spois  scattered  about  as  in  the  other  cases,  and  were 
also  observed  under  the  pulmonary  pleura.  The  left  ventricle  was  firmly 
contracted,  while  the  right  was  flalDby.  Both  auricles,  especially  the  right 
one,  were  filled  with  fluid  blood.  The  left  lung  was  free  from  adhesions. 
The  upper  lobe  of  the  right  lung  was  slightly  adherent.  The  left  lung  was 
in  the  same  condition  as  the  others,  but  slightly  cedematous.  The  right 
lung  was  in  the  same  condition.  There  was  a  well-marked  large  group  of 
petechial  spots  at  the  center  of  the  anterior  surface  of  the  left  ventricle. 

"  The  spleen  was  of  normal  size,  with  the  pulp  soft,  of  dark  red  color, 
and  somewhat  congested.  Pancreas  was  normal,  both  on  the  surface  and 
on  section.  The  gall-bladder  was  half  full  of  bile,  and  the'common  duct 
patulous.  The  liver  was  normal  in  every  respect.  The  left  kidney  was 
very  much  congested,  but  normal  in  all  other  respects.  The  right  kidney 
was  in  a  similar  condition.  A  careful  examination  of  the  intestines 
showed  nothing  abnormal.  The  bladder  was  collapsed  and  normal.  The 
trachea  was  normal. 

"In  addition  to  the  post-mortem.  Dr.  YanGieson  reported  that  the 
practical  results  of  the  microscopical  examinations  were,  that  the  passage 
of  the  electric  current  through  the  body  was  attended  with  no  recognizable 
changes  in  its  tissues  or  organs,  excepting  the  local  thermic  changes  in 
the  skin  at  the  points  of  application  of  the  electrodes  and  some  minute 
petechial  spots  on  several  of  the  organs."] 

Legal  Relations^. — Rare  as  the  combination  of  circumstances  must  be  in 
which  a  medico-legal  question  can  arise  in  reference  to  the  action  of  the 
electric  current  on  the  body,  a  case  was  tried  in  France  in  1845,  in  which 
medical  evidence  respecting  the  characters  of  wounds  caused  by  electricity 
was  of  considerable  importance.  In  August  of  that  year  some  buildings 
were  destroyed  at  Malaunay,  near  Rouen — as  it  was  alleged  on  the  one 


476  DEATH    FROM    COLD. 

side,  by  a  thunderstorm,  on  the  other,  by  a  whirlwind;  and,  as  the  par- 
ties were  insured  against  lig-htning,  they  brought  an  action  for  recovering 
the  amount  insured.  The  evidence  in  favor  of  the  accident  having  been 
due  to  electricity  consisted,  first,  in  the  alleged  carbonized  appearance  of 
the  leaves  of  some  trees  and  shrubs  growing  near ;  and,  secondly,  in  the 
characters  of  the  wounds  on  the  bodies  of  several  persons  who  were 
injured  at  the  time  of  the  occurrence.  Lesauvage  stated  at  the  trial  that 
there  was  an  appearance  of  dark  stains  scattered  over  the  bodies,  and  that 
those  who  survived  suffered  from  torpor,  pains  in  the  limbs,  and  a  partial 
paralysis  of  motion.  He  observed,  also,  that  decomposition  took  place 
very  speedily  in  the  bodies  of  those  who  were  killed.  In  one  instance  the 
muscles  were  torn  and  lacerated,  and  some  small  arteries  divided.  This 
witness  attributed  most  of  the  wounds  to  the  effects  of  electricity.  Funel 
deposed  that  in  each  of  the  dead  bodies  which  he  had  examined,  the  face 
and  neck  were  bloated  and  discolored,  as  if  death  had  taken  place  from 
asphyxia.  It  did  not  appear,  however,  that  there  were  any  circumstances 
decisively  proving  that  the  buildings  had  been  destroyed  by  lightning, 
Pouillet  gave  an  accurate  description  of  the  storm  ;  he  believed  that 
although,  as  deposed  to  by  some  of  the  witnesses  at  the  trial,  it  might 
have  been  attended  with  thunder  and  lightning,  the  buildings  with  the 
surrounding  trees  were  really  overthrown  by  the  mere  force  of  the  wind, 
and  not  by  lightning.  The  description  given  bears  out  this  view,  but  at 
the  same  time  it  is  unusual  that  trees  when  struck,  unless  old  or  dry  and 
withered,  should  present  any  marks  of  combustion  about  the  leaves  or 
trunk.  (Comp.  Rend.,  Sept.  184.5;  also  Lond.  Med.  Gaz.,  vol.  xxxvi.  p. 
1133.)  The  scientific  evidence  was  of  the  most  conflicting  kind.  The 
Royal  Court  of  Rouen  decided  that  the  disaster  was  occasioned  by  the 
atmosphere ;  and,  without  entering  into  the  various  theories  of  storms, 
condemned  the  insurance  companies  to  pay  the  amount  claimed.  (Law 
Times,  March  14,  1846,  p.  490.) 

Cold. 

Cause  of  Death. — The  protracted  exposure  of  the  human  body  to  a  low 
temperature  may  destroy  life  ;  and  although  in  this  country  cases  rarely 
occur  in  which  cold  alone  operates  fatally,  it  is  not  unusual,  during  a 
severe  winter,  to  hear  of  persons  in  a  ^tate  of  misery  and  destitution 
being  found  dead  in  exposed  situations.  On  these  occasions  we  may 
reasonably  suspect  that  the  want  of  proper  food  and  nourishment  has 
accelerated  death.  It  is,  however,  convenient  to  make  a  distinction  be- 
tween the  effects  of  cold  and  starvation  on  the  system,  as  the  symptoms 
preceding  death  and  the  rapidity  with  which  this  takes  place  are  different 
in  the  two  cases. 

Symptoms. — A  moderate  degree  of  cold  is  well  known  to  have  an 
invigorating  effect  upon  the  body;  but  if  the  cold  is  severe  and  the  ex- 
posure to  it  long  continued,  while  the  heat  is  not  maintained  by  warmth 
of  clothing  or  exercise,  the  skin  becomes  pale,  and  the  muscles  become 
gradually  stiff  and  contract  with  difficulty,  especially  those  of  the  face  and 
extremities.  Sensibility  is  lost,  a  state  of  torpor  ensues,  followed  by  pro- 
found sleep,  from  which  the  person  cannot  be  readily  roused  ;  in  this  state 
of  lethargy  the  vital  functions  gradually  cease,  and  the  person  finally 
perishes.  Such  are  the  general  effects  of  intense  cold  upon  the  body  ;  its 
influence  on  the  nervous  system  is  seen  in  the  numl:)ness,  torpor,  and 
sleepiness  which  have  been  described  as  consequences  of  a  long  exposure 
to  severe  cold.     Giddiness,  dimness  of  sight,  tetanus,  and  paralysis  have 


FATAL    EFFECTS    OF    COLD.  477 

in  some  cases  preceded  the  fatal  insensibility.  It  has  been  found  that 
temi)erature  materially  affects  the  amount  of  oxygen  taken  by  the  blood. 
At  a  low  temperature  this  fluid  takes  less  oxygen;  hence  it  becomes  less 
oxygenated,  and  this  state  of  the  blood  affects  the  condition  of  the  brain 
and  nervous  system.  (Bernard,  op.  cit.,  p.  114.)  It  was  observed  during 
the  retreat  of  the  French  from  Moscow  that  those  who  were  most  severely 
affected  by  cold  often  reeled  about  as  if  in  a  state  of  intoxication  ;  they 
also  complained  of  giddiness  and  indistinctness  of  vision  and  sank  under 
a  feeling  of  lassitude  into  a  state  of  lethargic  stupor  from  which  it  was 
found  impossible  to  rouse  them.  Sometimes  the  nervous  system  was 
at  once  affected;  tetanic  convulsions,  followed  by  rigidity  of  the  whole  of 
the  voluntary  muscles,  seized  the  individual,  and  he  rapidly  fell  a  victim. 
Symptoms  indicative  of  a  disturbance  of  the  functions  of  the  brain  and 
nervous  system  have  also  been  experienced  by  Arctic  travellers  during 
their  residence  within  the  Polar  circle.  The  researches  of  Pouchet  on  the 
effect  of  a  freezing  temperature  on  animals  led  him  to  the  conclusion  that 
death  is  due  to  a  physical  change  in  the  blood-globules,  and  not  to  any 
effect  on  the  nervous  system.  The  first  phenomenon  produced  by  cold  is 
a  contraction  of  the  capillary  vessels  to  such  an  extent  that  the  blood- 
corpuscles  cannot  enter  them  ;  these  vessels,  therefore,  remain  completely 
empty.  The  second  phenomenon  is  an  alteration  of  these  corpuscles, 
amounting  to  their  complete  disorganization.  Under  these  circumstances 
an  animal  cannot  be  restored.  (Chem.  News,  1865,  2,  p.  263.)  A  human 
being  may,  however,  perish  from  a  degree  of  cold  not  sufficient  to  produce 
congelation. 

Circumstances  which  accelerate  Death. — There  are  certain  conditions 
which  may  accelerate  death  from  cold.  In  all  cases  in  which  there  is  ex- 
haustion of  the  nervous  system,  as  in  those  who  are  worn  out  by  disease 
or  fatigue,  in  the  aged  and  infirm,  or,  lastly,  in  persons  who  are  addicted 
to  the  use  of  intoxicating  liquors,  the  fatal  effects  of  cold  are  more  rapidly 
manifested  than  in  others  who  are  healthy  and  temperate.  It  has  been 
uniformly  remarked  that,  whenever  the  nervous  energy  is  impaired,  either 
by  intoxication  or  exhaustion  from  fatigue,  a  man  dies  quickly  from  cold. 
The  exposure  of  drunken  persons  during  a  severe  winter  may  therefore 
suffice  to  destroy  life,  although  the  cold  might  not  be  so  intense  as  to  affect 
others  who  were  temperate.  Casualties  of  this  nature  sometimes  occur 
during  the  winter  season  in  the  metropolis;  and  a  knowledge  of  the 
influence  of  intoxication  in  accelerating  death  under  such  circumstances 
may  occasionally  serve  to  remove  a  doubt  in  the  mind  of  a  practitioner 
respecting  the  real  cause.  Infants,  especially  when  newly  born,  easily 
perish  from  exposure  to  cold.  Cold,  when  accompanied  by  rain  and  sleet, 
has  a  more  powerfully  depressing  influence  than  when  the  air  is  dry — 
probably  from  the  effects  of  evaporation.  The  following  case,  related  by 
Currie,  shows  the  fatal  effects  of  exposure  to  cold  winds  accompanied  with 
humidity  :  "  Of  several  persons  who  clung  to  a  wreck,  two  sat  on  the 
only  part  that  was  not  submerged  ;  of  the  others,  all  were  constantly  im- 
mersed in  the  sea  and  most  of  them  up  to  the  shoulders.  Three  "^only 
perished,  two  of  whom  were  generally  out  of  the  sea,  but  frequently 
overwhelmed  by  the  surge,  and  at  other  times  exposed  to  heavy  showers 
of  sleet  and  snow  and  to  a  high  piercing  wind.  Of  these  two,  one  died 
after  four  hours'  exposure ;  the  second  died  three  hours  later,  although  a 
strong  healthy  adult  and  inured  to  cold  and  hardship ;  the  third  "that 
perished  was  a  weakly  man.  The  remaining  eleven,  who  had  been  more 
or  less  completely  submerged,  were  taken  from  the  wreck  the  next  day 
after   twenty -three   hours'   exposure,  and   they  recovered.      The   person 


478  APPEARANCES    AFTER    DEATH    FROM    COLD. 

among  the  whole  who  seemed  to  have  suffered  least  was  a  negro  ;  of  the 
other  survivors,  several  were  by  no  means  strong  men,  and  most  of  them 
had  been  inured  to  the  warm  climate  of  Carolina."  The  fatal  action  of 
extreme  cold  on  animals  has  been  examined  by  Crecchio.  (Ann.  d'Hyg.^ 
1868,  t.  1,  p.  436.J 

Appearances  after  Death. — Opportunities  rarely  occur  of  examining 
bodies  when  death  results  purely  from  exposure  to  cold.  The  skin  is 
commonly  pallid  and  the  viscera  of  the  chest  and  abdomen  as  well  as  the 
brain  are  congested  with  blood.  Keilie  found,  in  two  cases  which  he 
examined,  a  redness  of  the  small  intestines  from  the  congestion  of  the 
capillary  vessels  and  a  great  effusion  in  the  ventricles  of  the  brain.  A 
sufficient  number  of  cases  have  not  yet  be^n  inspected  to  enable  us  to 
determine  how  far  these  two  last-mentioned  appearances  are  to  be  regarded 
as  consequences  of  death  from  cold  ;  but  all  observers  have  found  a  general 
congestion  of  the  bloodvessels  and  viscera.  In  consequence  of  the  great 
congestion  uniformlv  met  with  in  the  vessels  and  sinuses  of  the  brain, 
some  pathologists  have  regarded  death  from  cold  as  resulting  from  an 
attack  of  apoplexy  ;  but  the  symptoms  which  precede  death  do  not  bear 
out  this  view.  Effusions  of  blood  have  not  yet  been  observed,  and  a  mere 
fulness  of  the  cerebral  vessels  after  death  is  not  in  itself  sufScient  to 
justify  this  opinion.  It  will  be  observed  that,  on  the  whole,  these  appear- 
ances are  remarkably  siaiilar  to  those  which  are  found  in  death  from 
severe  burns  and  scalds.  In  a  case  which  occurred  to  Hilty,  a  man  £et.  57, 
in  a  state  of  intoxication,  died  from  exposure  to  cold  during  a  severe 
winter  night.  A  minute  description  of  the  appearances  is  given,  but  the 
principal  were — great  congestion  of  blood  in  all  the  cavities  of  the  heart 
and  the  large  vessels,  the  blood  fluid  and  of  a  dark-crimson  color,  a  con- 
gested state  of  all  the  internal  organs,  especially  of  the  liver  and  kidneys, 
numerous  spots  or  patches  of  redness  on  the  skin  (frost-erythema),  and  the 
bladder  distended  with  urine.  Vierteljahrsschr.  fUr  Gerichtl.  Med.,  1865,  2, 
p.  140.)  Thus,  then,  a  medical  jurist  will  perceive  that  in  order  to  come 
to  a  decision  whether,  on  the  discovery  of  a  dead  body,  death  has  taken 
place  from  cold  or  not,  is  a  task  of  some  difficulty.  The  season  of  the 
year,  the  place  and  circumstances  under  which  the  body  of  the  deceased  is 
found,  together  with  the  absence  of  all  other  possible  causes  of  death 
(such  as  from  violent  injuries  or  internal  disease),  form  the  only  basis  for 
a  medical  opinion.  Death  from  cold  is  not  to  be  determined  except  by 
negative  or  presumptive  evidence;  for  there  is  no  organic  change,  either 
externally  or  internally,  sufficiently  characteristic  of  it  to  enable  a  medical 
man  to  give  a  positive  opinion  on  the  subject. 

Ogston,  from  an  inspection  of  thirteen  bodies  of  persons  that  had  died 
from  the  effects  of  cold,  considers  that  the  following  peculiar  appearances 
afford  when  present  a  high  prol^ability  as  to  the  cause  of  death  being  cold  : 
1.  An  arterial  hue  of  the  blood  generally,  except  when  viewed  in  mass 
within  the  heart;  the  presence  of  this  coloration  not  having  been  noted 
in  two  instances.  2.  An  unusual  accumulation  of  arterial  and  venous 
blood  on  both  sides  of  the  heart  and  in  the  larger  bloodvessels  of  the 
chest.  3.  Pallor  of  the  general  surface  of  the  body,  and  anaemia  of  the 
viscera  most  largely  supplied  with  blood.  The  only  exceptions  to  this 
were  moderate  congestion  of  the  brain  in  three  of  the  cases,  and  of  the 
liver  in  seven  of  them.  4.  Irregular  and  diffused  dusky-red  patches  on 
limited  portions  of  the  exterior  of  the  bodies,  encountered  in  non-dependent 
parts,  these  patches  contrasting  forcibly  with  the  pallor  of  the  skin  and 
general  surface.  The  above  appearances  were  not,  however,  so  universally 
met  with  in  the  children  as  in  the  adults. 


DEATH    FROM    INTENSE    HEAT.  479 


Heat. 


Intense  Eeat.  Heat-apoplexy. — The  effect  of  an  intenselj-beated  atmos- 
phere in  causing  death  has  been  but  little  studied.  Some  years  since  the 
author  was  consulted  in  one  case  in  which  the  captain  of  a  steam-vessel 
was  charged  with  manslaughter,  for  causing  a  man  to  be  lashed  within  a 
short  distance  of  the  stoke-hole  of  the  furnace.  The  man  died  in  a  few 
hours,  apparently  from  the  effects  of  this  exposure.  The  engine-rooms  of 
steamers  in  the  tropics  have  been  observed  to  have  a  temperature  as  high 
as  140°  F. ;  and  engineers  after  a  time  become  habituated  to  this  excessive 
heat  witliout  appearing  to  suffer  materially  in  health.  In  certain  manu- 
factures the  body  appears  to  acquire  a  power,  by  habit,  of- resisting  these 
high  temperatures ;  still  it  has  been  proved  that  many  suffer  severely.  In 
a  Report  on  the  Employment  of  Children  (1865),  it  is  stated  that  in  a 
glass  manufactory  a  thermometer  held  close  to  a  boy's  head  stood  at 
130°  F. ,  and  as  the  inspector  stood  near  to  observe  the  instrument  his 
hat  actually  melted  out  of  shape.  Another  boy  had  his  hair  singed  by 
the  heat,  and  said  that  his  clothes  were  sometimes  singed  too  ;  while  a 
third  worked  in  a  temperature  of  no  less  than  150°.  Amid  this  tre- 
mendous heat  they  carry  on  work  which  requires  their  constant  atten- 
tion :  they  are  incessantly  in  motion.  In  the  Turkish  bath  higher  tem- 
peratures than  this  are  common,  but  there  is  reason  to  believe  that  serious 
symptoms  have  been  occasionally  produced  in  persons  unaccustomed  to 
them,  and  that  in  one  or  two  cases  death  has  resulted.  All  sudden  changes 
from  a  low  to  a  high  temperature  are  liable  to  cause  death  in  aged  persons 
or  in  those  who  are  sutfering  from  organic  diseases.  In  attempting  to 
breathe  humid  air  heated  to  temperatures  varying  from  180°  to  200°  F., 
there  is  a  sense  of  suffocation,  a  feeling  of  dizziness,  and  other  symptoms 
indicative  of  an  effect  on  the  brain ;  and  the  circulation  is  enormously 
quickened. 

In  1861,  an  inquest  v/as  held  on  the  body  of  a  stoker  of  an  Aberdeen 
steamship.  He  had  been  by  trade  a  grocer,  and  was  not  accustomed  to 
excessive  heat.  While  occupied  before  the  engine-furnace  he  was  observed 
to  fall  suddenly  on  the  floor  in  a  state  of  insensibility ;  when  carried  on 
deck  it  was  found  that  he  was  dead.  All  that  was  discovered  on  a  post- 
mortem examination  was  an  effusion  of  serum  into  the  ventricles  of  the 
brain  ;  death  had  been  caused  by  sudden  apoplexy.  In  some  cases  a  per- 
son may  sink  from  exhaustion  as  a  result  of  long  exposure.  Intense  heat 
appears  generally  to  operate  by  inducing  congestion  of  the  brain  (heat- 
apoplexy).  It  has  now  become  one  of  the  recognized  causes  of  death  in 
this  country  in  the  Registrar-General's  reports.  In  some  cases  a  person 
may  sink  and  die  suddenly  from  exhaustion,  or  symptoms  of  cerebral  dis- 
turbance may  continue  for  some  time,  and  the  case  ultimately  prove  fatal. 

Death  from  sunstroke,  when  this  is  not  immediately  fatal,  is  preceded 
by  some  well-marked  symptoms,  such  as  weakness,  giddiness,  headache, 
disturbed  vision,  flushing  of  the  face,  followed  by  oppression  and  difficulty 
of  breathing,  and  in  some  cases  stupor  passing  into  profound  coma.  The 
skin  is  dry  and  hot,  and  the  heat  of  the  body  is  much  greater  than  natural. 
(Ann.  d'Hyg.,  186T,  t.  1,  423.)  In  one  case  the  patient,  a  boy,  ast.  13, 
remained  in  a  state  of  semi-consciousness  for  four  days,  and  then  had  a 
cataleptic  seizure.  (Lancet,  1870,  ii.  p.  184.)  Passauer  has  fully  con- 
sidered this  subject  in  reference  to  armies  in  Vierteljahrsschr.  fiir  Gerichtl. 
Med.,  1867,  1,  p.  185.  The  symptoms  in  cases  of  sunstroke  have  not 
always  been  accurately  recorded.  In  one  instance  a  medical  man  who 
suffered  from  an  attack  while  on  a  voyage  in  the  tropics  was  able  to  note 


480  DEATH    FROM    STARVATION. 

and  describe  his  sj-mptoms  from  the  commencement  of  the  attack  up  to 
the  eiuhth  day,  when  he  recovered.  (See  Lancet,  1872,  i.  p.  464;  also 
ii.  p.  128.) 

[Dr.  H.  C.  Wood  (Boyleston  Prize  Essay,  Phil.  1872)  considers  that 
intense  heat  of  the  skin  is  characteristic  of  true  sunstroke,  the  tempera- 
ture reaching  in  some  instances  to  110°  or  even  113°  F.  In  all  autopsies 
made  by  him  the  heart  was  firmly  contracted,  especially  the  left  ventricle. 
He  ascribes  the  flaccidity  of  the  heart,  noticed  by  others,  to  the  fact  that 
the  examination  was  not  made  for  many  hours  after  death,  during  which 
time  putrefaction  had  set  in.  He  found  that  congestion  of  the  brain,  or 
effusion  into  the  ventricles,  was  not  of  frequent  occurrence,  nor  did  he 
observe  any  change  in  the  blood  microscopically.] 

Staryation. 

A  Bare  Cause  of  Death. — Heath  from  the  mere  privation  of  food  is  a 
rare  event,  although,  if  we  were  to  form  an  opinion  from  the  verdicts  of 
coroners'  juries,  its  occurrence  would  not  appear  to  be  uncommon  in  our 
large  cities.  In  one  of  the  Annual  Registration  Returns  it  is  stated  that 
130  persons  had  died  from  starvation.  Such  cases  must,  however,  be  re- 
ceived with  some  distrust,  as  care  is  rarely  taken  to  ascertain  precisely 
how  far  bodily  disease  may  have  been  concerned  in  the  fatal  result.  Still, 
it  cannot  be  denied  that  starvation  should  be  classed  among  the  forms  of 
violent  death,  being  sometimes  the  result  of  criminal  neglect  or  inatten- 
tion in  the  treatment  of  children,  lunatics,  or  of  infirm  and  decrepit  per- 
sons, and  thus  constituting  homicide ;  or  at  other  times,  although  rarely, 
arising  from  an  obstinate  determination  to  commit  suicide  in  those  from 
whom  all  other  means  of  self-destruction  are  cut  off. 

Acute  Starvation.  Symptoms. — The  symptoms  which  attend  on  the 
privation  of  food,  or  the  suj^ply  of  improper  food,  have  been  variously 
described.  Referring  to  cases  which  occurred  during  the  Irish  famine  of 
1847,  Donovan  states  that  the  persons  who  suffered  described  the  pain  of 
hunger  as  at  first  very  acute,  but  said  that  after  twenty-four  hours  had 
been  passed  without  food  the  pain  subsided  and  was  succeeded  by  a  feel- 
ing of  weakness  and  sinking,  experienced  principally  in  the  region  of  the 
stomach  ;  accompanied  with  insatiable  thirst,  a  strong  desire  for  cold 
water,  and  a  distressing  feeling  of  coldness  over  the  entire  surface  of  the 
body.  In  a  short  time,  the  face  and  limbs  became  frightfully  emaciated ; 
the  eyes  acquired  a  peculiar  stare ;  the  skin  exhaled  an  offensive  smell ; 
and  was  covered  with  a  brownish  filthy-looking  coating  almost  as  indeli- 
ble as  varnish.  This  he  was  at  first  inclined  to  regard  as  encrusted  filth, 
but  further  experience  convinced  him  that  it  was  a  morbid  secretion 
poured  out  on  the  surface  of  the  body.  The  sufferer  tottered  in  walking 
like  a  drunken  man ;  his  voice  was  weak,  like  that  of  a  person  affected 
with  cholera;  he  whined  like  a  child,  and  burst  into  tears  on  the  slightest 
occasion.  In  respect  to  the  mental  faculties,  their  prostration  kept  pace 
with  the  general  wreck  of  bodily  power ;  in  many  there  was  a  state  of 
imbecility,  in  some  almost  complete  idiocy;  but  in  no  instance  was  there 
delirium  or  mania,  which  have  been  described  as  symptoms  of  protracted 
abstinence  among  shipwrecked  mariners.     (Dub.  Med.  Press,  1848,  p.  67.) 

In  a  case  which  fell  under  the  notice  of  Sloan,  a  healthy  man,  set.  65,  was 
by  an  accident  shut  up  in  a  coal-mine  for  twenty-three  days  without  food. 
When  found,  he  was  conscious,  and  he  recognized  and  named  his  de- 
liverers. He  was  so  weak  that  he  could  scarcely  raise  his  hand  to  his 
mouth,  and  so  much  emaciated  as  to  excite  the  surprise  of  his  fellow- 


ACUTE    STARVATION — SYMPTOMS.  481 

workmen  by  the  extreme  lightness  of  his  body.  Under  careful  treatment 
he  so  far  recovered  as  to  give  an  account  of  his  feelings.  For  the  first 
two  days,  hunger  was  his  most  urgent  symptom.  This  passed  off,  and  he 
then  began  to  suffer  from  severe  thirst,  which  he  allayed  by  drinking 
Bome  foul  water.  After  ten  days  he  became  so  weak  that  he  was  unable 
to  move  from  the  spot  where  he  had  lain  down.  He  slept  but  little,  and 
not  soundly — never  entirely  losing  the  consciousness  of  his  situation.  His 
bowels  acted  only  once,  but  he  passed  urine  freely.  The  matter  brought 
from  his  bowels,  by  injections  after  his  rescue,  was  dark-colored,  like 
meconium,  and  very  fetid.  He  died  on  the  third  day  after  his  removal,  in 
spite  of  every  effort  to  save  liim,  and  on  the  day  of  his  death  he  was  in 
the  following' state  :  his  features  were  sharp  and  pale,  his  eyes  sunken  ;  the 
skin  of  the  abdomen  seemed  to  touch  the  backbone,  which  could  be  dis- 
tinctl}^  felt  through  it ;  his  body  presented  excessive  emaciation  ;  he  had 
altogether  a  dried  appearance,  very  much  like  that  of  natural  mummies 
found  in  catacombs;  his  pulse  was  gone  ;  his  voice  was  in  a  whisper,  like 
the  vox  cholerica ;  there  was  uneasiness,  increased  by  pressure,  in  the 
region  of  the  stomach  ;  his  intellect  was  sound,  and  remained  so  until 
death.  (Lond.  Med.  Gaz.,  vol.  xvii  p.  265.)  This  case  confirms  the  ob- 
servation of  Donovan,  that  delirium  is  not  a  necessary  attendant  on 
protracted  abstinence ;  and  it  proves  incontestably  that  a  person  may  die 
from  the  effects  of  abstinence  or  starvation  in  spite  of  the  best-directed 
efforts  for  recovery.  Thornhill  reports  the  case  of  eight  men  and  a  boy 
who  were  shut  in  a  coal-mine  for  eight  days  without  food  (Lond.  Med. 
Gaz.,  vol.  xvii.  p.  390);  but  the  symptoms  here  noted  were  rather  those 
of  hunger  than  of  long  abstinence.  They  all  suffered  from  excessive 
thirst;  they  were  all  troubled  with  oeular  illusions,  showing  cerebral  ex- 
citement. The  occurrence  of  ocular  spectra,  and  other  symptoms  indica- 
tive of  a  depressed  state  of  the  nervous  system,  have  also  been  noticed  by 
Casper. 

Under  art.  Abstinence,  Cyc.  Pr.  Med.,  Marshall  Hall  and  Latham  re- 
cord their  experience  of  the  effects  produced  by  the  privation  of  food.  In 
advanced  cases  they  found  among  the  symptoms  headache,  vertigo, 
delirium,  disordered  vision,  restlessness,  sleepless  nights,  convulsions,  dis- 
order of  the  intellectual  faculties,  and  apoplexy.  In  the  Staunton  case  (p. 
484),  the  possible  supervention  of  cerebral  or  nervous  symptoms  as  a  result 
of  an  insufficient  supply  of  food  was  ignored  by  the  medical  men  who  con- 
ducted the  defence,  and  symptoms  most  probably  depending  on  inanition 
were  referred  by  them  to  a  special  disease  of  the  brain  and  its  membranes. 

Copland,  in  his  Dictionary  of  Practical  Medicine,  besides  the  symptoms 
above  described,  enumerates  a  depressed  temperature,  followed  by  insensi- 
bility, stupor,  or  coma,  terminating  in  death.  In  all  cases  with  extreme 
emaciation  there  is  great  muscular  weakness.  The  person  stands  or 
moves  with  difficulty.     They  are  the  indications  of  extreme  exhaustion. 

According  to  Martin,  the  emaciation  in  starvation  is  characteristic;  it  is 
a  withering  or  shrivelling  up  of  the  skin,  which  has  lost  its  elasticity, 
giving  to  youth  the  aspect  of  age.  Death,  when  not  hastened  by  disease, 
is  slow  and  imperceptible,  or  it  is  precipitated  by  syncope  from  sudden 
effort,  or  by  exposure  to  severe  cold.  Delirium  is  not,  according  to  him,  a 
symptom  of  starvation.     (Med.  Times  and  Gaz.,  1861,  i.  p.  344.) 

During  March  to  May,  1890,  an  Italian  named  Succi  underwent  a  vol- 
untary fast  of  forty  days,  apparently  without  permanent  injurious  effect*. 
He  had,  however,  free  access  to  simple  liquids,  and  also  partook  occasion- 
ally of  a  narcotic.  At  the  termination  of  his  fast  Succi  gradually  reverted 
to  a  solid  dietarv.  His  case  merelv  proved  that  the  body  may  be  deprived 
31  ' 


482  PERIOD    OF    DEATH. 

of  food  for  a  considerable  period,  aud  yet  remain  fairly  healthy ;  it  added 
little  or  nothing,  nevertheless,  to  our  knowledge  of  fasting  from  a  medico- 
legal point  of  view.     (Brit.  Med.  Jour.,  1890,  i.  1444.) 

Period  of  Death. — The  period  which  it  requires  for  an  individual  to 
perish  from  hunger  (acute  starvation)  is  subject  to  variation  ;  it  will  de- 
pend materially  upon  the  fact  vt^hether  the  person  has  had  it  in  his  power 
or  not  to  take  at  intervals  a  ponion  of  liquid  to  relieve  the  overpowering 
thirst  which  is  commonly  experienced.  The  smallest  portion  of  liquid, 
thus  taken  occasionally,  is  found  to  be  capable  of  prolonging  life.  It  has 
been  supposed  that,  in  a  healthy  person,  under  perfect  abstinence,  death 
would  not  commonly  take  place  in  a  shorter  period  than  from  a  week  or 
ten  days.  This  opinion  derives  support  from  the  results  of  those  cases  in 
which  there  has  been  perfect  abstinence  owing  to  disease  in  the  throat  and 
a  difficulty  of  swallowing  food.  But  recent  experience  has  shown  that 
this  opinion  must  be  modified.  Age,  sex,  state  of  health,  and  the  effects 
of  exposure  to  cold,  may  accelerate  or  retard  a  fatal  termination. 

A  well-marked  instance  of  the  tolerance  of  entire  privation  of  food  for 
the  long  period  of  eleven  day  a  occurred  in  1878  on  the  Inman  line  of 
steamships.  A  young  man,  get.  20,  named  James  Donnelly,  stowed  him- 
self away  in  one  of  the  holds  of  the  ship  on  the  23d  of  Sept.,  the  evening 
before  the  ship  sailed  from  Liverpool.  The  ship  arrived  at  New  York  on 
the  4th  of  Oct.,  and  on  lifting  the  hatches  Donnelly  was  found  insensible 
beneath.  During  the  entire  passage  he  had  had  neither  food  nor  drink.  He 
found  some  salt  below,  of  which  he  ate  about  two  handfuls.  He  had  with 
him  an  empty  glass  flask,  from  w  hich  he  drank  his  urine  each  time  that  he 
voided  it.  He  suffered  from  hunger  only  on  the  second  day  ;  after  that 
he  had  intense  thirst  for  four  days.  He  then  became  insensible,  and  re- 
membered nothing  until  he  w^oke  up  in  Kew  York  on  the  evening  of  Oct. 
4th.  The  muscles  of  his  extremities  did  not  appear  to  be  much  wasted, 
but  his  cheeks  and  abdomen  were  greatly  retracted,  and  presented  a  livid 
appearance.     He  left  the  hospital  perfectly  recovered  on  Oct.  21st. 

Accidents  to  miners  throw  some  light  upon  the  pow  er  of  endurance  in 
the  absence  of  food.  In  1869  ten  men  and  three  boys  were  shut  up  in  a 
coal-mine  in  Staffordshire,  and  remained  for  eight  days  without  food  and 
light.  They  were  all  saved  excepting  one,  who  died  frantic.  In  18VT 
several  men  and  a  boy,  who  met  with  a  similar  accident  in  South  "Wales, 
were  rescued  in  an  exhausted  state  also  on  the  eighth  day.  These  cases 
show  that  an  adult  can  exist  without  food  for  a  period  of  eight  days,  and 
by  due  precaution  ultimately  recover.  Casper  believes  that  a  period  of 
from  twelve  to  fourteen  days  is  the  limit  for  the  survival  of  a  strong 
healthy  man  entirely  deprived  of  food.  Casper's  opinion  receives  some 
support  from  the  case  of  a  man,  at.  26.  (Lancet,  1845,  vol.  i.  p.  681.) 
The  patient  had  been  advised  to  abstain  from  food  and  to  take  only  water. 
For  eleven  days  he  acted  on  this  advice  and  tasted  no  kind  of  food,  with 
the  exception  of  a  teaspoonful  of  beef  tea  on  the  tenth  day.  He  died  on 
the  twelfth  day,  having  had  for  a  few  days  a  discharge  of  blood  from  the 
bowels. 

The  mode  in  which  death  takes  place  was  accurately  observed  in  the 
case  of  the  Welsh  fasting  girl  (p.  487).  During  the  last  hour  she  spoke 
nothing;  she  was  too  weak  and  too  far  gone.  She  w-as  not  sensible,  but 
she  appeared  to  be  in  a  stupor  like  a  dying  person.  In  the  case  of  Harriet 
Staunton,  death  took  place  under  similar  circumstances  (p.  484). 

Chronic  Starvation  — When  the  person  survives  for  some  weeks,  and 
the  food  supplied  is  insufficient  in  quantity  or  of  bad  quality,  other  symp- 
toms show  themselves.     Among  these  there  is  pain  in  the  region  of  the 


APPEARANCES    AFTER    DEATH.  483 

stomach,  and  suppression  of  the  feces;  or,  if  these  are  discharged,  they  are 
in  small  quantity,  dry,  and  dark-colored  ;  the  urine  is  scanty,  high-colored, 
and  turbid;  the  intellect  is  dull.  The  person  may  be  exhausted,  and  re- 
main without  motion  in  one  position,  or  be  seized  with  a  furious  delirium, 
which  may  drive  him  to  acts  of  violence.  In  the  last  stage  the  body  is 
reduced  to  an  extreme  state  of  emaciation,  and  before  death  evolves  an 
offensive  odor,  like  that  of  incipient  putrefaction.  The  excretions  have, 
also  a  putrescent  odor.  The  surface  of  the  skin  may  be  covered  with 
spots  (petechiiB),  and  the  person  finally  dies,  in  some  cases  slightly  con- 
vulsed. Chossat  found,  in  his  experiments  on  animals,  that  in  some  in- 
stances the  animal  died  after  having  had  successive  attacks  of  convulsions. 
(Beck's  Med.  Jurispr.) 

Appearances  after  Death. — There  are  but  few  details  of  the  appear- 
ances presented  by  the  bodies  #f  those  who  have  died  from  starvation, 
and  the  cases  themselves  are  too  rare  to  enable  us  to  decide  with  certainty 
upon  the  accuracy  of  the  reports  which  have  hitherto  appeared  on  the 
subject.  The  body  is  extremely  shrunken  and  emaciated,  and  remarkable 
for  its  lightness.  The  skin  is  dry,  shrivelled,  and  free  from  fat.  The 
muscles  are  soft,  deprived  of  fat,  and  much  reduced  in  size.  The  stomach 
and  intestines  are  usually  found  collapsed,  contracted,  and  empty,  the 
mucous  membrane  being  thinned  and  sometimes  ulcerated.  The  liver, 
lungs,  heart,  kidneys,  and  the  great  vessels  connected  with  these  organs 
are  shrunken,  collapsed,  and  destitute  of  blood  ;  the  heart  and  kidneys  free 
from  any  surrounding  fat;  the  gall-bladder  distended  with  bile;  the 
omentum  shrunken  and  destitute  of  fat.  One  body  was  observed  to  be  ex- 
tremely emaciated.  The  intestines  were  collapsed,  the  stomach  was  dis- 
tended with  gas  and  slightly  reddened  at  its  greater  extremity.  The 
omentum  had  almost  disappeared,  and  was  entirely  destitute  of  fat.  The 
liver  was  small,  and.  the  gall-bladder  distended  with  bile.  The  other 
viscera  were  in  their  normal  state.  (Loud.  Med.  Gaz.,  vol.  xvii.  p.  389.) 
In  another  case,  the  face  was  much  shrunken  and  emaciated  ;  the  eyes  were 
open  and  presented  a  very  red  appearance,  as  intense  as  in  a  case  of  acute 
ophthalmia  during  life.  This  red  appearance  has  also  been  met  with  by 
Donovan  in  death  from  exposure  to  cold.  (Dub.  Med.  Press,  1848,  p. 
66.)  The  skin  was  tough,  and  there  was  scarcely  any  cellular  membrane 
to  be  seen.  The  tongue,  lips,  and  throat  were  dry  and  rough.  A  peculiar 
odor  was  exhaled  from  the  body.  The  lungs  were  shrunken  and  contracted  ; 
the  investing  membrane  was  slightly  inflamed.  The  stomach  and  intes- 
tines were  empty,  but  quite  healthy  ;  the  gall-bladder  was  nearly  full  of 
bile,  and  the  surrounding  parts  were  much  tinged  by  this  liquid.  The 
urinary  bladder  was  empty  and  contracted.     (Lancet,  March,  1838.) 

In  some  cases  inspected  during  the  Irish  famine,  Donovan  states  that 
the  appearances  which  he  witnessed  were  extreme  emaciation,  total  ab- 
sorption of  the  fatty  matter  on  the  surface  of  the  body,  total  disappearance 
of  the  omentum,  and  a  peculiarly  thin  condition  of  the  small  intestines, 
which  in  such  cases  were  so  transparent  that,  when  the  deceased  had 
taken  any  food  immediately  before  death,  the  contents  could  be  seen 
through  the  coats  of  the  bowel ;  on  one  occasion  he  was  able  to  recognize 
a  portion  of  raw  green  cabbage  in  the  duodenum  of  a  man  who  had  died 
from  starvation.  This  thin  condition  of  the  coats  of  the  intestines  he 
looked  upon  as  the  strongest  proof  of  death  from  (chronic)  starvation. 
The  gall-bladder  was  usually  full,  and  the  parts  in  the  vicinity  of  it  were 
much  tinged  by  the  cadaveric  exudation  of  bile  ;  the  urinary  bladder  was 
generally  contracted  and  empty,  and  the  heart  pale,  soft,  and  flabby; 
there  was  no  abnormal  appearance  in  the  brain  or  lungs.    Martyn  assigns, 


484  DEATH    FROM    STARVATION    OR    DISEASE. 

as  a  condition  of  the  intestines  diagnostic  of  starvation,  that  they  are  not 
only  contracted,  but  shrunken  and  diminished  in  size,  shortened  in  length 
as  well  as  in  calibre,  and  like  a  mere  cord,  as  if  the  canal  were  obliterated. 
(Med.  Times  and  Gaz.,  1861,  i.  p.  344.)  Ho  met  with  this  state  in  three 
cases — once  in  starvation  from  want  of  food,  and  twice  from  total  obstruc- 
tion to  its  ingestion.  Fletcher  found  the  following  appearances  in  the 
cases  of  two  children  who  died  from  starvation — the  elder  aged  one  year 
and  ten  months,  the  younger  four  months.  In  the  body  of  the  elder  there 
was  extreme  emaciation,  without  the  slightest  trace  of  disea.se  in  any  of 
the  viscera.  Some  dirty  creamy  fluid  and  four  cherry-stones  were  found 
in  the  small  intestines,  but  no  distinctly  fecal  matter,  a  few  grains  of 
which,  however,  were  found  in  the  large  intestines;  scarcely  a  trace  of  fat 
was  visible.  In  the  infant  the  same  appearances  were  presented,  although 
the  emaciation  had  not  proceeded  to  the  .'«me  extent.  (Proc.  of  Liveri)Ool 
Med.  Soc,  1855-56.)  In  some  alleged  deaths  b}^  starvation,  ulceration  of 
the  bowels  is  met  with.  This  has  been  considered  to  arise  from  want  of 
food  ;  but  Donovan  did  not  meet  with  it  in  the  bodies  of  those  who  died 
of  lingering  or  c/(ro/72C  starvation.  (Dub.  Med.  Press,  1848,  p.  66;  also 
Lancet,  1845,  i.  p.  681 ;  1849,  i.  p.  180;  Dub.  Jour.  Med.  Sci.,  vol.  iii.  p. 
273.)  Copland  describes  among  the  appearances  in  the  cases  which  he 
quotes,  shrinking  of  the  viscera,  with  increa.sed  vascularity  of  the  brain 
and  its  membranes,  with  sometimes  a  limpid  serous  effusion  between  them. 
According  to  Osborne  (Dub.  Jour.,  1839,  vol.  xv.  p.  423),  in  cases  which 
prove  fatal  from  long  abstinence,  chronic  inflammation  of  the  stomach  is 
one  of  the  appearances  met  with.  He  says  that  those  who  die  of  starva- 
tion usually  die  with  the  mucous  membrane  of  the  stomach  and  bowels  in 
a  state  of  inflammation,  and  generally  of  ulceration.  Hence  it  may  be 
presumed  that  long  fasting  is  injurious  by  inducing  a  state  of  irritabilitv, 
causing  the  membrane  to  pass  very  readily  into  an  inflammatory  condition. 
A  congested  state  of  the  stomach  is,  therefore,  consistent  with  death  from 
starvation. 

Death  from  Starvation  or  Disease. — The  post-mortem  appearances,  in 
order  to  throw  a  light  upon  the  cause  of  death,  should  be  accompanied 
Avith  an  otherwise  heallhy  state  of  the  body  ;  since,  as  is  well  known,  some 
of  them  may  be  produced  by  organic  disease,  and  death  may  rttally  be  due 
to  disease  and  not  to  the  privation  of  food.  It  will  not  be  always  easy  to 
say  whether  the  emaciation  depends  on  disease  or  want  of  food,  unless  we 
are  put  in  possession  of  a  complete  history  of  the  case.  On  this  account, 
in  all  charges  of  homicidal  starvation,  the  defence  generally  turns  upon 
the  coexistence  of  disease  in  the  body,  and  the  sufficiency  of  this  to  account 
for  death.  As  in  most  cases  of  death  from  protracted  abstinence  or  priva- 
tion of  food,  disease  is  likely  to  be  set  up,  or,  if  already  existing,  to  be 
aggravated  by  the  want  of  proper  nourishment,  so  it  follows  that  in  the 
bodies  of  persons  who  have  died  of  starvation  traces  of  disease  are  gen- 
erally found.  The  cause  of  death  may  here  be  contested,  and  the  case 
often  admits  of  a  strong  defence. 

In  no  instance  probably  has  this  conflict  of  medical  opinion  been  more 
strikingly  shown  than  in  what  has  been  called  the  Penge  case.  (Reg.  v. 
Staunton  and  others,  C.  C.  C,  Sept.  1877.)  The  deceased,  Harriet 
Staunton,  had  been  kept  in  close  confinement  by  the  accused,  four  in  num- 
ber, and,  while  in  an  almost  moribund  state,  she  had  been  suddenly  re- 
moved by  them  to  Penge,  where  she  died,  in  a  state  of  complete  exhaustion, 
on  the  day  following  her  removal.  She  was  seen  a  fcAV  hours  before  her 
death  by  a  medical  man ;  she  was  then  insensible  and  in  a  state  of  com- 
plete collapse. 


-      MEDICAL    EVIDENCE    IN    THE    PENGE    CASE.  485 

As  the  only  persons  about  the  deceased  were  the  four  accused  and  a 
servant-girl,  a  relative  of  two  of  the  prisoners,  it  was  difficult  to  procure 
any  trustworthy  account  of  the  symptoms  preceding  her  removal  aud 
death.  Such  as  they  were,  they  substantially  corroborated  the  conclusions 
drawn  from  a  post-mortem  examination  of  the  body.  The  body  was  ex- 
amined by  Wilkinson,  Bright,  Harman,  and  three  other  surgeons.  The 
appearances  which  they  found  were — the  body  greatly  emaciated  ;  the 
skin  parchment-like,  dry,  and  shrivelled  ;  the  muscles  shrunken  and  entirely 
destitute  of  fat;  the  breasts  almost  imperceptible  ;  the  body  covered  with 
vermin.  The  entire  weight  was  only  seventy-four  pounds,  while  in  a 
healthy  adult  of  the  same  age  it  would  be  about  a  hundred  and  twenty 
pounds.  The  stomach  was  small  and  so  much  thinned  that  the  undigested 
food  in  it  was  distinctly  visible  through  its  coats.  Tlie  intestines  were 
pale,  shrunken,  and  empty ;  they  contained  neither  food  nor  fecal  matter. 
When  held  up  to  the  light,  the  wasting  of  the  coats  was  well  marked. 
The  omentum  was  scarcely  visible  and  quite  destitute  of  fat,  of  which 
there  was,  indeed,  a  total  absence  in  every  part  of  the  body.  The  organs 
of  the  chest  and  abdomen  were  shrunken  and  smaller  than  usual.  They 
were  generally  in  a  healthy  condition.  The  only  appearances  of  disease 
in  the  body  were :  1.  A  slight  tubercular  deposit  at  the  apex  of  the  left 
lung.  2.  A  congested  appearance  of  the  cardiac  extremity  of  the  stomach 
as  well  as  of  the  duodenum.  3.  There  were  two  small  patches  of  miliary 
tubercular  deposit  (recent)  upon  the  arachnoid  membrane  on  the  upper 
surface  of  the  left  hemisphere  of  the  brain.  There  was  no  deposit  on  the 
pia  mater  or  on  the  base  of  the  brain,  and  the  arachnoid  and  pia  mater 
were  not  adherent.  There  was  no  trace  of  meningitis,  i.  e.  inflammation 
of  the  membranes  of  the  brain,  either  simple  or  tubercular.  There  was 
no  effusion,  softening,  or  disease  of  the  brain.  From  the  appearances  tha 
medical  men  who  examined  the  body  drew  two  conclusions:  1.  That 
there  was  no  disease  in  the  body  sufficient  to  cause  death,  or  to  account 
for  the  extreme  emaciation  and  exhaustion.  2.  Considering  that  the  ap- 
pearances included  all  those  which  the  best  authorities  assigned  to  death 
by  starvation,  it  was  their  unanimous  opinion  that  the  cause  of  death  in 
the  deceased,  Harriet  Staunton,  was  starvation  and  neglect,  understanding 
by  this  an  insufficient  supply  of  proper  food. 

For  the  defence  it  was  urged  that  the  emaciation  and  other  symptoms 
of  starvation  were  due  to  disease — i.e.  to  tubercular  meningitis;  and  not 
to  the  privation  of  food  or  the  supply  of  insufficient  food.  If  there  was 
any  truth  in  this  theory,  it  followed  that  a  ^rave  mistake  had  been  made 
in  charging  the  accused  with  any  crime.  This  defence  was  set  up  by  three 
medical  men  who  had  not  had  an  opportunity  of  seeing  the  body  or  even 
of  consulting  with  those  who  had  made  the  inspection.  The  general  evi- 
dence given  at  the  trial  satisfied  the  jury  that  there  had  been  on  the  part 
of  the  accused  intentional  and  deliberate  neglect,  and  they  returned  a 
verdict  of  wilful  murder.  In  accordance  with  pulilic  opinion  the  capital 
sentence  was  commuted  to  penal  servitude  for  life  against  three  of  the 
accused;  while  the  fourth,  Alice  Rhodes,  against  whom  the  evidence  of 
complicity  and  motive  was  weak,  was  discharged. 

Looking  at  all  the  medical  facts  of  this  remarkable  case  the  author  saw 
no  reason  to  doubt  that  the  deceased  died  from  starvation  as  the  result  of 
an  insufficient  supply  of  food.  He  thought  there  was  no  proof  whatever 
that  the  diseased  appearances  met  with  in  the  body  had  reached  a  sta<re 
sufficient  to  account  for  death  irrespective  of  starvation  and  neglect.  Xo 
medical  man  had  been  called  in  to  see  the  deceased  during  her  long  con- 
finement.    Her  mother  and  all  her  relatives  had  been  studiously  prevented 


486  MEDICAL    EVIDENCE    IN    THE    PENGE    CASE. 

from  visiting  her.  She  was,  in  fact,  for  many  weeks  completely  isolated 
from  the  word  by  the  accused  persons ;  and  within  the  last  twenty-four 
hours  of  her  life,  while  in  an  exhausted  and  prostrate  condition,  she  was 
hurriedly  removed  in  an  open  vehicle  and  by  rail  a  distance  of  more  than 
twenty  miles.  The  only  motive  which  could  be  suggested  for  this  violent 
proceding  was  that  the  accused  persons  might  thus  be  enabled,  as  death 
Avas  imminent,  to  procure  a  certificate  of  death  from  a  medical  man  not 
acquainted  with  the  facts.  They  succeeded  in  procuring  a  certificate  of 
death  from  apoplexy ;  but  the  medical  man  who  signed  it  had  so  much 
doubt  that  on  hearing  something  of  the  previous  history  of  the  case  he  . 
gave  information  to  the  coroner. 

It  has  been  complained  that  on  this  occasion  an  undue  importance  was 
attached  by  the  witnesses  for  the  defence  to  the  presence  of  a  miliary 
tubercular  deposit,  about  Half  an  inch  in  diameter,  on  the  arachnoid  mem- 
brane of  the  brain.  The  witnesses  for  the  prosecution,  who  saw  it, 
agreed  that  it  was  recent  and  quite  insufficient  to  account  for  the  extreme 
emaciation  or  death  of  the  woman.  One  witness  for  the  defence  so  far 
agreed  with  them  as  to  say  that  he  had  never  known  such  an  amount  of 
emaciation  as  was  here  described  to  take  place  from  such  a  cause  within  so 
short  a  time. 

In  all  cases  of  death  from  alleged  starvation,  but  especially  in  those 
where  a  charge  of  murder  is  raised,  a  medical  man  or  expert  is  bound  to 
give  full  eff"ect  to  the  presence  of  disease,  its  extent,  and  its  adequacy  to 
cause  appearances  such  as  are  found  on  the  body.  All  the  medical  wit- 
nesses for  the  prosecution  agreed  that  there  was  no  meningitis  (inflamma- 
tion of  the  membranes  of  the  brain)  nor  any  of  the  products  of  inflam- 
mation. As  this  statement  was  made  by  them  from  actual  observation 
any  expert  subsequently  dealing  with  the  case  was  bound  to  accept  and 
act  upon  it,  or  to  reject  the  evidence  altogether.  In  place  of  this,  how- 
ever, and  in  the  absence  of  any  inspection  of  the  brain,  they  affirmed  that 
meningitis  was  present  and  that  the  Avoman  died  of  it  in  a  tubercular 
form.  In  a  summary  of  the  case  in  its  pathological  aspects  by  Virchow 
(Med.  Exam.,  Nov.  187T,  p.  882),  he  states  that  he  should  not  consider 
himself  justified  in  regarding  a  deposit  of  tubercle  such  as  that  described 
as  of  fatal  siijnificance,  at  least  in  a  case  (like  this)  where  such  deposit 
has  its  seat  upon  the  convex  surface  of  the  left  cerebral  hemisphere.  The 
jury  at  the  trial,  and  the  authorities  to  whom  an  appeal  was  subsequently 
made,  rejected  this  theory  of  the  cause  of  death.  If  this  mode  of  dealing 
with  medical  evidence  and  medical  facts  were  generally  followed,  it  would 
be  scarcely  possible  to  obtain  a  conviction  in  any  case  of  actual  homicidal 
starvation. 

The  editor  is  of  opinion  that  Harriet  Staunton's  death  was  accelerated 
by  the  cruel  and  neglectful  treatment  to  which  she — a  tubercular  woman — 
was  subjected  ;  but  that  there  was  not  sufficient  evidence  that  her  death 
was  due  to  sheer  starvation. 

Vohcntary  Starvation.  Pretended  Fasting. — There  are  a  few  cases 
recorded  in  which  persons  have  voluntarily  abstained  from  food,  liquid  or 
solid,  for  the  purpose  of  self-destruction.  Suicide  as  a  result  of  perfect 
abstinence  is,  however,  exceedingly  rare;  the  person  cannot  resist  the 
intolerable  thirst,  or  the  desire  for  food,  when  placed  within  his  reach. 
It  has  been  sometimes  observed  among  the  insane.  As  it  requires  a 
period  of  about  ten  days  for  the  destruction  of  life  under  these  circum- 
stances, i.e.  in  the  acute  form  of  starvation,  the  resolution  to  abstain  can 
be  rarely  maintained,  and  for  the  purpose  of  self-destruction  starvation 
■would  never  be  resorted  to  except  when  all  other  means  of  destroying  life 
were  removed. 


PRETENDED    FASTING.  487 

Pretended  fasting  has  been  a  subject  of  imposture  at  various  times. 
The  case  of  Sarah  Jacobs,  the  Welsh  Fastinj^  Girl,  shows  how  it  may  be 
certainly  detected  by  strict  watching.  This  girl,  set.  13,  was  stated  to 
have  voluntarily  abstained  from  any  kind  of  food  for  a  period  of  two  years. 
She  had  kept  her  bed  during  that  time — lying  in  it  decorated  as  a  bride, 
visited  by  hundreds  of  persons — in  fact,  she  was  thus  publicly  exhibited 
by  her  parents  as  a  girl  of  miraculous  powers.  Her  lips  were  moistened 
with  water  once  a  fortnight,  but,  according  to  the  parents,  no  food  was 
given  to  her.  Four  professional  nurses  from  Guy's  Hospital  were  set  to 
watch  her,  and  the  result  was  that,  after  passing  through  the  usual  stages  of 
actual  starvation,  she  died  on  the  ninth  day.  She  refused  to  take  food  at 
any  time  during  the  strict  watching,  and  voluntarily  accepted  a  lingering 
death  rather  than  reveal  the  imposture.  Her  parents  and  those  around  her 
allowed  her  to  die.  A  post-mortem  examination  presented  the  following" 
appearances  :  The  body  was  plump  and  well-formed  ;  the  membranes  of  the 
brain  were  much  injected,  the  brain  itself  was  healthy  and  of  proper  con- 
sistency. There  was  a  layer  of  fat  from  half  an  inch  to  an  inch  thick  be- 
neath the  skin  of  the  chest  and  abdomen.  The  contents  of  the  chest  were 
healthy.  The  stomach  contained  three  teaspoonfuls  of  a  semi-gelatinous 
substance  of  the  consistency  of  syrup,  having  a  slightly  acid  reaction. 
The  small  intestines  were  empty,  and  presented  no  attenuation  or  thin- 
ning of  the  coats.  In  the  colon  and  rectum  there  was  half  a  pound  of 
solid  excrement  in  a  hardened  state,  which  might  have  been  there,  accord- 
ing to  the  medical  witness,  a  fortnight  or  longer.  The  liver  was  healthy, 
and  the  gall-bladder  was  greatly  distended  with  bile  ;  the  kidneys  and 
spleen  were  healthy,  and  the  urinary  bladder  was  empty. 

The  medical  evidence  was  to  the  effect  that  the  child  had  died  from  ex- 
haustion as  the  result  of  starvation.  The  parents  were  tried  on  a  charge 
of  manslaughter.  (Reg.  v.  Jacobs  and  wife,  Carmarthen  Sum.  Ass, 
1870.)  An  attempt  was  made  in  the  defence  to  refer  death  to  shock  and 
not  to  the  want  of  food.  The  medical  facts  relied  upon  in  support  of  this 
theory  were  the  presence  of  fat  in  the  body  and  the  absence  of  any  thin- 
ning of  the  coats  of  the  intestines  ;  but  as  Fowler  very  properly  pointed 
out  (Lancet,  1870,  ii.  p.  150),  the  absence  of  fat  and  the  thinning  of  the 
intestines  are  only  likely  to  be  met  with  after  long  or  chronic  fasting 
when  the  person  has  survived  many  weeks  on  insufficient  or  innutritions 
food.  In  the  case  of  this  girl,  the  only  proved  abstinence  from  food  was 
during  the  last  eight  days  of  her  life,  when  she  was  thoroughly  watched, 
and  this  period  of  time  would  not  suffice  for  the  entire  removal  of  the  fat 
and  the  thinning  of  the  coats  of  the  intestines.  The  prisoners  were  con- 
victed of  causing  the  death  of  their  child  by  criminal  negligence.  (Lancet, 
1870,  ii.  p.  132.) 

In  1880,  Dr.  Tanner,  an  American  physician,  entered  upon,  and  is  said 
to  have  successfully  accomplished,  a  forty  days'  fast.  It  is  doubtful 
whether  this  was  a  great  imposture  or  a  remarkable  feat  of  foolhardy  en- 
durance. The  conditions  under  which  he  was  watched  were  by  no  means 
satisfactory.  Water  was  taken,  at  times  freely  ;  and  at  one  time  it  was 
said  that  he  increased  his  weight  upon  a  water  dietary.  (Brit.  Med.  Jour., 
1880,  ii.  p.  215.)  No  complete  medical  history  of  this  case  has  been  pub- 
lished.    Tanner  is  said  to- have  had  several  imitators. 

[Succi,  the  Italian,  made  a  successful  experiment  in  New  York,  under 
the  personal  supervision  of  a  committee  of  phvsicians  and  representatives 
of  the  press  (N.  Y.  Herald),  and  fasted  forty-five  days.  Water  was  taken 
freely,  and  occasionally  a  fluid  called  elixir  not  containing  sustenance.  The 
watch  was  perfectly  kept  in  his  case.] 


488  SIGNS    OF    PREGNANCY. 


PREGNANCY. 


CHAPTER  XLIV. 

SIGXS     OF     PREGNANCY. SDPPKESSION     OF     THE     MENSES. QUICKENING. SOUNnS     OP     THE 

FCETAL    HEART. FEIGNED     PREGNANCY. CONCEALED     PREGNANCY. PREGNANCY    IN     THE 

DEAD. IMPREGNATION    IN    A    STATE    OF    UNCONSCIOUSNESS. ^LEGAL    RELATIONS. 

Signs  of  Pregnancy. 

Suppressicm  of  the  Menses. — It  is  well  known  that,  in  the  greater 
number  of  healthy  women,  so  soon  as  conception  has  taken  place,  this 
secretion  is  arrested.  But  there  are  certain  abnormal  conditions  which 
must  not  be  overlooked.  There  are  some  cases  recorded  which  show  that 
women  in  whom  the  menses  have  never  appeared  may  become  pregnant. 
This,  however,  is  allowed  by  all  accoucheurs  to  be  rare ;  and,  when  it 
occurs,  which  we  may  readily  learn  from  the  account  of  the  woman,  it 
will  be  necessary  to  search  for  other  signs  in  order  to  determine  the  fact 
of  pregnancy.  Irregularity  as  to  the  period  at  which  the  function  takes 
place  is  common  among  females.  This  irregularity  may  depend  upon  the 
age  of  the  person,  or  upon  disease,  either  of  which  causes  it  will  not  be 
difficult  to  recognize.  The  continuance  of  the  menses  after  conception 
may  make  a  pregnancy  appear  short.  A  case  is  reported  in  which  a 
woman  was  married  in  the  summer  of  185t),  and  the  menses  continued 
after  as  before  marriage.  In  Oct.  1857,  they  ceased  for  the  first  time,  and 
in  the  following  December  the  woman  was  delivered  of  a  full-grown  child  : 
as  the  abdomen  was  not  much  enlarged,  she  thought  that  she  was  only 
two  months  pregnant.     (New  York  Jour.,   1859,  p.  286.) 

There  are  numerous  disorders  of  the  womb  under  which,  irrespective  of 
pregnancy,  the  menses  may  become  suppressed.  The  continuance  of  the 
menstrual  discharge,  when  once  set  up,  is  not  a  necessary  condition  for 
ifnpregnation.  Murphy  has  reported  the  case  of  a  woman  who  for  sixteen 
years  went  on  bearing  children,  eight  in  number,  without  having  had 
during  that  period  any  appearance  of  the  menses.  Reid,  who  quotes  this 
case,  mentions  five  instances  that  fell  within  his  own  knowledge  in  which 
females  became  pregnant  notwithstanding  a  long  previous  cessation  of  the 
discharge.  (Lancet,  1853,  ii.  p.  236.)  The  absence  of  the  menses  as  a 
consequence  of  pregnancy  is  generally  indicated  by  the  good  health  which 
a  female  enjoys  ;  and  although  disease  may  coincide  with  pregnancy,  yet 
a  careful  practitioner  will  be  able  to  estimate  from  the  general  symptoms 
the  probable  cause  to  which  the  suppression  is  due.  On  the  other  hand, 
a  discharge  analogous  to  the  menstrual  sometimes  manifests  itself,  not 
merely  for  several  periods  in  a  pres-nant  woman,  but  during  the  whole 
course  of  pregnancy.  (Murphv's  Obst.  Rep.,  1844,  p.  9;  also  Henke's 
Zeitschrift  der  S.  A.,  1844,  p.  265.  See  Ann.  d'Hyg.,  1873,  t.  2,  p.  140.) 
Whitehead  has  collected  seven  well-marked  instances  of  menstruation  dur- 
ing pregnancy.    (On  Abortion,  p.  218.)    These  facts  show  that  we  should 


FEIGNED    MENSTRUATION — STATE    OF    THE    BREASTS.       489 

be  cautious  in  forming  an  opinion  ;  we  must  not  assert  that,  because  a 
discharge  continues,  pregnancy  cannot  possibly  exist,  or,  because  there  is 
no  discharge,  a  female  must  be  pregnant.  The  retention  of  the  menses 
within  the  womb  from  any  cause  may  produce  enlargement  of  the  abdo- 
men and  give  rise  to  some  of  the  external  symptoms  of  pregnancy. 

Feigned  3Ien  sir  nation. — The  menses  may  be  either  suppressed  or  re- 
tained ;  but  if  there  be  any  strong  motive  for  the  concealment  of  her  con- 
dition, a  woman  may  feign  menstruation.  Montgomery  detected  a  case 
of  this  kind  by  the  examination  of  the  areolae  of  the  breasts.  The  woman 
had  stained  her  linen  with  blood  in  order  to  make  it  appear  that  the 
menses  continued,  but  she  subsequently  admitted  that  this  was  an  imposi- 
tion. There  are  no  certain  means  of  distinguishing  between  menstrual 
and  ordinary  mammalian  blood. 

Prominence  of  the  Abdomen. — A  gradual  and  progressive  enlargement 
of  the  abdomen  is  a  well-marked  character  of  pregnancy  ;  the  skin  becomes 
stretched  and  the  navel  almost  obliterated.  This  enlargement  in  general 
begins  to  be  obvious  about  the  third  month,  although  there  are  some 
women  in  whom  the  enlargement  may  not  become  perceptible  until  the 
fifth  or  sixth  month,  or  even  later;  still,  it  may  be  detected  on  examina- 
tion. In  fact,  this  sign  can  never  be  absent  in  pregnancy,  although  it 
miy  not  be  so  apparent  in  some  women  as  it  is  in  others.  The  objection 
which  exists  to  it  is  that  numerous  morbid  causes  may  give  rise  to  promi- 
nence of  the  abdomen.  This  is  undoubtedly  the  fact,  as  we  have  occasion 
to  witness  in  the  various  kinds  of  dropsy,  or  in  suppressed  and  retained 
menses — diseases  which,  in  several  instances,  have  been  mistaken  for 
pregnancy  by  eminent  practitioners.  On  the  other  hand,  instances  are 
not  wanting  in  which,  owing  to  the  persistence  of  menstruation,  and  the 
absence  of  quickening,  the  gravid  womb  has  been  actually  tapped  by  mis- 
take for  an  ovarian  tumor;  the  operation  being  speedily  followed  hj  the 
birth  of  a  child  (Whitehead  On  Abortion,  p.  186);  but  the  history  of  a 
case  will  in  general  enable  a  practitioner  to.  form  a  correct  opinion.  (Ann. 
d'Kyg.,  18T3,  t.  2,  pp.  143  and  144.) 

A  Change  in  the  Breasts. — These  organs  in  a  pregnant  woman  are  full 
and  prominent,  and  the  areola;  around  the  nipples  undergo  changes  of  color 
which  Montgomery  and  others  regard  as  highly  characteristic  of  the  preg- 
nant state.  A  mere  fulness  or  pain  in  the  breasts,  and  even  in  some  rare 
instances  the  secretion  of  milk,  may  arise  from  other  causes  than  preg- 
nancy. Severe  uterine  or  ovarian  irritation  or  disease  may  cause  the 
breasts  to  become  painful,  swollen,  and  secrete  milk.  The  fulness  of  the 
breasts  from  pregnancy  is  not  commonly  observable  until  about  the  second 
or  third  month.  A  more  or  less  transparent  fluid  is  secreted  by  the  gland- 
tissue  of  the  breast,  and  can  be  expressed  from  the  nipples.  Such  cases, 
however,  are  not  very  common ;  but  after  a  woman  has  once  secreted 
milk  the  secretion  may  be  reproduced  in  the  breasts  by  very  slight  causes, 
quite  independently  of  pregnancy. 

The  areola  is  generally  observed  during  pregnancy  to  become  consider- 
ably darker  in  color  and  larger  in  diameter.  The  skin  of  which  the  areola 
is  formed  is  soft,  moist,  and  slightly  tumid.  The  little  glandular  follicles 
about  it  are  prominent,  and  often  bedewed  with  a  secretion :  the  change 
of  color  has  been  chiefly  attended  to.  The  areolae  are  commonly  well 
marked  in  from  the  second  to  the  fourth  month  of  pregnancy — the  inten- 
sity of  color  being  the  last  condition  of  the  ai-eola  to  appear.  The  promi- 
nence of  the  glandular  follicles  does  not  always  exist  in  y)regnancy,  and 
the  areola  may  become  large  and  dark-colored  from  other  "causes ;  conse- 
quently, these  signs  are  only  to   be   looked    upon  as  corroborative.     In 


490  PROOF    OF    QUICKENING. 

females  of  dark  complexion,  the  areolse  are  naturally  dark  irrespective  of 
pregiiancy ;  and  in  some  advanced  cases  these  changes  in  the  areolse  are 
entirely  absent.  (Edin.  Month.  Jour.,  March,  1848,  p.  693.)  Montgom- 
ery has  described  as  a  sign  of  pregnancy  the  existence  of  a  brown  line  ex- 
tending from  the  pubes  to  the  navel,  especially  in  women  of  dark  com- 
plexion, and  a  dark-colored  but  not  raised  areola  of  about  a  quarter  of  an 
inch  in  breadth  around  the  navel;  but  this  also  may  be  'produced  by 
uterine  or  ovarian  disease. 

Quickening. — The  signs  above  given  are  applicable  to  the  early  as  well 
as  to  the  late  stages  of  utero-gestation  ;  but  that  which  we  have  here  to 
consider  is  one  which  is  rarely  manifested  until  about  the  fourth  or  fifth 
month.  Quickening  is  the  name  applied  to  peculiar  sensations  experienced 
by  a  woman  about  this  stage  of  pregnancy.  The  symptoms  are  popularly 
ascribed  to  the  first  perception  of  the  movements  of  the  foetus,  which  occur 
when  the  womb  begins  to  rise  out  of  the  pelvis ;  and  to  these  movements 
as  well  as  probably  to  a  change  of  position  in  the  womb,  the  sensation  is 
perhaps  really  due.  The  movements  of  the  foetus  are  perceptible  to  the 
mother  before  they  are  made  evident  by  an  external  examination.  The 
term  is  derived  from  an  old  Saxon  word  "quick,"  signifying  living;  as, 
at  the  time  when  medical  science  was  in  its  infancy,  it  was  considered 
that  the  foetus  only  received  vitality  when  the  mother  experienced  the 
sensation  of  its  motion.  On  the  occurrence  of  quickening  there  is  gener- 
ally a  great  disturbance  of  the  system  indicated  by  syncope,  nausea,  and 
other  distressing  symptoms.  After  a  short  time  the  woman  recovers ; 
and,  if  sickness  has  hitherto  attended  the  pregnant  state,  it  has  been  fre- 
quently observed  to  disappear  when  the  period,  of  quickening  has  passed. 

No  evidence  but  that  of  the  woman  herself  can  satisfactorily  establish 
the  fact  of  quickening,  and  this  it  is  necessary  to  bear  in  mind;  since,  in 
some  cases  in  which  pregnancy  is  an  object  of  medico-legal  importance, 
proof  of  quickening  may  be  demanded  by  law.  Reid  remarks  (Lancet, 
1853,  ii.  p.  237),  with  respect  to  this  sign,  that  few  women  can  tell  the 
exact  day  on  which  they  first  feel  it ;  and  a  large  proportion  cannot  place 
it  within  a  range  of  fourteen  days,  which  is  of  little  assistance  in  the  calcu- 
lation of  the  probable  date  of  delivery.  Women  who  profess  to  be  most 
exact  in  noting  the  period  of  quickening  differ  with  each  other  as  to  the 
time.  There  is  much  self-deception  as  to  this  symptom.  The  discovery 
of  the  movements  of  a  child  by  an  examiner  is  really  a  proof  that  the  usual 
period  of  quickening  is  past,  but  their  non-discovery  at  the  time  of  exam- 
ination is  ho  proof  whatever  that  the  woman  has  not  quickened ;  since 
the  movements  are  by  no  means  constant,  and  may  be  accidentally  sus- 
pended even  at  several  successive  examinations.  Besides,  cases  occur  in 
which  well-formed,  healthy  women  do  not  experience  the  sensation  of 
quickening  durmg  the  whole  course  of  pregnancy  ;  and,  what  is  of  more 
importance,  the  movements  of  the  child  may  be  at  no  time  perceptible  to 
the  examiner.  The  uncertainty  of  quickening  as  a  sign  of  pregnancy  is 
too  well  known  to  require  more  than  adverting  to.  Women  have  been 
known  to  mistake  other  sensations  for  it,  and  in  the  end  it  has  been  proved 
that  they  were  not  pregnant.  A  woman  may  declare  that  she  has  felt 
quickening  when  she  has  not;  and  unless  the  movements  of  the  child  are 
perceived  by  the  examiner  at  the  time,  how  is  he  to  confirm  or  disprove 
her  statement?  Quickening,  then  (so  far  as  it  concerns  the  statement  of 
the  woman),  cannot  be  relied  on  as  a  proof  of  pregnancy  ;  but  if  the  move- 
ments of  a  child  can  be  felt  by  the  examiner  through  the  abdomen,  this  is 
clear  evidence,  not  only  of  the  woman  being  pregnant,  but  of  her  having 
passed  the  period  of  quickening.     According  to  the  general  experience  of 


SOUNDS    OF    THE    FCETAL    HEART.  491 

accoucheurs,  quickening  takes  place  from  the  tenth  to  the  twenty-fifth 
week  of  pregnancy  ;  but  the  greater  number  of  instances  occur  between 
the  twelfth  and  sixteenth  week,  or  between  the  fourteenth  and  eighteenth 
week  after  the  last  menstruation. 

From  these  observations,  it  will  be  seen  that  an  examiner  may  some- 
times detect  the  movements  of  the  child  about  the  third  or  fourth  month, 
at  others  not  until  the  fifth  or  sixth,  and  in  other  instances  not  at  all 
throughout  pregnancy.  Ahlfeld  found  that  in  forty-three  cases  in  which 
the  day  of  its  occurrence  was  noted,  it  ranged  from  108  to  134  days — the 
average  being  132.7  days.  (Amer.  Jour.  Med.  Sei.,  Oct.  1870,  p.  5G7.) 
Even  in  those  cases  in  which  the  movements  of  the  child  have  indisputably 
existed,  they  are  not  at  all  times  to  be  perceived  ;  hence  several  examina- 
tions should  be  resorted  to  before  any  opinion  can  be  fairly  expressed  from 
their  absence.  The  best  mode  of  examining  the  abdomen  for  foetal  move- 
ments is  to  allow  the  hand  to  remain  at  rest  on  the  al)domen.  If  the 
patient  has  quickened  recently,  the  impulse  is  slight,  and  generally  at  only 
one  spot,  which,  however,  is  seldom  the  same.  Should  she  have  advanced 
farther,  then  the  movements  will  be  more  rolling,  and  the  parts  of  the 
child  be  detected  at  the  same  time.  In  making  these  examinations,  a 
diagnosis  may  be  facilitated  by  previously  immersing  the  hand  in  cold 
water  and  then  suddenly  applying  it  to  the  abdomen.  When  the  move- 
ments of  the  child  are  distinctly  perceived  through  the  skin  of  the  abdo- 
men, they  constitute  a  certain  sign  of  pregnancy  ;  but  their  non-discovery 
at  a  particular  time  is  no  proof  that  a  female  is  not  pregnant.  The  jury 
of  matrons  probably  trusted  to  this  sign  ;  hence  their  verdicts  commonly 
turned  out  to  be  erroneous.  There  is  another  source  of  fallacy  which  may 
present  itself  when  an  artful  woman  is  desirous  of  making  it  appear  that 
she  is  pregnant — -namely,  that  a  woman  may  simulate  the  movements  of 
a  child  by  a  peculiar  action  of  the  abdominal  muscles.  Medical  prac- 
titioners of  repute  have  been  deceived  for  a  time  by  this  artifice;  "but  this 
occurred  before  the  discovery  of  chloroform  and  the  stethoscope. 

Sounds  of  the  Foital  Heart. — Another  sign  is  that  which  is  derived 
from  auscultation.  By  the  application  of  the  ear  or  a  stethoscope  to  the 
abdomen,  at  or  about  the  fifth  month  of  pregnancy  (rarely  earlier),  the 
pulsations  of  the  foetal  heart  may  be  recognized  and  counted.  These 
pulsations  are  not  synchronous  with  those  in  the  arteries  of  the  mother; 
they  are  much  more  rapid,  and  thus  it  is  impossible  to  mistake  them.  Their 
frequency,  according  to  Hope,  is  in  an  inverse  ratio  to  the  stage  of  gesta- 
tion, being  160  at  the  fifth,  and  120  at  the  ninth  month.  Sometimes, 
however,  the  foetal  pulse  may  descend  to  80  or  even  60  beats  in  a  minute. 
This  sign,  when  present  (like  the  foetal  movements),  not  only  establishes 
the  fact  of  pregnancy  beyond  all  dispute,  but  shows  that  the  child  is  living. 
The  sound  of  the  foetal  heart  is,  however,  not  always  perceptible ;  Avhen 
the  child  is  dead,  of  course  it  will  not  be  met  with ;  but  its  absence  is  no 
proof  of  the  death  of  the  child,  because  the  hearing  of  the  pulsations  by  an 
examiner  will  depend  very  much  upon  the  position  of  the  child's  body, 
the  quantity  of  liquor  amnii,  the  presence  of  disease,  and  other  circum- 
stances. Thus  the  sounds  may  be  distinctly  heard  at  one  time  and  not  at 
another ;  they  may  be  absent  for  a  week  or  fortnight,  and  then  will  re- 
appear;  so  that,  although  their  presence  alfords  positive  evidence,  their 
absence  furnishes  uncertain  negative  evidence ;  and  several  examinations 
should  be  made,  in  the  latter  case,  before  an  opinion  is  formed.  The  earliest 
time  at  which  the  pulsations  may  be  heard  has  been  stated  to  be  about  the 
fourth  month;  but  they  will  be  best  heard  after  the  sixth  month.  The 
reason  why  the  sounds  of  the  foetial  heart  are  not  always  perceived  is 


492  CHANGES    IN    THE    MOUTH    AND    NECK    OF    WOMB. 

owing,  not  only  to  changes  in  the  position  of  the  child,  but  to  the  vibra- 
tions having  to  traverse  the  liquor  aniuii  and  the  soft  layers  of  the  skin 
of  the  abdomen.  The  presence  of  much  fat  in  these  layers  intercepts  them. 
The  point  where  the  sounds  can  be  most  readily  perceived  is  in  the  centre 
of  a  line  drawn  from  the  navel  to  the  anterior  inferior  spinous  process  of 
the  ilium  on  either  side — perhaps  most  commonly  on  the  right.  When 
clearly  detected,  they  furnish  an  unequivocal  sign  of  the  pregnant  state. 
Besides  the  sounds  of  the  foetal  heart,  there  are  other  sounds  to  which  the 
name  of  "placental  murmur"  or  vterine  sounds  has  been  given.  These 
are  heard  from  an  earlier  date,  i.  e.  at  any  time  after  the  third  month.  As 
they  may  occur  in  connection  with  fibroid  tumors  of  the  womb,  they  do 
not  necessarily  indicate  pregnancy. 

In  reference  to  these  signs  of  the  pregnant  state  it  may  be  observed 
that,  if  the  motions  of  the  child  or  sounds  of  the  heart  be  perceptible,  no 
other  evidence  of  pregnancy  need  be  sought  for.  The  mere  suppression 
of  the  menses,  prominence  of  the  abdomen,  and  fulness  of  the  breasts  can- 
not alone  establish  the  fact;  but  unless  the  morbid  causes  of  these  abnor- 
mal states  of  the  system  be  clearly  and  satisfactorily  obvious  to  the 
examiner,  it  is  a  fair  presumption  from  these  symptoms  that  the  woman 
is  pregnant.  In  any  case  in  which  a  doubt  exists  we  should  require  suffi- 
cient time  to  form  a  correct  opinion. 

Changes  in  the  Mouth  and  Neck  of  the  Womb. — The  signs  hitherto 
mentioned  are  chiefly  relied  on  in  medical  practice ;  but  it  must  be  re- 
membered that  no  case  can  occur  in  civil  or  criminal  jurisprudence  in 
which  it  will  not  be  in  the  power  of  a  medical  witness  to  make  an  exami- 
nation of  the  woman.  He  may  then  form  a  safe  judgment  from  the 
changes  which  take  place  in  the  nock  of  the  womb,  and  from  the  sensation 
imparted  to  the  finger  by  the  presence  of  a  rounded  body  (like  the  foetus) 
floating  in  a  liquid,  when  an  impulse  is  given  to  the  womb  from  below. 
Up  to  the  fifth  or  sixth  month  of  pregnancy,  the  neck  of  the  womb,  of  its 
usual  length,  hard  and  firm,  may  be  commonly  felt  projecting  into  the 
vagina.  After  that  period,  the  womb  rises  into  the  pelvis,  and  the  neck 
is  spread  out  and  is  shorter  and  softer,  the  aperture  increasing  in  size 
and  becoming  rounder.  Towards  the  end  of  gestation,  the  neck  of  the 
womb  appears  to  be  lost,  becoming  like  a  thin  membrane,  and  sometimes 
no  aperture  can  be  felt. 

A  well-marked  test  of  pregnancy  is  the  motion  perceptible  to  the  finger 
on  giving  a  sudden  impulse  to  the  child  through  the  neck  of  the  womb. 
Capuron  calls  this  the  touchstone  in  the  distinction  of  the  pregnant  state  ; 
and,  without  it,  he  considers  a  medical  jurist  may  be  easily  deceived.  To 
this  passive  motion  of  a  child  the  name  of  ballottemevt  is  given.  It  can- 
not be  easily  determined  before  the  fifth  or  sixth  moiith  ;  but  after  the 
latter  period,  especially  as  pregnancy  becomes  advanced,  it  is  alwaj^s  avail- 
able. In  the  French  schools,  the  method  of  applying  the  toucher  and 
hallottement  to  pregnant  females  is  systematically  taught,  and  by  a  little 
practice  it  may  be  easily  acquired.  This  motion  to  the  child  can  also  be 
given  through  the  abdomen,  by  external  hallottement,  in  two  ways;  either 
by  the  patient  lying  on  her  side,  the  hand  placed  on  the  most  dependent 
part  of  the  womb,  or  by  placing  the  patient  on  her  elbows  and  knees ;  the 
womb  will  then  fall  forwards,  the  child  also  will  fall  in  contact  with  the 
front  wall  of  the  womb,  and  its  presence  thus  be  made  more  perceptible. 
This  latter  mode  is  best  adapted  to  the  early  stages  of  pregnancy. 

If  we  find  amenorrhoea  or  suppressed  menses,  and  a  tumor  distended  to 
a  size  consistent  with  the  duration  of  the  amenorrhoea — if  the  tumor  be 
more  or  less  central,  alternately  relaxing  and  contracting,  containing  an 


FEIGNED    PREGNANCY.  493 

irregularly-shaped  body,  which  is  freely  moved  within,  and  also  self-moving, 
■ — we  have  clear  indications  of  a  living  foetus;  and  if  we  add  to  these  the 
foetal  heart-sounds,  with  the  other  minor  symptoms,  we  have  a  condition 
which,  if  clearly  made  out,  must  be  considered  complete  proof  of  preg- 
nancy. Of  course,  we  may  have  certainty  with  the  foetal  heart-sounds 
and  "movements  if  well-marked,  and  a  strong  suspicion  from  the  other 
symptoms. 

As  most  of  these  signs  refer  to  an  advanced  stage,  a  witness  may  be 
asked — What  are  the  unequivocal  indications  of  pregnancy  before  the  fifth 
and  sixth  months'^  The  answer  to  this  question  is  of  little  moment  to  a 
medical  jurist,  since  he  is  rarely  required  to  give  an  opinion  under  these 
circumstances.  In  all  juridical  cases,  when  pregnancy  is  alleged  or  sus- 
pected, it  is  the  practice  for  a  judge  or  magistrate,  on  a  representation 
being  made  by  a  medical  witness,  to  postpone  the  decision  one,  two,  or 
three  months,  according  to  the  time  required  for  obtaining  certain  evi- 
dence. This  evidence  will  consist  in  plainly  distinguishing  (1)  a  rounded 
body  floating  freely  in  a  tumor  w^iich  alternately  relaxes  and  contracts; 
(2)  the  movements  of  a  foetus  ;  and  (3)  the  sounds  of  the  foetal  heart.  The 
most  experienced  men  agree  that  before  the  nixth  month  the  changes  in 
the  neck  and  mouth  of  the  womb  are  of  themselves  too  uncertain  to  enable 
an  examiner  to  form  a  safe  opinion;  and,  a  fortiori,  it  is  impossible  to 
trust  to  external  signs  alone.  Whitehead  dissents  from  this  view,  and 
considers  that  a  specular  examination  of  the  mouth  of  the  womb  is  not 
only  more  satisfactory  than  any  other  mode  of  exploration,  but  that  it 
will  enable  a  person  to  determine  with  certainty  the  existence  of  pregnancy 
during  its  earlier  stages — from  a  few  days  after  conception  to  the  middle 
or  end  of  the  fourth  month,  when  auscultation  first  becomes  available.  In 
the  fourth  week  the  lips  of  the  mouth  of  the  womb  at  the  centre  of  their 
margins  are  permanently  separated  to  the  extent  of  one  or  two  lines ;  and 
the  OS  tincae  (the  aperture)  itself,  which  was  before  a  mere  chink  with 
parallel  boundaries,  forms  an  elliptical  or  sometimes  rounded  aperture, 
which  is  occupied  by  a  deposit  of  transparent  gelatinous  mucus.  At  aix 
or  eight  weeks  it  is  decidedly  oval,  or  irregularly  circular,  with  a  puckered 
or  indented  boundary  having  a  relaxed  and  lobulated  character.  The 
whole  circumference  of  its  neck  is  enlarged,  and  the  commissures  or  angles 
of  the  mouth  are  obliterated.  The  mouth  continues  of  this  irregular  form 
throughout  the  whole  period  of  gestation  ;  but  from  the  time  of  quicken- 
ing to  the  end  of  the  seventh  month  the  progressive  changes  are  not  so 
marked  as  to  form  a  guide  for  determining  the  period  of  pregnancy. 
(Whitehead,  On  Abortion,  p.  204.)  This  condition  of  the  mouth  of  the 
womb  must  not  be  confounded  with  i:s  menstrual  state  in  the  early  stages, 
nor  with  a  diseased  state  in  the  latter  stage  of  gestation. 

[Prof.  Reese  says  that  a  bluish  or  dusky  color  of  the  vagina,  produced 
by  venous  congestion,  was  originally  declared  by  Jacquemin  to  be  an 
almost  certain  sign  of  pregnancy  in  females  who  are  not  subject  to  hemor- 
rhoids. This  statement  has  been  confirmed  by  Kluge,  Parent,  Duchatelet, 
Killian,  Wistrand,  and  Montgomery,  the  last  of  whom  says:  "In  every 
instance,  without  a  single  exception,  in  which  I  have  found  this  appear- 
ance distinctly  marked,  pregnancy  coexisted:"  Sig.  and  Symp.  of  Preg., 
2d  Ed.  p.  245.  It  should  be,  however,  remembered  that  pregnancy  may 
exist,  although  that  sign  may  not  be  visible :  Wharton  &  Stille,  Med. 
Jurisp.,  1873,  II.  p.  15.  The  presence  of  kiestein  in  the  urine  is  no 
longer  regarded  as  affording  positive  proof  of  pregnancy.] 

Feigned  Pregnancy. — Pregnancy  has  been  sometimes  feigned  or  sim- 
ulated for  the  purpose  of  extorting  charity,  of  obtaining  a  settlement  in  a 


494  CONCEALED    PREGNANCY. 

parish,  or  of  compelling  marriage  ;  but  it  is  scarcely  necessar}'^  to  observe 
that  ail  impostor  may  be  easily  detected  by  a  Avell-informed  piactitioner, 
since  a  woman  always  feigns  an  advanced  stage  of  pregnancy.  It  is  more 
easy  to  prove  in  most  cases  that  a  woman  is  not  pregnant  than  that  she 
is.  (Ann.  d'Hyg.,  1873,  t.  2,  p.  145.)  Although  she  may  state  that  she 
has  some  of  the  symptoms  depending  upon  pregnancy  (and,  unless  she 
has  already  borne  children,  she  will  not  be  able  to  sustain  a  cross-examina- 
tion.even  respecting  these),  yet  it  is  not  possible  for  her  to  sinmlate, 
without  detection,  a  distention  of  the  abdomen  or  the  state  of  the  breasts. 
If  she  submits  to  an  examination,  the  imposition  must  be  detected  ;  if  she 
refuses,  the  inference  will  be  that  she  is  an  impostor.  Women  have  been 
known  to  possess  the  power  of  giving  apparent  prominence  to  the  abdo- 
men, and  even  of  simulating  the  movements  of  a  child  by  the  aid  of  the 
abdominal  muscles.  By  placing  them  under  the  influence  of  chloroform, 
the  abdomen  at  once  collapses,  and  the  imposture  is  detected.  These  cases 
of  spurious  or  feigned  pregnancy  are  sometimes  met  with  in  hysterical 
females.  (Simpson,  Edin.  Month.  Jour.,  Ib54,  ix.  473;  Lancet,  1855,  i. 
pp.  381,  429,  533.)  Pregnancy  may  be  feigned  by  a  woman  in  order  to 
escape  the  punishment  of  hard  labor,  to  which  she  may  have  been  sen- 
tenced. If  in  this  case  the  slightest  doubt  should  exist  whether  the  woman 
is  really  pregnant  or  not,  a  restricted  afiSrmative  opinion  should  be  given, 
since  great  and  even  irreparable  mischief  might  result  by  taking  an 
opposite  course. 

In  civil  cases  of  feigned  pregnancy,  an  examination  should  always  be 
made  before  giving  an  opinion,  or  the  reputation  of  a  medical  man  may 
suffer  by  his  forming  a  hasty  conclusion  on  the  subject  from  insufficient 
data,  in  this  respect  the  case  of  Devonald  v.  Hope  (Q,.  B.,  Dec.  1838)  is 
of  some  interest.  A  medical  man  having  an  opinion  that  a  female  patient 
was  pregnant,  subsequently  brought  an  action  against  her  for  medical 
attendance.  It  turned  out,  however,  that  she  was  not  pregnant,  and  that 
there  were  no  satisfactory  medical  grounds  upon  which  his  opinion  was 
based.  The  ])laintiff  complained  of  having  been  deceived  by  the  defendant 
as  to  her  condition  ;  but  it  is  obviousl}'  in  the  power  of  any  medical  man 
to  prevent  such  a  deception  being  practised  on  him.  An  external  ex- 
amination only  will  not  suffice  either  to  affirm  or  negative  the  allegation 
of  pregnancy,  except  M'hen  it  is  stated  to  be  far  advanced.  (For  a  singular 
case  in  which,  on  a  charge  of  assault,  evidence  of  this  kind  was  tendered, 
see  Lond.  Med.  Gaz.,  vol.  xxxvi.  pp.  1083,  1169.  On  the  fallacy  of  the 
signs  of  pregnancy,  and  the  simulation  of  this  state,  see  papers  bv  Tardieu 
and  others,  Ann."d'Hvg.,  1845,  t.  2,  429;  1846,  t.  1,  83;  also  1873,  t.  2, 
p.  145.) 

Concealed  Pregnancy  ■ — B}'  the  law  of  Scotland,  if  a  woman  conceals 
her  pregnane}''  during  the  whole  period  thereof,  and  if  the  child  of  Vvhich 
she  was  pregnant  be  found  dead,  or  is  amissing,  she  is  guilty  of  an  ofl'ence, 
and  is  liable  to  prosecution.  Evidence  is  sometimes  given  as  to  outward 
appearances  indicative  of  pregnancy  ;  but  the  main  proof  of  a  woman 
having  been  pregnant,  and  that  which  is  relied  on  for  conviction,  is  clear 
and  distinct  evidence  of  the  actual  delivery  of  a  child.  This  is  generally 
furnished  by  medical  witnesses.  The  Scotch  law,  by  making  the  conceal- 
ment of  pregnancy  under  the  circumstances  above  mentioned  an  offence, 
proceeds  on  the  principle  that  every  pregnant  woman  is  bound  to  make 
preparations  for  the  safe  delivery  of  a  child;  and  it  is  therefore  assumed 
that  if  a  child  be  born  clandestinely  without  preparation,  and  is  found  dead 
or  is  amissing,  its  death  is  owing  to  the  want  of  such  preparation.  The 
English  law  impcses  no  obligation  to  make  a  pregnancy  known. 


UNCONSCIOUS    PREGNANCY.  495 

Impregnation  in  a  State  of  UnconHciousness. — It  was  formerly  a  ques- 
*tioii  whether  a  woman  could  become  pregna7il  without  her  knowledge. 
This  may  undoubtedly  happen,  when  intercourse  has  taken  place  during 
profound  sleep  (lethargy),  or  when  a  woman  has  been  thrown  into  this 
state  by  narcotic  drugs  or  vapors.  But  it  is  difficult  to  admit  that  any 
woman  should  remain  pregnant  up  to  the  time  of  her  delivery  without 
being  conscious  of  her  condition,  if  the  intercourse  took  place  during  the 
waking  state.  A  woman  endowed  with  ordinary  intellect  could  not  avoid 
suspecting  her  condition  after  the  fourth  or  fifth  month  ;  and  this  alone 
would  be  sufficient  to  induce  her  to  seek  advice  whereby  the  fact  would 
become  known  to  her.  When  a  woman  is  impregnated  in  a  lethargic 
state,  it  is  unlikely  that  she  should  go  beyond  the  sixth  month  Avithout 
being  fully  aware  of  her  pregnancy  ;  and  if  her  motives  were  innocent, 
she  would  undoubtedly  make  some  communication  to  her  friends.  Cap- 
uron  mentions  a  case  of  this  kind,  in  which  the  fact  of  pregnancy  was  first 
ascertained  at  the  end  of  the  fourth  month,  by  the  woman  having  com- 
plained to  one  of  her  sisters  of  a  stranee  sensation  which  she  experienced 
in  the  lower  part  of  her  abdomen.  (M^d.  Leg.  des  Accouchements,  p.  86.) 
A  young  woman  wh  o  had  had  intercourse  knowingly  was  supposed  not 
to  have  been  aware  of  her  pregnancy  until  the  seventh  month  ;  but  there  is 
reason  to  believe  that  this  woman  was  guilty  of  deception.  (Lond.  Med. 
Gaz.,  vol.  xxxix.  p.  212.)  There  are  generally  in  these  cases  strong 
motives  for  falsehood  ;  hence  such  stories  require  close  investigation  be- 
fore they  are  allowed  to  influence  the  opinion  of  a  practitioner.  A  case 
occurred  in  1857,  in  which  a  woman,  set.  22,  described  as  modest  and 
decorous  in  her  behavior,  then  advanced  to  the  sixth  month  of  pregnancy, 
asserted  that  she  had  not  consciously  bad  connection  with  any  one, 
although  she  specified  a  date  at  which  she  remembered  she  had  lost  her 
consciousness — at  which  date  intercourse  might  have  been  had.  On  being 
questioned,  she  denied  that  she  had  had  at  any  time  any  soreness  or  pain 
in  her  private  parts.  Although  there  may  be  unconscious  intercourse 
followed  by  pregnancy,  it  is  not  probable  that  in  the  case  of  a  virgin  there 
should  be  such  intercourse  without  the  production  of  pain,  soreness,  or 
laceration  ;  and  these  symptoms,  if  not  perceived  at  the  time,  should  be 
felt  subsequently  and  create  a  suspicion,  if  not  an  actual  knowledge,  of 
what  had  happened.  This  rendered  the  account  which  the  woman  gave 
wholly  improbable.  The  fact  that  she  was  able  to  fix  a  date  for  her  un- 
consciousness with  an  accuracy  in  accordance  with  her  condition,  was  also 
a  suspicious  circumstance. 

Unconscious  Pregnancy. — It  is  quite  possible  that  women  who  are 
living  in  connubial  intercourse  may  become  pregnant  without  being  con- 
scious of  it.  Riittel  mentions  the.  case  of  a  woman,  aet.  41,  who  had 
been  married  upwards  of  sixteen  years,  and  Avho,  while  returning  from  a 
neighboring  village,  was  suddenly  delivered  of  her  first  child,  when  only 
a  few  days  before  she  had  been  complaining  that  she  was  not  likely  to 
have  any  children.  The  child  was  born  living  and  mature.  (Henke, 
Zeitschrift  der  S.  A.,  1844,  p.  264.)  Long  met  with  a  case  in  which  a 
married  woman,  set.  24,  subject  to  irregular  menstruation,  consulted  him 
for  an  attack  of  spasms.  On  his  arrival  he  found  that  she  had  suddenly 
given  birth  to  a  seven-months'  child.  Neither  her  husband  nor  herself  had 
the  slightest  idea  that  she  was  pregnant.  She  had  noticed  that  she  had 
become  somewhat  stout  and  that  her  breasts  were  more  full  than  natural. 
She  attributed  her  condition  to  improved  health,  and  the  cessation  of 
the  menstrual  discharge  was  set  down  to  some  accidental  cause.  (Med. 
Times  and  Gaz.,  1857,  i.  p.  592.     See  also  a  case  at  full  term  by  Tanner, 


496  PREGNANCY    IN    THE    DEAD. 

Obst.  Trans.,  vol.  4,  p.  113.)  A  married  lady  who  had  not  had  a  child 
for  a  period  of  nineteen  years  found  herself,  as  she  thought,  getting  un- 
usually stout.  She  was  moving  about  with  her  family  to  different  places. 
At  last  her  size  alarmed  her,  and  she  thought  she  was  suffering  from 
dropsy  :  she  consulted  a  physician,  who  informed  her  that  she  was  in  an 
advanced  state  of  pregnancy.  She  treated  this  opinion  ^vith  great  con- 
tempt. In  travelling  with  her  daughter,  they  arrived  at  a  miserable  inn  ; 
on  the  night  of  their  arrival  this  lady  was  seized  with  the  pains  of  labor 
and  was  delivered  of  a  child.  She  had  made  no  preparation  for  the  birth, 
and,  up  to  the  moment  when  she  was  seized  with  labor-pains,  she  had  not, 
with  all  her  former  experience,  the  slightest  idea  that  she  was  pregnant. 
(For  other  cases  in  which  married  women  have  had  no  consciousness  of 
pregnancy,  see  Lancet,  18^0,  i.  pp.  609,  643.)  Instances  of  this  kind  are 
important  in  reference  to  alleged  unconscious  delivery  in  women  charged 
witb  infanticide.  At  the  same  time,  all  cases  in  which  there  are  motives 
for  pleading  unconscious  intercourse  or  pregnancy  require  close  examina- 
tion :  they  will  frequently  be  found  to  be  quite  unworthy  of  belief.  This 
remark  especially  applies  to  unmarried  women  who  often  consult  a  medical 
man  on  their  condition  with  a  full  knowledge  that  they  have  exposed 
themselves  to  the  chances  of  pregnancy.  Up  to  the  time  at  which  the 
foetal  movements  are  perceptible  a  woman  may  honestly  attribute  her 
condition  to  other  causes.  Dating  from  the  middle  period  of  pregnancy, 
however,  she  must  be  aware  of  her  state,  but  she  endeavors  to  dissemble 
this  even  to  herself. 

Pregnancy  in  the  Dead. — There  is  no  special  case  in  law  wherein  the 
fact  of  pregnancy  requires  to  be  verified  after  the  death  of  a  woman  ; 
but  an  examination  may  be  necessary  in  order  to  determine  the  identity 
of  a  body  or  to  rescue  the  reputation  of  the  deceased  from  a  charge  of 
unchastity.  The  discovery  of  an  embryo  or  foetus  with  its  membranes  in 
the  womb  would  of  course  at  once  solve  the  question  when  the  necessity 
for  an  examination  occurred ;  and  the  practitioner  will  remember  that, 
even  supposing  many  years  to  have  elapsed  since  interment  and  the 
body  to  have  been  reduced  to  a  skeleton,  still  if  the  foetus  had  reached  the 
period  at  which  ossification  takes  place,  traces  of  its  bones  will  be  found 
amidst  the  bones  of  the  woman.  The  common  practice  of  placing  the 
body  of  a  stillborn  foetus  in  the  coffin  of  a  woman  to  whom  the  foetus 
bears  no  relation  must,  however,  be  borne  in  mind.  It  is  possible,  too, 
that  where  a  child  is  buried  with  the  body  of  a  female  the  bones  of  the 
two  may  become  intermingled  in  the  course  of  time.  In  examining  the 
body  of  a  woman  long  after  death,  for  the  purpose  of  determining  whether 
she  was  or  was  not  pregnant  at  the  time  of  death,  it  may  be  proper  to 
bear  in  mind  that  the  unimpregnated  w^omb  undergoes  decomposition 
much  more  slowly  than  other  soft  organs.  In  the  case  of  a  woman  who 
had  been  missin.,^  for  a  period  of  nine  months — whose  body  was  found 
in  the  soil  of  a  privy,  so  decomposed  that  the  bones  separated  from  the 
soft  parts — the  womb  was  of  a  reddish  color,  hard  when  felt,  and  its  sub- 
stance was  firm  when  cut.  The  fact  was  of  importance.  It  was  alleged 
that  the  deceased  was  pregnant  by  a  young  man,  and  that  in  order  to 
conceal  her  condition  he  had  murdered  her.  From  the  state  of  the  womb 
Casper  was  able  to  affirm  that  this  organ  was  in  its  virgin  condition,  and 
that  the  deceased  was  not  pregnant  at  the  time  of  her  death.  On  this  rep- 
re.sentation  the  accused  was  liberated.  (Ger.  Leich-Oeffn.,  vol.  1,  p.  93.) 
In  examining  bodies  many  months  after  interment,  and  in  one  case  up- 
wards of  a  year,  we  found  that  while  other  soft  organs  were  decomposed 


LEGAL    RELATIONS.  497 

the  womb  had  scarcely  undergone  any  change — its  substance  was  still 
firm  and  hard. 

It  may  happen  that  the  appearances  in  the  womb  are  sufficient  to  create 
a  strong  suspicion  that  a  woman  has  been  pregnant,  but  the  ovum,  embryo, 
or  foetus  may  have  been  expelled  :  in  this  case  several  medico-legal  ques- 
tions will  arise  in  reference  to  delivery. 

Legal  Relations. — There  are  two  cases  in  English  jurisprudence  in 
which  proof  of  the  pregnancy  of  a  woman  may  be  required.  It  is  im- 
possible that  a  medical  opinion  can  be  given  in  either  case  until  the 
woman  has  undergone  examination.  If  she  is  acting  bona  fide  it  is  to 
her  interest  to  submit  to  this,  and  the  medical  man  incurs  no  responsi- 
bility. Assuming  that  an  opinion  is  required  on  the  pregnancy  of  a 
woman  who  refuses  to  be  examined,  a  medical  man  would  be  acting  ille- 
gally in  compelling  her  to  undergo  an  examination,  and  he  might  bring 
on  himself  a  charge  of  indecent  assault.  It  is  only  by  the  free  consent 
of  the  woman  that  such  an  examination  can  be  at  any  time  made.  (See 
Infanticide,  pod.) 

In  the  two  cases  in  which  opinions  are  usually  required,  a  woman  alleges 
that  she  is  pregnant,  but  she  would  not  be  benefited  by  the  allegation 
until  she  had  undergone  an  examination.  One  of  them  relates  to  the  civil 
and  the  other  to  the  criminal  law.  1.  Under  a  writ  de  ventre  inspiciendo. 
When  a  woman  asserts  that  she  is  pregnant  and  is  likely  to  give  birth  ty 
a  posthumous  child,  the  heir-at-law  to  the  estate  may  claim  a  right  to  have 
her  statement  verified  and  proof  given  that  she  is  really  pregnant.  The 
object  of  this  proceeding  is  to  prevent  the  possibility  of  the  heir  being 
defeated  of  his  rights  by  the  fraudulent  substitution  of  the  child  of 
another  person.  Formerly  the  proof  of  pregnancy  in  such  cases  was 
entrusted  to  matrons  nominated  by  the  sheriff,  but  now  the  matter  is 
more  considerately  left  to  skilled  medical  practitioners.  There  will  be 
no  difficulty  in  such  a  case  provided  the  pregnancy  is  at  all  advanced. 
Examinations  may  be  made  at  intervals,  until  the  motions  of  a  foetus 
are  clearly  perceived,  with  the  other  concomitant  signs  above  described. 
An  examination  of  this  kind  should  be  made  completely.  No  woman 
sliould  be  able  so  to  feign  pregnancy  as  to  deceive  a  skilled  medical  man. 
2.  The  other  case,  referring  to  criminal  law,  is  where  a  woman  after  a  capital 
conviction  pleads  her  pregnancy  in  bar  of  execution.  If  she  is  pregnant 
the  execution  of  the  sentence  is  postponed  until  after  her  delivery.  The 
strict  letter  of  the  law  requires  that  married  women  taken  from  any  who 
may  be  in  court  should  be  impanelled  to  examine  the  convict  and  report 
on  her  condition.  They  are  required  to  decide  whether  she  has  or  has  not 
passed  the  stage  of  quickening.  It  is,  however,  now  the  general  practice 
to  direct  the  examination  to  be  made  by  medical  men  for  the  purpose  of 
avoiding  those  mistakes  into  which  a  jury  of  ignorant  matrons  has  fre- 
quently fallen. 

These  are  the  only  cases  in  which  pregnancy  appears  to  have  any  direct 
relation  to  medical  jurisprudence  ;  and  it  is  remarkable  that,  with  respect 
to  them  the  law  of  England  has  expressly  provided  that  they  should  be 
left  to  the  decision  of  non-medical  persons.  The  following  conclusions 
may  therefore  be  drawn  :  1.  That  the  cases  in  which  the  signs  of  preg- 
nancy become  a  subject  of  legal  inquiry  in  England  are  rare.  2.  That 
there  is  no  case  in  English  law  in  which  a  medical  man  will  not  have  an 
opportunity  of  performing  an  exammntion  per  vaginain,  but  this  can  only 
be  made  with  the  consent  of  the  woman.  3.  That  a  medical  opinion  is 
never  required  by  English  law-authorities  until  the  pregnancy  is  so  far 
32 


498  LEGAL    RELATIONS. 

advanced  as  to  render  its  detection  certain.  Hence  discussions  concerning 
areolifi,  the  condition  of  the  breasts,  the  presence  of  kiestein  in  the  urine, 
etc.,  are,  in  a  practical  point  of  view,  unnecessary  to  a  medical  jurist. 
By  these  remarks  we  do  uot  intend  to  undervalue  the  importance  of  an 
accurate  knowledge  of  the  signs  of  pregnancy  to  a  medical  practitioner. 
Cases  which  may  never  come  before  a  court  of  law  will  be  referred  to 
him,  and  the  serious  moral  injury  which  he  may  inflict  on  an  innocent 
woman  by  inaccuracy  shoiild  make  him  cautious  in  conducting  an  exami- 
nation aiid  in  expressing  his  opinion.  The  medico-legal  questions  con- 
nected with  the  i)regnant  state  have  been  comprehensively  examined  by 
Stolz.     (Ann.  d'Hyg.,  1873,  t.  2,  p.  137.) 


DELIVERY.  499 


DELIVERY. 


CHAPTER     XLV. 

DELIVERY  IN  THE  LIVING. CONCEALED  DELIVERY. SIGNS  OF  ABORTION  IN  THE  EARLY  STAGES 

OF    PREGNANCY. SIGNS    OF    RECENT    AND    REMOTE    DELIVERY. FEIGNED    DELIVERY. DE- 
LIVERY IN  A  STATE  OF  UNCONSCIOUSNESS. SIGNS  OF    DELIVERY  IN  THE    DEAD. TRUE  AND 

FALSE  COPORA  LUTEA. CHARACTERS    OF  THE  OVUM    OR  EMBRYO. MOLES. CONCEALMENT 

OF  BIRTH. 

Delivery  is  a  subject  which  much  more  frequently  requires  medico- 
leg-al  intervention  than  pregnancy.  It  will  be  sufficient  to  state  that  the 
concealment  of  birth,  the  crimes  of  abortion  and  infanticide,  with  ques- 
tions relative  to  supposititious  children,  are  closely  dependent  on  the  proof 
of  parturition.  This  subject  will  admit  of  being  considered  under  two 
heads  :  1.  As  it  relates  to  delivery  in  the  living.  2.  As  it  relates  to  de- 
livery in  the  dead.  In  undertaking  the  investigation,  we  ought,  if  possi- 
ble, to  ascertain,  either  from  the  female  herself  or  from  those  around  her, 
whether  there  was  reason  to  suspect  that  she  had  been  pregnant.  If  we 
can  acquire  any  knowledge  on  this  point,  it  will  materially  facilitate  our 
inquiry  ;  but  this  is  not  always  possible.  It  has  generally  happened  that 
previous  pregnancy  has  been  so  concealed  that  few  who  saw  the  woman  sus- 
pected her  condition  ;  then  again,  as  the  admission  of  her  delivery  may  be 
the  strongest  proof  of  her  criminality,  she  will  perhaps  resolutely  deny  it; 
and  a  medical  practitioner  lias  no  right  to  extort  this  admission  from  her. 
From  this  it  will  be  seen  that  a  medical  witness  must  often  be  prepared  to 
prove  the  fact  of  delivery  against  the  woman  who  is  criminally  charged. 

Delivery  in  the  Living.  Concealed  Delivery. — The  signs  of  delivery 
in  a  living  woman  vary  materially  according'  to  the  time  at  which  this 
event  has  taken  place.  In  common  language,  if  the  contents  of  the  womb 
are  expelled  before  the  sixth  month,  the  woman  is  said  to  miscarry,  or  to 
have  an  abortion;  if  after  the  sixth  month,  she  is  said  to  have  a  prema- 
ture labor.  The  law  does  not  admit  any  such  distinction  ;  the  expulsion 
of  the  ovum,  foetus,  or  child  by  criminal  violence,  at  any  period  of  utero- 
gestation,  is  regarded  as  a  miscarriage  or  abortion.  It  has  been  well  ob- 
served that  the  signs  of  delivery  are  indistinct  in  proportion  to  the  im- 
maturity of  the  ovum.  Thus,  when  it  takes  place  at  the  second  or  third 
month  there  are  scarcely  any  proofs  which  can  be  derived  from  an  exami- 
nation of  the  woman.  All  the  ordinary  signs  of  delivery  at  the  full 
period  will  be  absent — the  development  of  the  embryo  not  having  i)een 
sufficient  to  cause  any  prominence  in  the  abdomen,  or  to  give  rise  to  those 
changes  in  the  system  which  take  place  previously  to  the  birth  of  a 
mature  child;  e.  g.  enlargement  of  the  breasts  and  dilatation  of  the  mouth 
of  the  womb.  Abortion  at  this  period  (the  second  or  third  month)  is  gene- 
rally accompanied  by  loss  of  blood,  which  may  manifest  itself  by  its  effects 
on  the  body.  This,  however,  caii  only  give  rise  to  a  suspicion.  At  a  later 
period  of  gestation  there  may  be  a  discharge  resembling  the  lochia,  and  the 


500  SIGNS    01'    DEicIVERY    IN    THE    LIVING. 

mouth  of  the  womb  may  be  found  enlarged  and  soft ;  but  from  the  small 
size  of  the  foetus  the  outlet  may  present  no  positive  evidence  of  delivery. 
The  quantity  of  blood  lost  may  be  greater  and  may  have  a  more  decided 
eifect  on  the  system.  Of  course,  if  the  ovum,  foetus,  or  any  of  its  mem- 
branes be  found,  then  the  presumption  of  abortion  v^'ill  be  strongly  sup- 
ported ;  but  women  who  designedly  conceal  their  condition  will  commonly 
take  effectual  means  to  prevent  the  examiner  from  obtaining  evidence  of 
this  kind. 

Signs  of  Recent  Delivery  in  the  Living — The  woman  is  weak,  the 
countenance  pale,  the  eyes  are  surrounded  by  livid  areolae,  and  there  is 
an  appearance  of  general  indisposition.  Any  severe  illness  may,  however, 
give  rise  to  similar  symptoms.  Their  sudden  occurrence  after  a  state  of 
previous  good  health,  especially  when  pregnancy  is  known  or  suspected, 
will  create  a  strong  suspicion.  The  breasts  are  large  and  full,  especially 
about  the  third  or  fourth  day  after  delivery  ;  the  nipples  are  enlarged,  and 
the  areolae  around  them  present  all  the  characters  of  advanced  pregnancy. 
If  the  appearances  described  are  not  well  marked  at  the  first  examination, 
they  may  be  seen  at  a  later  period  ;  and  in  a  doubtful  case,  when  the  em- 
bryo or  foetus  is  not  forthcoming,  a  second  examination  should  be  made 
before  a  final  opinion  is  given. 

1.  The  skin  of  the  abdomen  is  relaxed,  sometimes  thrown  into  folds  ; 
the  cuticle  interrupted  by  light  colored  broken  streaks  {linese  alhicantes), 
passing  especially  from  the  groins  and  pubes  towards  the  navel,  which  is 
more  or  less  stretched  and  altered  in  appearance.  Any  disease  which  has 
caused  enlai'gement  of  the  abdomen  may  give  rise  to  a  similar  appearance 
in  the  skin,  so  that,  when  taken  alone,  much  confidence  cannot  be  placed 
in  these  lines  or  streaks  as  proofs  of  delivery.  The  round  form  of  the 
enlarged  and  semi-contracted  womb  may  be  felt  at  the  lower  part  of  the 
abdomen,  generally  lying  towards  one  or  the  other  side.  The  apparent 
size  of  this  organ  will  depend  upon  the  degree  to  which  it  has  con- 
tracted, and  therefore  greatly  upon  the  time  at  which  an  examination  is 
made.  Montgomery  has  pointed  out  the  existence  of  a  dark  line  ex- 
tending from  the  pubes  to  the  navel,  with  a  dark  areola  round  the  latter, 
in  cases  of  recent  delivery;  but  he  has  found  this  line  to  exist  indepen- 
dently of  pregnancy  and  delivery — in  one  case  in  a  girl  aged  10,  and  in 
another  instance  in  a  lady  laboring  under  an  ovarian  tumor. 

i2.  The  organs  of  generation  wmII  be  found  externally  swollen,  contused, 
or  even  lacerated,  with  clots  of  blood  about  them.  The  outlet  is  much 
dilated,  the  vagina  relaxed,  the  mouth  of  the  womb  considerably  open, 
and  its  margin  much  relaxed.  The  neck  of  the  womb  is  shortened  and 
scarcely  perceptible ;  and  the  body  of  this  organ  is  from  two  to  four 
times  the  size  which  it  has  in  the  unimpregnated  state.  It  occasionally 
happens  that  the  neck  of  the  womb  is  lacerated  on  one  side  during  the 
passage  of  the  head  in  primipara? :  should  a  laceration  or  a  cicatrix  be  found, 
it  will  much  assist  in  proving  delivery. 

3.  The  Presence  of  the  Lochia,  (from  xoxo^,  childbirth).— This  is  a  dis- 
charge, at  first  of  a  sero-sanguineous  liquid,  but  which  afterwards  appears 
as  a  brown  or  green  colored  serum.  It  commences  soon  after  delivery, 
and  continues  from  a  week  to  a  fortnight,  or  even  longer  ;  it  may  be  absent 
after  the  third  day.  The  discharge  has  so  peculiar  an  odor  that  some 
have  regarded  this  alone  as  furnishing  strong  evidence  of  recent  delivery. 

The  signs  which  have  been  here  enumerated  are  found  only  when  no 
delay  has  taken  place  in  making  the  examination  and  the  woman  has  been 
recently  delivered.     In  some  strong  and  vigorous  women,  the  body  re- 


SIGNS    OF    REMOTE    DELIVERY.  501 

sunies  its  natural  state  within  a  few  days,  and  the  traces  of  parturition 
may  have  wholly  disappeared  or  have  become  so  ambiguous  as  to  furuisli 
no    satisfactory   evidence.     In  others,   again,   proofs  of  delivery  will  be 
obtainable  for  a  fortnight  or  three  weeks  afterwards.     In  most  cases,  how- 
ever, it  is  difficult,  if  not  impossible,  to  say,  after  the  lapse  of  eight  or  ten 
days,  that  delivery  has  certainly  taken  place,  the  sig-ns  having-  commonly 
by  that  time  disappeared.      In  all  cases,  the  earlier  the  period  at  which  an 
examination  is  made  the  more  satisfactory  will  be  the  evidence  obtained. 
Monti^oniery  once  examined  a  woman  five  days  after  her  delivery  at  the 
full  time,  and  he  was  particularly   struck  with  the  degree  to  w^hich  the 
parts  had  become  restored  to  their  ordinary  condition,  especially  the  mouth 
and  neck  of  the  womb,  which  hardly  differed  from  their  natural  and  unim- 
pregnated  form.     This  inquiry  becomes  of  considerable  importance  in  a 
ease  of  alleged  child-murder.      When  the  body  of  a  child  is  not  found  until 
after  two  or  three  weeks  from  the    time  of  its  birth,   and  the  suspected 
woman  denied  that  she  has  been  delivered  of  a  child,  she  will  probably  not 
deny  her  pregnancy,  but  may  assert  that  she  has   had  an  abortion  at  an 
early  period.     (See  a  case  in  Yierteljahrsschr.  fiir  Gerichtl.  Med.,  1863,  p. 
2T5.)     In  cases  of  abortion  at  an  earlier  period,  the  placenta  is  not  always 
discharged  at  the  time  at  which  the  embryo  or  foetus  is  expelled  from  the 
womb.     (Med.  Times  and   Graz.,    1859,   i.   p.  2T8.)      A  microscopical  ex- 
amination of  the  discharges  might  reveal  placental  or  chorionic  structures. 
In  a  case  which  occurred  to  Paxton,  all  the  usual  signs  of  delivery  were 
present  in  a  woman  set.  20  ;  she  had  evidently  lost  much  blood,  and  was 
much  reduced.     From  the  state  of  the  organs,  Paxton  considered  that  she 
had  been  delivered  of  a  child  within   three  days.     There  was   no    lochial 
discharge  at  the  date  of  examination.     The  woman  had  previously  denied 
her  pregnancy  when  charged  with  concealment  of  it,  but  after  the  medical 
examination  she  altered  her  statement,  and  said  that  she  had  not  onlv  been 
pregnant,  but  was  so  at  that  time.     On  a  further  examination,  the  womb 
was  found  to  contain  a  foetus  advanced  to  about  the  sixth  month,  and  in 
three  months  more  she  was  delivered  of  a  child.     What  caused  the  appear- 
ances   of  delivery,   the    condition  of  "the   breasts,   etc.  ?     Either  she  had 
shortly  before  been  delivered  of  a  child  or  of  a   blighted  ovum   or  foetus. 
N'either  foetus  nor  placenta  was  ever  seen  or  could  be  found,  but  the  woman 
had  had  ample  opportunity  to  dispose  of  them.     This  may  have  been  a 
ease  of  twin  conception  or  of  superfoetation.     It  shows  that,  in  charges  of 
concealment  of  pregnancy  or  delivery,  it  must  not  be  inferred,  when  the 
appearances    of  delivery    clearly  exist,    that  the  womb  is  empty.     This 
organ  should  always  be  examined  in  order  to  determine  whether  it  con- 
tains another  foetus. 

Signs  of  Delivery  at  a  Remote  Period. — A  question  may  arise  whether 
it  is  in  the  power  of  a  medical   practitioner  to   determine  the  period  at 
which  delivery  took  place,  i.  e.  how  long  a  time   has  elapsed.     This  be- 
comes necessary  when,  in  cases  of  concealed  birth,  abortion,  or  infanticide 
(some  time  after  suspected  parturition),  a  child  is  found,  and  it  is  required 
to  determine  whether  the  time  which  has  elapsed  since  the  birth  of  the 
child,  either  dead  or  living,  corresponds  with  the  supposed  delivery  of  a 
suspected  woman.      An  opinion  may  be  given   within  eight   or  ten  days 
after  delivery,  from  the  state  of  the   breasts,   of  ^he  discharges  (lochia), 
and  of  the  mouth  of  the  womb;  but  it  becomes  difficult  after  the   sixt' 
day  ;  and  when  the  tenth  or  twelfth  day  has  passed  it  is  still  more  d' 
cult.      After  two  or  three  months,  it  may  be  regarded   as  impossib^ 
assign  the  date  of  delivery  with  any  degree  of  precision.     (See  De' 
Med.  Leg.,  vol.  1,  p.  446.) 


502  FEIGNED    DELIVERY. 

In  a  case  of  pretended  delivery,  contested  legitimacy,  or  disputed  chas- 
tity, a  medical  jurist  may  be  required  to  say  whether  a  woman  has,  at 
any  antecedent  period  of  her  life,  been  delivered  of  a  child.  This  ques- 
tion, it  must  be  remarked,  can  be  raised  only  in  respect  to  delivery  at  the 
full  period,  since  there  is  no  doubt  that  abortion  in  the  early  stages  of 
pregnancy  may  take  place  and  leave  no  traces  of  such  an  event  discover- 
able in  after-life.  Indeed,  a  few  days  or  weeks  are  sometimes  sufficient  to 
obliterate  all  evidence  of  the  fact.  With  respect  to  delivery  at  the  full 
term,  certain  signs  have  been  mentioned,  which  by  some  are  considered 
indelible.  These  are — shining  streaks  on  the  skin  of  the  abdomen,  a 
brown  mark  reaching  from  the  navel  to  the  pubes,  and  the  state  of  the 
mouth  of  the  v^^omb,  which  is  said  never  to  close  so  effectually  as  in  the 
virgin.  In  regard  to  the  appearance  of  the  skin  of  the  abdomen,  it  may 
be  remarked  that  any  morbid  causes  giving  rise  to  a  distention  of  the 
cavity — as  ovarian  enlargement  or  dropsy — will  produce  the  same  effect ; 
so,  also,  to  a  certain  extent,  extreme  emaciation  from  a  state  of  obesity. 
(See  Med.  Times  and  Gaz.,  1861,  i.  p.  450,  on  False  Cicatrices.)  Then, 
again,  these  marks  on  the  skin  are  not  always  persistent  throughout  life. 
Besides,  a  woman,  according  to  the  statements  of  good  observers,  may  be 
not  only  once,  but  repeatedly  delivered,  without  having  these  marks  pro- 
duced. "  (Med.  Times  and  Gaz.,  1860,  i.  p.  583 ;  also  Ann.  d'Hyg.,  1873, 
t.  2,  p.  139.) 

With  regard  to  the  state  of  the  mouth  of  the  womb,  it  is  liable  to  vary 
in  different  women  and  to  be  affected  by  disease — so  that  a  certain  judg- 
ment cannot  always  be  formed  from  its  condition.  In  a  woman  who  has 
not  borne  children  the  mouth  of  the  womb  is  in  the  form  of  a  slit,  the 
angles  being  bent  down  and  giving  to  it  the  appearance  of  the  os  tineas 
(tench's  mouth).  Whitehead  has  observed  that  in  a  woman  who  has 
borne  children  the  mouth  becomes  elongated  and  loses  the  slight  bend  at 
each  of  its  extremities ;  the  labia  are  thickened,  and  more  nearly  of  equal 
size  ;  the  commissures  are  less  clearly  defined,  and  the  whole  of  the  neck 
is  enlarged  and  not  so  compact  in  texture.  (On  Abortion,  p.  195.)  It 
must  be  remembered,  however,  that  the  condition  of  the  mouth  of  the 
womb,  even  in  the  virgin,  varies  at  each  menstrual  period.  Should  there 
be  congenital  occlusion  of  the  vagina,  or  the  hvmen  be  found  imperforate, 
this  will  at  once  negative  a  previous  delivery  ;  but  the  latter  condition 
will  not  negative  a  previous  pregnancy,  since  a  woman  may  have  been 
impregnated,  and  have  had  an  abortion  in  an  early  stage  of  pregnancy, 
without  a  necessary  destruction  of  the  hymen.  This  sort  of  negative  evi- 
dence may,  however,  be  sometimes  of  great  value.  There  is  a  total  want 
of  good  affirmative  evidence  of  delivery  at  a  remote  period  in  the  living, 
if  we  except  that  which  is  furnished  by  the  presence  of  cicatrices  in  the 
vagina,  or  of  a  cicatrix  as  a  result  of  a  lacerated  perineum.  It  is  rare, 
however,  that  any  decision  on  this  subject  is  required  in  medical  jurispru- 
dence. It  might  be  demanded,  either  in  a  case  of  infanticide,  when  a 
woman  was  accused  of  having  destroyed  her  alleged  offspring  some  months 
or  years  before ;  or  in  a  case  of  contested  legitimacy,  when  a  female  is 
accused  of  having  substituted  a  child  of  which  she  pretends  she  had  been 
delivered  at  some  remote  period  of  time. 

Feigned  Delivery. — Delivery  has  often  been  feigned  by  women  for  the 
purpose  of  extorting  charity,  compelling  marriage,  or  disinheriting  parties 
who  have  claims  to  an  e.itate,  and  in  other  cases  without  any  assignable 
motive.  Of  course,  an  imposition  of  this  kind  could  not  be  sustained  before 
a  medical  practitioner  ;  a  id  detection  is  rendered  eas}^,  because  it  is  recent 
and  not  remote  delivery  which  is  assumed.    The  latter  would,  if  pretended, 


UNCONSCIOUS    DELIVERY.  503 

be  g-enerally  cleared  up  by  an  examination,  as  well  as  by  circumstantial 
evidence.  (See  case,  Lond.  Med.  Gaz.,  vol.  xix.  p.  231  ;  also  anotlier  by 
Capuron,  M6d.  Ld^;.  des  Accouchements,  p.  110.) 

Can  a  Woman  be  delivered  unconsciously  f — Another  important  ques- 
tion relative  to  delivery  in  the  living-  is  whether  a  woman  can  be  delivered 
without  being  conscious  of  it.  The  signs  of  delivery  may  be  discovered 
by  a  practitioner;  the  offspring  may  also  be  found;  the  woman  may  ad- 
mit the  fact  of  her  delivery,  but  allege  that  she  was  totally  unconscious  of 
it.  The  only  medico-leyal  case  in  v^hich  this  plea  is  occasionally  rai.sed  is 
in  infanticide;  and  as  the  possibility  of  the  occurrence  may  be  questioned, 
the  practitioner  must  be  provided  with  a  knowledge  of  those  facts  which 
medico-legal  writers  have  accumulated  respecting  it.  There  is  no  doubt 
that  a  woman  may  be  delivered  unconsciously  during  profound  sleep — 
while  laboring  under  coma,  apoplexy,  asphyxia,  syncope,  or  when  suffer- 
ing from  the  effects  of  narcotic  prisons — e.  g.  the  vapors  of  chloroform  and 
ether,  or  intoxicating  liquors.  It  is  said,  also,  that  delivery  has  taken 
place  spontaneously  while  a  woman  was  in  the  act  of  dying.  This,  how- 
ever, has  no  bearing  on  the  present  question.  It  is  in  those  cases  where, 
after  her  recovery,  a  woman  pleads  unconsciousness  of  delivery  that  nied- 
jcal  practitioners  are  chiefly  consulted.  Besides  the  cases  enumerated, 
hysteria,  when  accompanied  by  loss  of  sense  and  motion,  has  been  men- 
tioned as  a  state  in  which  parturition  is  liable  to  occur  unconsciously.  We 
need  not  be  surprised  at  delivery  taking  place  under  these  circumstances, 
when  we  consider  that  the  contractile  power  of  the  womb  is  altogether 
independent  of  volition  ;  but,  unless  the  morbid  states  already  mentioned 
are  accompanied  by  the  most  profound  lethargy  and  entire  loss  of  sensa- 
tion, it  can  rarely  happen  that  the  contractions  of  this  organ  in  its  efforts 
to  expel  the  child  should  not  at  once  rouse  a  woman  into  consciousness. 
We  ought  particularly  to  expect  this  in  primiparae,  i.  e.  in  those  who  have 
never  before  borne  children.  At  the  same  time,  it  must  be  remembered 
that  parturition  in  some  women,  especially  when  the  pelvis  is  wide  and 
the  child  small,  may  take  place  with  such  rapidity  and  ease  as  scarcely  to 
be  accompanied  with  pain. 

It  has  been  observed  that  when  a  woman  has  frequently  borne  children 
delivery  sometimes  takes  place  without  effort,  and  M^ithout  any  conscious- 
ness on  her  part.  On  other  occasions  a  woman  may  lie  in  a  kind  of  torpor 
or  stupor,  or  suffer  from  puerperal  convulsions,  and  have  no  recollection 
of  her  delivery.  The  following  case  is  possible:  a  woman  may  be  deliv- 
ered while  under  the  influence  of  puerperal  convulsions,  which  might 
have  attacked  her  before  labor  set  in  ;  and  after  delivery,  but  before  com- 
plete recovery,  she  might  become  maniacal — a  not  unfrequent  condition — 
during  which  interval  she  may  have  killed  or  injured  her  child  ;  or  the 
child  may  have  been  born  dead  or  suffering  from  some  accidental  injury. 
She  would  with  truth  assert  her  entire  ignorance  of  it.  Her  statement 
would  be  verified  by  a  bitten  tongue  and  a  congested  conjunctiva  or  face. 
Should  albumen  be  found  in  the  urine,  this  fact  would  be  still  more  con- 
firmative. Of  course,  puerperal  convulsions  occur  Vv'ithout  these  results. 
The  statement  might  be  disproved  by  finding  that  her  actions  had  shown 
care  and  design  in  other  circumstances  at  the  time  she  said  she  was  uncon- 
scious. King  has  described  the  case  of  a  woman,  ?et.  36,  the  mother  of 
nine  children.  She  received  his  assistance  in  her  tenth  labor:  when  sum- 
moned, she  was  lying  calmly  and  placidly  in  bed,  and  was  perfectly  insen- 
sible. He  found  that  the  child  had  been  expelled  with  the  placenta.  The 
woman  did  not  recover  her  consciousness  for  ten  or  twelve  hours,  and  then 
stated  that  she  had  no  recollection  either  of  the  birth  of  the  child  or  of  any 


60J:  UNCONSCIOUS    DELIVERY. 

circumstances  connected  with  this  event:  she  suffered  no  pain  or  uneasi- 
ness. Another  case  is  mentioned  by  him  in  which  sensation  appeared  to 
be  entirely  paralyzed  during-  labor.  (Med.  Times,  1874,  i.  p.  284.)  It  is 
beyond  doubt  that  profound  lethargy  occasionally  makes  its  appearance 
about  the  time  of  delivery.  Schulze  met  with  a  case  in  which  a  woman 
remained  in  a  state  of  sleep  for  three  days,  and  was  delivered  while  in 
this  unconscious  condition  :  on  awaking,  she  had  no  recollection  of  having 
sutfered  any  pain  during  delivery.  (Ann.  d'Hyg.,  1842,  t.  1,  p.  216; 
Lond.  Aled.  Gaz.,  vol.  xxxvi.  p.  40.)  •  Montgomery  relates  the  case  of  a 
lady,  the  mother  of  several  children,  who,  on  one  occasion,  was  uncon- 
sciously delivered  during  sleep.  (Cyc.  Pr.  Med.  ;  see  also  case  in  Brit, 
and  For.  Med.  Rev.,  No.  9,  p.  256.)  Palfrey  described  a  case  in  which 
labor  commenced  and  progressed  in  a  woman  to  the  second  stage  during 
sleep.     (Lancet,  18G4,  vol.  i.  p.  36.) 

The  results  obtained  by  the  use  of  the  vapors  of  chloroform  and  ether 
shuvv^  that  the  expulsive  efforts  of  the  womb  are  often  as  energetic  in  the 
unconscious  as  in  the  conscious  state.  It  may  appear  extraordinary,  how- 
ever, that  a  primiparous  woman,  unless  rendered  unconscious  by  narcotic 
substances,  should  be  delivered  without  suffering  pain;  nevertheless,  a 
case  of  this  kind  is  recorded  by  Wharrie.  The  woman's  age  was  21  ;  she 
had  been  in  labor  about  six  hours ;  she  complained  of  no  pain,  and  the 
child  was  born  without  efl'ort  or  consciousness.  The  child  was  healthy, 
but  small,  weighing  rather  more  than  four  pounds.  (Cormack's  Jour., 
1846,  p.  12.)  Notwithstanding  this  case,  it  is  in  the  highest  degree  im- 
probable that  any  primiparous  female  should  be  delivered  during  ordinary 
sleep,  without  being  roused  and  brought  to  a  sense  of  her  condition. 

There  is  another  condition  in  which  a  woman  may  state  that  her  de- 
livery took  place  unconsciously  ;  and  this,  from  its  being  one  of  the  most 
common  species  of  defence  set  up  by  a  female  charged  with  child-murder, 
must  here  claim  our  attention.  Thus  she  will  allege  that,  while  suffering 
from  pain,  she  felt  a  strong  desire  to  relieve  her  bowels;  that  she  went  to 
the  closet  for  that  purpose,  and  was  there  delivered  without  knowino-  any- 
thing of  the  occurrence,  until  it  was  too  late  to  save  the  child.  This  kind 
of  desire  is  a  very  common  S3niiptom  of  the  parturient  state ;  and  it  is 
often  difficult  to  restrain  a  woman  from  yielding  to  the  feeling,  when  it 
certainly  would  be  attended  with  hazard  to  the  child.  (Med.  Times  and 
Gaz.,  1857,  i.  p.  347.)  We  must,  therefore,  admit  that  an  accident  of  this 
kind  can  occur  ;  although  here,  as  in  every  other  instance  in  which  uncon- 
scious delivery  is  pleaded,  a  medical  Avitness  ought  to  inform  himself,  or 
be  informed,  of  all  the  particulars  uhich  are  stated  to  have  attended  de- 
livery, before  he  gives  an  answer  applicable  to  the  case.  As  a  general 
rule,  it  cannot  be  denied  that  delivery  may  take  place  under  these  circum- 
stances, and  a  woman  not  be  conscious  of  it ;  but  before  we  make  this 
admission  in  regard  to  any  particular  instance,  we  ought  to  have  a  state- 
ment of  all  the  facts  from  the  female  herself.  It  is  thus  that  we  shall 
avoid  the  risk  of  seeing  a  premature  medical  opinion  set  aside  by  the  sub- 
sequent production  of  circumstantial  evidence.  Besides,  it  has  been 
properly  observed  that,  after  an  accident  of  this  kind,  a  woman  cannot  be 
ignorant  of  her  having  been  delivered.  Women  who  have  raised  this  plea 
in  cases  of  child-murder  have  often  been  known  to  maintain  that  they 
were  unconscious  of  their  preg^nancy,  and  thus  have  attempted  to  excuse 
themselves  for  not  having  prepared  the  articles  necessary  for  childbirth. 
Ii  is  possible  that  a  woman,  especially  one  who  is  pregnant  for  the  first 
time,  may  not  be  aware  of  her  preg-nancy  in  the  earlier  stage;  but  it  is 
rare  for  one  to  advance  to  the  full  term  without  beinff  conscious  of  it. 


SIGNS    OF    DELIVERY    IN    TUB    DEAD.  505 

Women  who  have  borne  children  have  not  unfrequently  consulted  medical 
men,  and  although  nearly  at  full  term,  they  have  been  unconscious  of  their 
state.  In  the  majority  of  instances,  it  may  be  presumed  that  a  woman 
thus  situated  must  have  some  reason  to  suspect  her  condition  ;  and  if  only 
a  suspicion  existed  in  the  mind  of  one  who  did  not  contemplate  the  de- 
struction of  her  offspring,  there  would  be  many  circumstances  forthcoming 
which  would  at  once  establish  her  innocence.  If  this  remark  applies  to 
married  women,  it  applies  with  still  greater  force  to  those  who  are  un- 
married, since  the  fact  of  illicit  connection  and  the  fear  of  its  consequences 
must  render  them  peculiarly  alive  to  all  those  changes  which,  by  common 
repute,  take  place  during  pregnancy. 

Signs  of  Delivers/  in  the  Dead. — It  will  not  be  proper  to  examine  the 
signs  of  delivery  which  are  derivable  from  an  examination  of  the  body 
of  a  woman  after  death.  Occasionally  we  may  obtain  some  historv  of 
the  case  daring  life,  by  which  our  labor  will  be  much  facilitated ;  but,  on 
the  other  hand,  every  fact  may  be  studiously  concealed  from  us,  and  then 
we  may  be  required  to  prove,  not  only  the  delivery,  but  the  previous  preg- 
nancy. These  investigations  relative  to  pregnancy  and  delivery  in  the 
dead  body  are  almost  exclusively  confined  to  (.'ases  of  criminal  abortion, 
where  the  contents  of  the  womb  have  been  expelled  at  the  sacrifice  of  the 
life  of  the  woman.  Death  commonly  ensues  in  these  cases  within  two  or 
three  days  after  delivery,  and  then  satisfactory  proofs  are  obtainable  by  a 
post-mortem  examination;  but  if  the  woman  has  survived  three  or  four 
weeks,  it  will  be  as  difficult  to  determine  delivery  in  the  dead  as  in  the 
living  subject.  This  remark  applies  to  delivery  at  the  full  period ;  for  if 
the  womb  have  expelled  its  contents  in  the  first  months  of  pregnancy,  the 
traces  of  this  expulsion  will  have  generally  disappeared  in  the  course  of  a 
few  days. 

The  following  may  be  taken  as  the  chief  appearances  when  the  body  of 
a  woman  is  examined  soon  after  delivery  at  the  full  period :  The  womb 
is  like  a  large  flattened  pouch  from  nine  to  twelve  inches  lonir,  its  mouth 
being  wide  open.  The  cavity  contains  clots  of  blood  or  a  bloody  fluid ; 
and  its  surface  is  covered  with  the  .remains  of  a  decidua — the  outermost 
membrane  of  the  embryo  or  foetus.  In  the  part  to  which  the  placenta  has 
been  attached,  the  substance  of  the  organ  appears  exposed,  presenting 
several  large  semilunar  or  valvular  openings.  This  portion  of  the  womb 
has  been  found  of  a  very  dark  color,  which  has  given  rise  to  a  suspicion 
that  the  organ  was  gangrenous.  The  vessels  are  extremely  large  and 
numerous.  The  Fallopian  tubes,  round  ligaments,  and  ovaries  are  so 
vascular  (full  of  blood)  that  they  have  a  purple  color.  The  spot  whence 
the  ovum  has  escaped  is  more  congested  than  the  rest  of  the  ovarian  sur- 
face. Obstetric  writers  differ  greatly  in  their  statements  respectin"-  the 
size  of  the  womb  at  different  periods  after  parturition  ;  and  these  differences 
may  be  explained,  partly  by  the  fact  that  the  womb  contracts  more  rapidlv 
in  some  women  than  in  others,  and  partly  perhaps  by  the  circumstance  of 
the  birth  having  been  in  some  instances  premature.  Toulmouche  has  re- 
ported some  instructive  eases  of  delivery  at  different  periods,  showing  the 
influence  of  time  on  the  appearances.     (Ann.  d'Hyg.,  1864,  t.  2,  p.  349.) 

Montgomery  states  that  after  delivery  at  the  full  period,  and  under 
perfect  contraction  of  the  womb,  if  the  body  be  examined  within  a  day 
or  two,  the  womb  will  be  found  seven  inches  long  and  four  broad.  Its 
substance,  on  section,  Avill  be  from  an  inch  to  an  inch  and  a  half  in  thick- 
ness, and  will  present  the  orifices  of  a  great  number  of  large  vessels.  At 
the  end  of  a  week,  the  womb  is  between  five  and  six  inches,  and  at  the 
end  of  a  fortnight  about  five  inches  in  length;  the  density  of  its  structure 


506  PARITY    AND    NULLIPARITY. 

has  during  this  period  increased,  but  its  substance  has  considerably 
diminished.  The  inner  surface  is  still  bloody,  and  covered  partially  with  a 
pulpy  membrane  resembling  the  decidua.  The  orbicular  direction  of  the 
fibres  around  the  internal  orifices  of  the  Fallopian  tubes  is  at  this  time 
very  distinct.  In  about  a  month,  the  womb  will  have  become  fully  con- 
tracted ;  but  the  mouth  rarely,  if  ever,  closes  so  completely  as  in  the  virgin 
state.  In  a  case  examined  by  Barnes,  in  which  a  primiparous  woman,  aet. 
26,  died  from  puerperal  fever  on  the  sixth  day  after  delivery,  the  following 
appearances  were  met  with  in  the  womb :  The  internal  surface  was 
blackened  and  congested,  especially  in  those  parts  to  which  the  placenta 
had  been  attached.  There  was  the  appearance  of  suppurative  action  in 
this  part.  The  substance  of  the  womb  was  healthy  ;  there  was  no  pus  in 
the  sinuses.  The  mouth  of  the  womb  showed  considerable  ecchymosis. 
The  vagina  was  healthy  ;  the  iliac  veins  contained  nothing  but  loosely 
coagulated  blood.  There  was  in  the  left  ovary  a  small  well-marked  corpus 
luteum,  having  a  central  cavity.  (Lond.  JVJed.  Gaz.,  vol.  xli.  p.  294.) 
This  condition  of  the  womb  must  not  be  confounded  with  the  appearances 
w^hich  are  observed  when  death  takes  place  during  mevstruation.  Judee 
found  in  the  body  of  three  women  who  died  during  menstruation  that  the 
womb  was  somewhat  enlarged — its  walls  being  thickened,  and  its  interior 
lined  by  a  reddish  gelatinous  layer  about  1-1 2ih  of  an  inch  thick,  consist- 
ing of  a  capillary  network  of  vessels,  enclosed  in  a  mucus-like  membrane. 
When  this  was  removed,  the  womb  below  was  found  to  be  white  and  firm. 
The  interior  of  the  neck  was  of  a  grayish  color;  the  lips  were  swollen,  of 
a  dull  red,  bluish,  or  even  black  color.  On  compressing  this  part,  small 
drops  of  blood  issued.  This  was  not  observed  either  in  the  neck  or  body 
of  the  vagina.  A  section  of  the  womb  presented  only  the  normal  fibrous 
tissue  ;  but  at  the  level  of  the  mouth  (os  uteri)  there  was  a  mass  of  tissue 
resembling  a  portion  of  an  apoplectic  lung.  The  blood  during  menstrua- 
tion, according  to  him,  issues  entirely  from  the  highly  congested  mouth  of 
the  womb.  (Med.  Times  and  Gaz^,  1855,  i.  p.  632.)  An  ecchymosed 
condition  of  the  neck  of  the  womb  is  very  commonly  found  as  the  result 
of  even  an  easy  labor,  and  therefore- forms  a  good  guide  where  present. 
This  point  must  be  borne  in  mind  in  reference  to  criminal  abortion,  in- 
asmuch as  the  neck  may  present  an  appearance  as  if  violence  had  been 
employed. 

From  the  appearances  given  above,  it  will  be  seen  that  there  must  be 
considerable  difficulty  in  determining  the  period  prior  to  death  at  which 
delivery  took  place.  "^  The  difficulty  is  increased  when  a  woman  has  been 
prematurely  delivered,  or  when  death  has  not  taken  place  until  some  time 
after  delivery.  A  medical  opinion  may  be  then  in  some  degree  strength- 
ened by  searching  for  those  signs  which  have  been  described  as  character- 
istic of  delivery  in  the  living.  These,  if  present,  will  always  furnish 
strong  corroborative  evidence,  not  only  of  the  fact  of  delivery,  but  of  the 
period  at  which  it  had  probably  occurred. 

Parity  and  Niillipariti/. — The  medical  question  whether  a  M^oman  has 
ever  borne  a  child  or  not  may  be  mtiterial  in  reference  to  proof  of  iden- 
tity. In  Reg.  V.  Wainwright  (C.  C.  C,  December,  1875),  the  charge 
air'ainst  the  prisoner  was  that  he  had  murdered  Harriet  Lane,  a  woman 
with  whom  he  had  cohabited  She  had  been  missing  a  whole  year,  and 
the  remains  of  a  woman  were  found  buried  in  premises  belonging  to  the 
prisoner  ;  they  had  been  cut  up  into  various  portions,  and  were  so  mangK  d 
and  decomposed  that  it  was  necessary  to  establish  the  identity  of  the  body 
as  that  of  the  missing  woman.  One  of  the  medical  points  raised  referred 
to  the  condition  of  the  womb — i.  e.  whether  the  appearances  which  this 


EVIDENCE    FROxM    CORPORA    LUTEA,  507 

organ  presented  were  such  as  to  indicate  conclusively  that  the  deceased 
had  borne  children.  The  missing-  Harriet  Lane  had  had  two  children  by 
the  prisoner,  the  last  having  been  born  some  time  before  Christmas, 
1873  ;  therefore  about  nine  months  previous  to  her  disappearance.  From 
their  examination  of  the  womb,  Larkin  and  Bond  came  to  the  conclusion 
that  this  woman  had  borne  a  child.  Meadows,  who  appeared  as  an  ob- 
stetric expert  for  the  defence,  stated  that,  in  his  opinion,  the  woman  of 
these  remains  had  never  borne  a  child.  He  qualified  this  opinion,  how- 
ever, by  stating  that  he  believed  it  to  be  impossible  to  decide  this  question 
in  any  case  with  absolute  certainty.  If  this  witness  had  been  able  to 
swear  positively  that  the  indications  of  childbearing  were  absolutely  cer- 
tain, and  could  never  be  mistaken  for  a  virgin  or  unimpregnated  state  of 
the  womb,  his  evidence  would  have  gone  far  to  show  that  this  could  not. 
have  been  the  body  of  Harriet  Lane.  He  felt,  however,  he  could  not 
carry  his  evidence  to  such  an  extent,  and  the  effect  of  it  simply  amounted 
to  a  difference  of  opinion  on  the  answer  to  this  question.  (Brit.  Med. 
Jour.,  18T5,  ii.  p.  744.)  The  condition  of  the  womb,  according  to  the 
evidence  for  the  prosecution,  was  inconsistent  with  virginity.  This  organ 
was  in  every  way  enlarged.  It  was  flaccid,  and  the  walls  were  unusually 
thin.  There  were  one  or  two  white  lines  [linese  alhicantes)  in  the  skin  of 
the  lower  part  of  the  abdomen,  and  other  marks  of  a  darker  color  in  the 
inguinal  region.  The  obstetric  expert  for  the  defence  considered  that  the 
shape  of  the  womb  and  thinness  of  its  walls  indicated  that  the  deceased 
was  nuUiparous,  i.  e.  that  she  had  never  borne  a  child.  The  evidence  of 
the  medical  witnesses  for  the  prosecution  was  strongly  corroborated  by  a 
number  of  facts  tending  to  prove  that  this  was  the  body  of  Harriet  Lane; 
and  the  prisoner  was  convicted.  It  would  appear  from  the  discussions  on 
this  case  that  took  place  at  the  Obstetric  Society,  that  medical  science  alone 
cannot  at  present  furnish  a  certain  answer  to  this  question.  (Trans.  Obst. 
Soc,  1876,  vol.  xvii.  p.  355,  and  vol.  xviii.  p.  69.) 

Corpora  Lulea. — -The  condition  of  the  ovaries  has  been  considered  to 
furnish  strong  evidence,  not  so  much  of  delivery  as  of  previous  pregnancy. 
These  organs,  as  it  has  been  already  stated,  when  examined  soon  after 
delivery,  are  found  of  a  deep  purple  color,  owing  to  their  extreme  vascu- 
larity. If  the  woman  has  really  been  pregnant,  we  may  expect  to  find  on 
one  of  the  ovaries  the  appearance  which  is  denominated  a  corpus  luteum. 
The  accounts  given  by  obstetric  writers  of  the  characters  of  corpora  lutea 
and  the  evidence  which  they  are  capable  of  furnishing  in  legal  medicine 
are  very  conflicting.  According  to  Montgomery,  in  a  true  corpus  luteum 
(^.  e.  of  pregnancy)  the  ovary  presents  a  protuberance  with  a  distinct 
cicatrix  on  the  part  whence  the  ovum  has  escaped.  The  protuberant  por- 
tion will  be  found,  on  section,  to  have  an  oval  form  and  to  be  of  a  dull 
yellow  color — hence  the  name  corpus  luteum.  It  is  full  of  blood,  and  in 
texture  resembles  the  section  of  a  kidney.  It  is  of  its  greatest  size  in  the 
early  stage  of  pregnancy,  and  gradually  diminishes  as  gestation  advances. 
In  the  centre  of  this  section  there  may  be  either  a  caviti/  or  a  radiated 
white  cicatrix  (scar),  according  to  the  period  at  which  the  examination  is 
made.  The  cavity  remains  for  about  three  or  four  months  after  concep- 
tion, and  is  surrounded  by  a  dense  white  cyst;  as  gestation  advances,  tlie 
opposite  sides  approximate  and  a  radiated  white  cicatrix  results.  The 
size  and  vascularity  of  the  corpus  luteum  are  considerably  diminished  by 
the  time  gestation  is  completed,  and  in  about  five  or  six  months  afterwards 
— i.  e.  fourteen  months  after  its  first  formation — it  disappears  altogether 
from  the  ovary  ;  so  that  the  corpus  luteum  of  one  conception  is  not  found 
with  that  of  another,  unless  a  premature  expulsion  of  the  contents  of  the 


608         CHARACTERS  OF  THE  OVUM  OR  EMBRYO. 

womb  has  taken  place.  (Cye.  Pr.  Med.  Pregnancy,  p.  496  :  see  also  Edin. 
Med.  Jour., 1845,  i.  p.  58.)  The  presence  of  a  corpus  lutuem,  as  it  is  here 
described,  does  not  prove  that  a  woman  has  borne  a  child.  In  the  opinion 
of  some  obstetric  authorities,  it  establishes  that  conception  had  taken  place ; 
but  the  embryo  may  have  been  converted  into  a  mole  or  blighted  IcEtus 
and  expelled  at  an  early  period. 

Baly  and  Kirkes  concluded  from  their  researches  that  cases  seldom 
occur  in  which  the  mere  presence  of  a  corpus  luteum  can  be  taken  as  a 
proof  of  previous  impregnation  ;  and  they  consider  the  following  rules  to 
be  deducible  from  the  facts  which  they  have  collected  :  1.  A  corpus  lutenm 
in  its  early  stage  (that  is,  a  large  vesicle  filled  with  coagulated  blood, 
having  a  ruptured  orifice  and  a  thin  layer  of  yellow  matter  within  its 
walls)  affords  no  proof  of  impregnation  having  taken  place.  2.  From  the 
presence  of  a  corpus  luteum,  the  opening  of  which  is  closed,  and  the  cavity 
reduced  or  obliterated  (only  a  stellate  cicatrix  remaining^,  no  conclusion 
as  to  pregnancy  having  existed  can  be  drawn,  if  the  corpus  hdevm  be  of 
small  size,  and  does  not  contain  so  much  yellow  substance  as  would  form 
a  mass  the  size  of  a  small  pea.  3.  A  similar  corpus  luteum  of  larger  size 
than  a  common  pea  would  furnish  strong  presvmplive  evidence,  not  only 
of  impregnation  having  taken  place,  but  of  pregnancy  having  existed 
during  seveial  weeks  at  least;  and  the  evidence  would  approximate  more 
and  more  to  complete  proof  in  proportion  as  the  size  of  the  corpus  luteum 
was  greater. 

From  these  considerations,  therefore,  it  appears  to  us  that  the  only  con- 
clusion which  we  can  draw  is  that  medical  evidence  respecting  the  nature 
of  a  corpus  luteum  in  an  unknown  case,  if  received  by  a  court  of  law  at 
all,  should  be  received  with  the  greatest  caution,  and  only  from  a  witness 
of  great  experience.  The  old  doctrine  on  this  subject,  that  the  presence 
of  such  a  body  on  the  ovary  affords  certairi  and  undeniable  evidence  of 
impregnation,  may  be  regarded  as  completely  subverted. 

Characters  of  the  Ovum  or  Embryo  to  the  Sixth  Month. — Hitherto  the 
examination  has  been  confined  to  the  woman,  but  it  is  now  necessary  to 
describe  the  characters  of  the  ovum  or  embryo  and  its  enveloping  mcm- 
bi'anes  at  the  early  stages  of  pregnancy,  since,  when  this  can  be  procured, 
it  may  furnish  good  medical  evidence.  The  "  ovum  "  signifies  the  embryo 
and  its  membranous  coverings  ;  the  "  embryo  "  is  the  body  which  is  after- 
wards converted  into  the  foetus  ;  the  term  "  foetus  "  is  applied  to  the  em- 
bryo after  the  third  or  fourth  month  of  gestation.  If  the  ovum  be  ex- 
pelled within  a  month  after  conception,  it  is  scarcely  possible  to  detect 
it,  owing  to  its  small  size  and  its  being  enveloped  in  clots  of  blood.  Burns 
examined  three  wombs  within  the  first  month,  where  no  expulsion  bad 
taken  place,  but  even  under  these  favorable  circumstances  he  failed  to 
discover  the  ovum.  At  first  the  ovum  contains  no  visible  embryo,  but  it 
appears  merely  to  consist  of  vesicular  membranous  coverings.  According 
to  this  authority,  when  first  distinctly  seen  through  its  membranes,  it  is 
of  an  oblong  form  and  about  a  line  (the  tM'elfth  of  an  inch)  in  length.  At 
the  sixth,  week  it  is  slightly  curved,  resembling,  as  it  floats,  a  split  pea. 
In  the  seventh  week  it  is  equal  in  size  to  a  small  bee ;  and  by  the  end  of 
the  second  month  it  is  bent,  and  is  as  long  as  a  kidney  bean.  After  the 
second  month  development  goes  on  rapidly  ;  the  features  are  in  part  well 
marked,  and  the  limbs  are  gradually  formed.  At  the  third  month  the 
foetus  weighs  from  one  to  two  ounces  ;  when  stretched  out  it  measures 
about  three  inches,  and  the  genital  organs,  although  the  sex  is  not  then 
distinguishable,  are  large  in  proportion  to  the  rest  of  the  body.  The 
membranes  are  larger  than  a  goose's  e.g^.     At  ihe  fourth  month  \\\q  foetus 


EXAMINATION    OF    THE    OVUM.  609 

is  from  five  to  six  inches  long,  and  weighs  from  two  to  three  ounces;  at 
the  fifth  month  it  measures  from  six  to  seven  inches,  and  weighs  from 
five  to  seven  ounces ;  and  at  the  sixth  month  its  length  is  from  eight  to 
ten  inches,  and  its  weight  is  about  a  pound.  (For  the  characters  of  the 
child  beyond  this  period,  see  Infanticide,  x>ost.)  The  great  difficulty  will 
consist  in  determining  the  nature  of  the  supposed  ovum  or  embr3-o  be- 
tween the  second  and  third  months.  In  making  the  examination  the  ovum 
should  be  placed  in  water,  and  all  clots  gently  washed  away  from  the 
membranous  coverings  or  removed  by  some  blunt  instrument.  Alcohol 
may  be  used  as  a  substitute  for  water  after  the  blood  has  been  removed. 
If  the  embryo  cannot  be  found,  the  decidua  and  chorion  or  portions  of 
them  may  be  recognized — the  former  by  its  forming  the  outer  investment 
with  its  smooth  internal  and  rough  external  or  uterine  surface  ;  the  latter 
by  the  villous  or  shaggy  appearance  of  that  portion  of  it  which  would 
have  become  the  placenta.  Between  the  third  and  fourth  months  the 
foetus  may  be  commonly  identified  without  much  difficulty.  The  ovum 'in 
many  instances  escapes  first,  leaving  the  decidua  behind.  This  comes 
away  after  a  time,  but  it  is  important  to  remember  that  in  some  states  of 
the  virgin  decidua-like  structures  are  thrown  off  from  the  uterine  mucous 
membrane,  which,  when  examined  by  the  microscope,  resemble  the  true 
decidua.  Both  are  constituted  of  the  innermost  portion  of  the  uterine 
mucous  membrane,  and  contain  all  its  elements.  Keiller  (Edin.  Med. 
Jour.,  1865,  ii.  p.  82)  and  Bell  (ibid.,  p.  120)  have  called  attention  to  the 
fact  that  an  erroneous  medical  opinion  on  the  date  of  pregnancy  may  be 
formed  by  trusting  too  much  to  the  appearance  of  the  ovular  membranes. 
The  ovum  or  foetus  may  die  and  the  membranes  afterwards  continue  to 
grow,  thus  giving  the  appearance  of  a  more  remote  date  to  pregnancy. 
An  examination  of  the  embryo  alone  can  give  any  satisfactory  results  on 
this  point.  The  membranes  may  be  also  enlarged  as  the  result  of  dropsi- 
cal accumulation,  and  this  may  be  set  down  to  pregnancy  of  some  dura- 
tion, when  it  may  not  actually  have  extended  beyond  the  second  or  third 
month. 

A  mole  is  the  result  of  conception,  the  foetus  having  died  in  consequence 
of  the  effusion  of  blood  into  the  decidua  and  the  various  membranes,  and, 
should  a  placenta  exist,  into  its  structure.  The  symptoms  accompanying 
a  mole  resemble  those  of  pregnancy ;  and  the  appearances  produced  by  its 
expulsion  are  not  to  be  distinguished  from  those  attending  the  abortion  of 
a  foetus  at  an  early  period  of  gestation.  The  only  means  of  distinction 
would  be  derived  from  an  examination  of  the  expelled  matters.  The  local 
effects  produced  on  the  organs  of  generation  by  the  expulsion  of  these  bodies 
are  by  no  means  so  great  as  those  arising  from  delivery  at  the  full  period. 

When  from  some  accident  the  foetus  dies  at  any  time  before  the  com- 
plete formation  of  the  placenta,  the  villi  of  the  chorion,  instead  of  com- 
pletely dying,  grow  imperfectly  ;  whilst  serous  fluid  is  effused  within,  and 
the  part  is  distended  into  a  globular  form.  This  is  called  a  vesicular  mole. 
In  the  early  stage  of  pregnancy  a  decidual  covering  will  always  be  found 
more  or  less  complete  around  this  mole ;  but  if  the  size  of  the  mass  be 
great,  then,  although  present,  it  will  be  less  observable,  being  spread  over 
a  larger  surface.  A  corpus  luteum  v/ill  also  be  found,  but  not  so  perfectly 
formed  as  in  normal  pregnancy.  The  ordinary  symptoms  of  pregnancy 
accompany  this  state,  although  in  all  forms  of  mole-pregnancy  it  is  either 
imperfectly  marked  or  it  only  proceeds  to  a  certain  point.  (See  case 
Obst.  Rec,  vol.  i.  p.  21.)  It  is  also  to  be  remembered  that  the  effects 
produced  by  the  expulsion  of  a  mole  are  very  similar  to  those  of  an  abor- 
tion.    These  facts  may  have  an  important  bearing  in  medico-legal  practice. 


510  CONCEALMENT    OF    BIRTH. 

Concealment  of  BirHh. — Medical  evidence  respecting'  delivery  is  re- 
quired in  two  cases:  first,  when  the  birth  of  a  child  is  wilfully  concealed  ; 
and  second,  when  the  contents  of  the  womb  have  been  prematurely  ex- 
pelled by  criminal  means.  The  concealment  of  pregnancy  is  no  ofFence  in 
the  English  law  ;  but  the  concealment  of  delivery  or  of  the  birth  of  a 
child  is  a  misdemeanor  by  the  24  and  25  Vict.,  c.  100,  sec.  60,  the  words 
of  which  are  to  the  following  effect:  "  If  any  woman  shall  be  delivered  of 
a  child,  every  person  who  shall  by  any  secret  disposition  of  the  dead  body 
of  the  said  child,  whether  such  child  died  before,  at,  or  after  its  birth,  en- 
deavor to  conceal  the  birth  thereof,  shall  be  guilty  of  a  misdemeanor." 
Willes,  J.,  remarked  upon  the  statute  that  women  tried  on  this  charge  are 
punished,  not  for  concealment  of  birth,  but  concealment  of  the  body — a 
distinction  which  not  only  increases  the  difficulty  of  obtaining  evidence, 
but  excites  hope  in  the  criminal  that,  if  she  can  finally  do  away  with  the 
body,  she  may  be  free  of  the  law.  Various  interpretations  have  been  put 
upon  the  terms  "  concealment "  or  "  secret  disposition  "  of  the  body.  This 
part  of  the  evidence  does  not  affect  a  medical  witness,  unless  he  himself 
has  found  the  dead  body  or  was  present  when  it  was  found.  It  will  rest 
with  the  judge  to  determine  whether  the  body  has  been  so  disposed  of  as 
to  constitute  a  misdemeanor.  (Reg.  v.  Clarke,  Chelmsford  Sum.  Ass., 
1864.) 

[In  the  American  States  the  statute  laws  make  it  a  criminal  offence  to 
conceal  the  birth  of  a  child.  They  vary  to  such  an  extent  that  the  only 
safe  rule  to  adopt  is,  that  each  case  must  be  considered  and  construed 
under  the  law  existing  where  the  offence  was  committed.  The  courts  in 
all  cases  construe  these  statutes  with  great  strictness.  In  some  of  the 
American  States  the  statutes  require  that  it  must  appear  that  the  child 
was  born  alive,  and  that  if  the  child  was  stillborn  there  could  be  no 
crime:  Desty  Am.  Crim.  Law,  §  90,  citing  State  v.  Kiiiiy,  51  Me.  30; 
State  V.  Jones,  4  Hawks.  (N.  Car.)  350;  State  v.  Love,  1  Bay  (S.  Car.), 
167  ;  Douglass  v.  Com.,  8  Watts  (Pa.),  538. 

It  has  been  said  of  all  these  statutes  :  "  That  they  make  heavily  punish- 
able what  of  itself  is  nearly  or  quite  innocent,  simply  because  of  its 
tendency  toward  an  unproved  wrong.  Hence  the  interpretation  is  always 
specially  strict:"  Amer.  and  English  Encycl.  of  Law,  vol.  3,  p.  416.] 

Medical  men  must  be  here  cautioned,  as  in  some  other  crimes  com- 
mitted by  women,  that  they  have  no  legal  right,  except  by  the  consent  of 
the  woman,  to  examine  her  person  in  order  to  ascertain  whether  she  has 
been  recently  delivered  or  not.  According  to  English  law,  no  person  is 
bound  to  furnish  evidence  against  himself  or  herself.  A  medical  man  who 
neglects  this  rule  may  find  himself  charged  with  an  indecent  assault,  and 
be  sued  for  damages.  [The  rule  is  different  in  the  American  States  or 
many  of  them.  A  physician  who  attended  the  mother  would  not  be  per- 
mitted to  disclose  any  fact  coming  to  his  knowledge  while  attending  her 
in  his  professional  capacity.  The  statutes  of  New  York  and  many  Am- 
erican States  make  all  such  knowledge  privileged,  and  the  physician  is 
prohibited  from  testifying  regarding  it.]  In  Agnew  v.  Jobson  and  others 
(Newcastle  Lent  Ass.,  1877),  the  plaintiff  was  suspected  of  concealing  the 
birth  of  her  illegitimate  child,  of  which  she  was  afterwards  convicted.  An 
inspector  of  police,  wishing  to  have  evidence  of  her  physical  condition, 
gave  to  Mackay  authority  to  examine  the  plaintiff's  person.  Having- 
some  doubt  about  the  legality  of  the  proceeding,  he  applied  to  the  defen- 
dant Jobson,  a  magistrate,  who  gave  him  a  written  order  for  the  purpose. 
Jobson,  Mackay,  and  another  were  sued  for  damages  for  an  indecent 
assault.     The  evidence  made  it  clear  that  the  girl  did  not  give  her  consent. 


DEFINITION    OF    A    "CHILD."  511 

but  her  alarm  prevented  her  from  resisting*.  The  judge  summed  up,  and 
the  jury  returned  a  verdict  for  the  plaintiff,  with  50/.  damages.  (Brit. 
Med.  Jour.,  1877,  i.  p.  336.)  A  medical  man  may,  however,  examine  the 
clothes  of  the  accused,  as  well  as  the  body  of  the  child,  if  they  are  handed 
to  him  by  the  police  for  this  purpose. 

This  is  an  offence  of  which  women  charged  with  child-murder  are  com- 
monly convicted  in  England  ;  while  the  Scotch  law  punishes  women  for 
the  concealment  of  pregnancy  if  the  child  be  dead  or  amissing.  (Alison's 
Crim.  Law,  p.  153.)  The  medical  evidence  on  trials  for  this  misdemeanor 
in  Scotland  is  exclusively  derived  from  an  examination  of  the  mother  ; 
and  thus  much  will  depend  upon  the  time  at  which  this  is  made.  With 
regard  to  the  child,  its  body  need  not  even  be  produced,  provided  there  be 
satisfactory  evidence  of  its  death  ;  the  body  may  have  been  secretly  buried 
or  burnt,  and  in  the  latter  case  it  may  be  necessary  to  examine  the  bones- 
or  ashes. 

According  to  the  English  statute,  the  child  must  be  dead — the  conceal- 
ment of  the  birth  of  a  liviug  child  not  being  any  offence  unless  it  should 
happen  to  die  before  its  birth  was  made  known.  In  the  case  of  Reg.  v. 
Woodman  (Kingston  Lent  Ass.,  1845),  the  woman  was  acquitted  be- 
cause the  child  was  living  when  concealed.  Chitty  says  that,  in  order  to 
constitute  the  offence,  the  child  must  have  advanced  to  the  end  of  the 
seventh  month  (Med.  Jur.  p.  412)  ;  but  it  is  to  be  presumed  that  the  con- 
cealment of  the  birth  of  a  dead  child  at  the  sixth,  or  under  the  seventh 
month,  would  be  as  much  an  infringement  of  the  statute  as  if  it  were 
more  advanced.  The  concealment  of  the  aborted  but  undeveloped  ovum 
or  embryo,  of  a  monster — i.  e.  a  child  without  human  shape,  a  mole,  or 
other  morbid  growth — would  not  probably  be  considered  a  contravention 
of  the  statute.  We  are  not  aware  that  there  has  been  any  judicial  decision 
on  this  point.  Lane  communicated  to  the  Med.  Times  (Aug.  1845)  a 
case  in  which  a  charge  of  concealed  birth  was  dismissed,  because  the  con- 
cealment referred  to  a  child  born  at  the  eighth  month  in  its  membranes. 
The  woman  stated  that  she  did  not  consider  it  to  be  a  child.  The  case, 
being  entirely  new,  should  have  been  sent  for  trial ;  for  a  mag-isterial  de- 
cision can  furnish  no  precedent  on  a  question  of  this  kind.  This  woman 
must  have  been  delivered  of  a  child,  foetus,  or  embryo,  or  of  course  there 
would  have  been  no  pretence  for  the  charge.  That  a  child  may  be  thus 
born  and  removed  from  the  membranes  alive  is  a  fact  established  by  ex- 
perience. Brunton  reported  to  the  Obstetrical  Society  a  case  in  which 
the  entire  ovum  was  expelled  at  the  seventh  month  of  gestation,  and  the 
child  was  rescued  alive,  although  born  fifteen  minutes  before  being  taken 
out  of  the  membranes.  (Med.  Times  and  Gaz.,  1871,  i.  412.)  In  another 
case  of  sudden  delivery  the  child  in  its  membranes  with  the  placenta  was 
discharged  into  a  bucket.  It  was  not  rescued  in  time  to  save  life.  (Amer. 
Jour.  Med.  Sci.,  April,  1870,  p.  430.) 

It  is  difficult  to  suggest  a  proper  le^al  definition  of  a  "child."  From 
some  observations  made  by  a  Recorder  of  London,  there  appears  to  be 
some  uncertainty  on  this  point.  In  reference  to  the  case  of  Reg.  v.  Knight 
(C.  C.  C,  Oct.  1865),  where  a  woman  was  charged  with  concealment  of 
birth,  the  prisoner  admitted  to  a  policeman  that  she  had  been  delivered  of 
"a  something''  (not  forthcomina).  "Now,  was  she  delivered  of  a  child, 
and  had  she  disposed  of  the  body  in  such  a  way  as  to  conceal  the  fact  of 
her  having  been  so  delivered?  Then  what  was  'a  child?' — for  those 
were  the  words  used  in  the  statute.  He  felt  himself  a  little  debarred  from 
expressin;;  his  own  opinion  in  reply  to  this  question,  because  two  of  the 
judges  had  given  decisions  directly  contrary  the  one  to  the  other  upon 


512  DEFINITION    OF    A    "CIIILD," 

this  subject.  One  of  them  said  it  was  not  a  child  unless  it  had  attained 
that  state  in  which  it  could  live,  supposing  it  had  been  born  alive.  If  it 
had  attained  that  state,  then  he  was  of  opinion  that  it  was  a  child.  The 
other  judge  said  that  this  was  not  his  idea  of  a  child  ;  but  that  if  it  had 
the  outAvard  form  of  a  child,  it  was  a  child  according  to  the  statute.  The 
one  contended  that  it  ought  to  have  attained  to  a  state  in  which  it  had  a 
capability  of  living  {viability)  ;  and  the  other  that  at  any  rate  it  should 
have  the  outward  form  of  a  child.  Was  there  any  proof  of  this  kind  here  ? 
The  prisoner  herself  said,  she  did  not  know  whether  she  had  been  in  the 
family  way  for  three  months.  Taking  the  widest  view  of  the  judges — • 
Had  what  was  born  in  this  case  the  outward  form  of  a  child  ?  If  it  had 
not,  then  the  prisoner  was  not  guilty  of  the  offence  charged  against  her." 

The  proposed  new  Criminal  Code  contained  this  provision  (section  146): 
"  No  foetus  shall  be  deemed  to  be  a  child  within  the  meaning  of  this  sec- 
tion which  had  not,  when  born,  reached  the  period  at  which  it  might 
have  been  born  alive."  This,  as  it  will  be  seen  under  Infanticide,  is  not 
a  fixed  period,  but  no  doubt  the  earliest  period  at  which  a  child  has  been 
known  to  come  into  the  world  living  would  be  taken  as  the  limit. 

It  will  be  perceived  that  it  is  not  material  here,  as  in  a  case  of  alleged 
infanticide,  to  prove  when  the  child  died — whether  before,  during,  or  after 
its  birth  ;  and  thus  those  subtleties  and  technicalities  which  are  met  with 
in  cases  of  child-murder  are  avoided.  In  regard  to  i)roof  of  concealment, 
and  Avhat  constitutes  it,  these  are  essentially  legal  points ;  but  a  medical 
practitioner  may  sometimes  benefit  an  accused  person  if  he  can  prove  that 
the  woman  had  made  application  to  him  on  the  subject  of  her  pregnancy 
and  delivery.  The  law  is  especially  lenient  under  such  circumstances.  A 
very  strict  interpretation  appears  to  be  put  upon  this  term  concealment. 
Tiiere  must  be  a  "secret  disposition"  of  the  dead  body.  The  medical 
Avitness  may  even  have  to  deal,  not  with  the  body,  but  with  the  remains 
in  a  mutilated  state  or  burnt.  He  must  be  able  to  prove  that  they  really 
are  human  remains.  In  one  case  (Cornwall  Sum.  Ass.,  1871),  the  pris- 
oner, a  married  woman,  was  charged  with  the  murder  of  her  illegitimate 
child.  The  body  was  found  mutilated,  and  partly  burnt.  The  Avoman 
had  concealed  the  mutilated  body  of  the  child,  and  had  tried  to  get  rid  of 
it  by  burning.  She  said  the  burnt  bones  found  and  some  blood  on  a  rug 
were  those  of  a  fowl.  It  A\'as  proved,  however,  that  they  were  the  bones 
of  a  child  and  that  the  blood  Avas  not  that  of  a  fowl. 

Questions  connected  with  concealment  of  birth  do  not  fall  under  the 
jurisdiction  of  a  coroner  ;  the  medical  evidence  is  therefore  required  by  a 
magistrate. 


ABORTION  —  NATURAL  CAUSES.  513 


CRIMINAL  ABORTION. 


CHAPTER   XLVI. 

ABORTION    FROM    NATURAL    CAUSES. CRIMINAL    CAUSES. MECHANICAL    MEANS. MEDICINAL 

SUBSTANCES. SIGNS      OF      ABORTION. SPECIFIC      ABORTIVES. LOCAL      APPLICATIONS. 

FEIGNED    ABORTION. MEANING     OF    THE    \yORD    "  NOXIOUS"    AS    APPLIED    TO    DRUGS. —  ON 

INDUCING    PREMATURE    LABOR. PROOF    OF    PREGNANCY     NOT     NECESSARY. ABORTION     OF 

MONSTERS. MOLES  AND  HYDATIDS. 

By  abortion  is  commonly  understood,  in  medicine,  the  expulsion  of  the 
contents  of  the  womb  before  the  sixth  month  of  gestation.  If  the  expul- 
sion takes  place  between  the  sixth  and  ninth  months,  the  woman  is  said 
to  have  a  premature  labor.  The  law  makes  no  distinction  of  this  kind, 
but  the  term  "  abortion"  is  applied  to  the  expulsion  of  the  foetus  at  any 
period  of  pregnancy  before  the  term  of  gestation  is  completed  ;  and  in 
this  sense  it  is  synonymous  with  the  popular  term  miscarriage.  Crimi- 
nal abortion  is  incorrectly  thought  to  be  rarely  attempted  before  the  third 
month  ;  it  is  now  very  common  to  perform  it  before  the  second  month, 
because  then  a  woman  begins  for  the  first  time  to  acquire  a  certainty  of 
her  pregnancy.  The  causes  of  abortion  may  be  either  natural  or  violent. 
The  latter  only  fall  under  the  cognizance  of  the  law  ;  but  a  medical  witness 
should  be  well  acquainted  with  the  causes  which  are  called  natural,  in 
contradistinction  to  others  which  depend  on  the  application  of  violence. 
These  natural  causes  are  sometimes  very  obscure,  and  the  real  cause  is 
thus  often  overlooked.  They  are  so'frequent,  that — according  to  White- 
head's observation — of  2000  pregnancies,  one  in  seven  terminated  in 
abortion.  These  causes  are  commonly  aseribable  to  peculiarities  in  the 
female  system,  to  the  presence  of  uterine  or  other  diseases,  or  to  some 
shock  sustained  by  a  woman  during  pregnancy.  Any  diseases  which 
strongly  affect  the  womb  or  general  S3^stem  of  a  woman  may  give  rise  to 
abortion.  An  attack  of  smallpox  has  been  known  to  produce  it ;  and  it 
has  been  suggested  by  Acton  that  the  presence  of  constitutional  syphilis 
in  the  father  is  not  only  a  cause  of  infection  in  the  offspring,  but  of 
repeated  abortions  in  the  woman.  (Lend.  Med.  Gaz.,  vol.  xxxvi.  p.  164  ; 
Ramsbotham's  Obst.  Med.,  p.  655.)  These  facts  deserve  attention,  when 
it  is  proved  that  a  woman  has  really  aborted,  and  an  attempt  is  unjustly 
made  to  fix  an  alleged  act  of  criminality  on  another.  For  further  in- 
formation on  the  numerous  natural  and  accidental  causes  which  may  give 
rise  to  abortion,  the  reader  may  consult  the  work  of  Whitehead  (On 
Abortion  and  Sterility,  p.  252) ;  and,  for  the  effects  of  undue  lactation 
and  diseases  of  the  placenta  in  causing  abortion,  the  Med.  Times  and 
Gaz.,  1852,  ii.  p.  580,  and  1853,  i.  p.  302.  In  considering  the  operations 
of  these  causes,  it  is  proper  to  bear  in  mind  that,  during  pregnancy,  the 
womb  is  subject  to  a  natural  periodical  excitement  corresponding  to  what 
would  have  been  the  menstrual  periods  dating  from  the  last  cessation. 
Hence  comparatively  trivial  causes  operating  at  these  periods  may  lead  to 
33 


514  VIOLENT    CAUSES. 

au  expulsion  of  the  foetus.  Salomon  has  reported  two  eases  in  which  pre- 
mature delivery  followed  the  mercurializatiou  of  the  system.  (Lond.  Med. 
Gaz.,  vol.  xxxvi.  p.  658.) 

The  violent  causes  of  abortion  may  be  of  an  accidental  or  criminal 
nature.  In  general  the  distinction  will  not  be  difficult:  the  kind  of  vio- 
lence and  the  adequac}"  of  the  alleged  cause  to  produce  abortion  will  be 
apparent  from  the  evidence.  In  reference  to  criminal  cases,  the  causes 
mav  be  referred  either,  first  to  the  use  of  mechanical  means;  or  second, 
of  u-ritating  medicinal  substances  acting  upon  the  womb  or  bowels 
They  operate  with  greater  certainty  in  proportion  as  the  pregnancy  is 
advanced. 

Mechanical  Means. — Among  the  mechanical  causes  may  be  mentioned — 
severe  exercise,  the  violent  agitation  of  the  bod}^  as  by  riding  or  driving 
over  a  rough  pavement,  in  which  case  no  marks  of  violence  would  be 
apparent.  Any  physical  shock  sustained  by  the  body  may  operate  indi- 
rectlv  on  the  womb.  Violent  pressure  or  blows  on  the  abdomen  are 
sometimes  resorted  to  ;  but  in  these  cases  the  mai'ks  of  violence  will  be 
commonl}^  perceptible.  Instruments  have  been  devised  for  the  purpose 
of  piercing  the  membranes,  destroying  the  child,  and  thereby  leading  to 
its  expulsion.  It  cannot  be  denied  that  cases  have  occurred  which  show 
that  the  crime  is  frequently  perpetrated  by  persons  who  basel}^  derive  a 
profit  from  the  practice  ;  and  for  one  case  that  comes  to  light  probably 
many  are  efiectually  concealed.  In  the  evidence  given  on  four  trials 
within  a  recent  period  the  cases  presented  no  feature  of  novelty  or  in- 
terest. Instruments  were  employed,  and  drugs  in  large  doses  were  proved 
to  have  been  also  administered. 

Mechanical  means  are  undoubtedly  more  effectual  in  producing  abortion 
than  mechanical  substances;  yet  when  the  attempt  is  made  by  ignorant 
persons  the  woman  often  dies  from  inflammation  of  the  womb  or  perito- 
neum or  other  serious  after-consequences.  A  case  was  tried  some  years 
since  in  which  the  evidence  showed  that  the  prisoner  had  attempted  to 
produce  abortion  in  the  deceased,  by  thrusting  wooden  skewers  into  the 
suljstance  of  the  womb.  Inflammation  and  gangrene  took  place,  and  the 
woman  died.  The  prisoner  was  convicted  of  murder.  (For  similar  cases, 
see  Lond.  Med.  Gaz.,  vol.  xxxvi.  p.  102  ;  xlv.  p.  693.)  This  kind  of  injury 
to  the  womb  generally,  but  not  always,  implies  the  interference  of  some 
other  person  in  the  perpetration  of  the  crime.  Mechanical  means  often 
leave  marks  of  violence  on  the  womb,  as  well  as  on  the  body  of  the  child. 
If  the  mother  should  die  an  inspection  will  at  once  settle  the  point.  (Ann. 
d'Hvg,  1834,  t.  1,  p.  191;  1838,  t.  1,  p.  425;  1839,  t.  2,  p.  109.)  An 
important  case  of  this  kind  was  the  subject  of  a  criminal  trial  in  Scotland 
in  1858.  (Case  of  Keid,  Lond.  Med.  Gaz.,  Dec.  11,  1858.)  The  womb 
near  its  mouth  presented  two  openings  in  its  substance,  described  as 
punctured  wounds  by  the  medical  witnesses  for  the  prosecution  who  made 
the  examination,  and  as  the  openings  of  torn  bloodvessels  by  others  who 
were  called  for  the  defence.  There  was  also  a  rupture  of  one  ovary.  The 
prisoner  was  convicted,  and  the  medical  man  who  was  supposed  to  have 
been  the  principal  agent  in  the  crime  committed  suicide.  The  case  is 
chieflv  imi)Ortant  in  showing  that  any  apparent  mechanical  injury  to  the 
womb  should  be  minutely  examined  at  the  time  of  inspection,  so  that  no 
doubt  of  the  cause  may  afterwards  be  entertained  by  any  present.  If,  in 
a  case  of  this  kind,  the  mother  should  survive  and  the  child  be  expelled, 
then  marks  of  violence  may  be  found  on  its  body.  These  marks  may  not 
be  sufficient  to  account  for  its  death  ;  but  this  is  not  here  the  question. 
If  it  can  be  proved  that  they  have  not  resulted  from  accidental  causes 


MECHANICAL    MEANS — INSTRUMENTS.  615 

durini^  gestation  or  subsequently  to  delivery,  then  their  presence  may 
furnish  stron^ii:  corroborative  evidence  of  the  actual  means  by  which 
abortion  was  attempted.  It  is  said  tliat  abortion  has  been  in  some  in- 
stances accomplished  by  frequent  bleeding  from  the  arm.  This  effect  may 
follow  as  a  result  of  shock  produced  by  the  sudden  loss  of  a  large  quan- 
tity of  blood.  An  examination  of  the  veins  of  the  arms  would  show 
whether  any  such  attempt  had  been  made. 

There  can  be  no  doubt  that  of  all  the  exciting  causes  of  abortion  the 
most  effectual,  and  that  which  most  certainly  brings  on  the  expulsive 
action  of  the  womb,  is  the  destruction  of  the  ovum  or  embryo.  If  by 
accident  or  'design  the  ovular  membrane  should  become  ruptured,  gesta- 
tion is  arrested,  and  abortion  necessarily  ensues.  At  any  period  of  preg- 
nancy, therefore,  a  puncture  through  the  membranes  will  sooner  or  later 
occasion  the  evacuation  of  the  womb.  (Ramsbotham's  Obst.  Med.,  p. 
655.)  This  author  remarks  that  the  performance  of  the  operation  de- 
mands a  most  accurate  knowledge  of  the  anatomy  of  the  ovum  and  the 
maternal  structures,  as  well  as  of  the  state  of  development  which  the 
neck  of  the  womb  assumes  at  different  periods  of  pregnancy.  In  medical 
practice,  for  the  induction  of  premature  labor  the  membranes  are  rup- 
tured either  by  th^^  use  of  a  catheter  or  by  an  instrument  of  this  shape, 
but  including  a  blade  like  a  tonsil-lancet.  Unless  the  inner  membrane  or 
amnion  be  opened,  gestatio:!  may  still  proceed,  and  abortion  will  not  take 
place.  When  all  the  membranes  are  completely  penetrated  and  the  waters 
are  discharged,  uterine  action  is  invariably  induced,  but  the  time  which 
elapses  from  the  performance  of  the  operation  to  the  commencement  of 
labor  is  subject  to  great  variation.  Ramsb^  thani  states  that  he  has  known 
the  womb  begin  to  act  in  ten  hours  after  the  rupture,  but  in  another  case 
a  week  elapsed  before  its  action  commenced.  As  a  rule,  uterine  action 
is  in  general  fully  established  in  from  fifty  to  sixty  hours.  In  Reg.  v. 
Sharpe  (Notts  Lent  Ass.,  1873),  the  prisoner,  who  was  a  charwoman, 
but  said  by  profession  to  be  an  abortion-monger,  was  convicted  of  this 
crime.  It  was  proved  that  she  ruptured  the  membranes  with  an  ivory 
crochet-needle,  and  three  days  afterwards  the  woman  was  delivered  of  a 
stillborn  child.  Another  woman,  proved  to  be  an  accessory  to  the  act, 
was  sentenced  to  fifteen  months'  imprisonment.      (Lancet,  1873,  i.  p.  422.) 

It  must  not  be  supposed,  however,  that,  where  a  criminal  intention 
exists,  a  long  period  is  required  for  removing  the  contents  of  the  womb. 
In  a  criminal  attempt  by  a  medical  practitioner,  in  which  the  woman 
would  be  a  consenting  party  to  the  act,  the  removal  of  the  embryo  or 
foetus  might  be  effected  in  a  much  shorter  period  of  time  than  in  those 
cases  of  obstetric  practice  in  which  there  was  no  desire  to  expose  the 
woman  to  the  slightest  risk,  and  premature  labor  was  openly  induced.  At 
any  rate,  the  time  for  the  completion  of  abortion  could  not  be  measured 
by  cases  in  which  the  womb  has  been  loft  to  undergo  spontaneous  con- 
traction after  the  membranes  had  been  punctured,  and  the  waters  had 
escaped.  There  would,  however,  be  great  dan<>-er  to  a  woman  in  the 
necessary  manipulations  r(>quired.  The  reader  will  find  reports  by  Tardieu 
(Ann.  d'Hyg.,  1855,  t.  1,  p.  406)  of  numerous  cases  of  abortion  as  a  result 
of  mechanical  means  applied  to  the  womb  ;  and  some  good  practical  re- 
marks by  the  same  writer  on  the  mode  in  which  these  inquiries  should  be 
conducted,  in  the  Ann.  d'Hyg.,  1856,  t.  1,  p.  141.  On  the  mechanical 
means  for  procuring  abortion  and  the  results,  see  a  paper  by  Lex.  (Vier- 
teljahrsschr.  fur  Gerichtl.  Med.,  1866,  1,  p.  253.) 

It  is  obvious  that  this  mode  of  perpetrating  abortion  is  only  likely  to 
succeed  in  the  hands  of  persons  who  have  a  complete  anatomical  knowl- 


616  USE    OF    MEDICINAL    SUBSTANCES. 

edge  of  the  parts.  The  death  of  the  woman  will  convert  the  crime  into 
murder  if  instruments  are  introduced  into  her  body  by  persons  who  are 
ignorant  of  anatomy.  In  Keg-,  v.  Heap  (Liverpool  Lent  Ass.,  IS'ZS),  it 
was  proved  that  the  prisoner  had  caused  abortion  by  the  use  of  instruments. 
The  man  procured  abortion  and  brought  about  the  death  of  the  woman 
by  driving  a  weaver's  spindle  into  the  womb,  the  fundus  of  which  was 
completely  transfixed  and  a  fatal  peritonitis  induced.  On  an  inspection, 
two  sharply-punctured  wounds  were  found  in  the  womb,  and  to  these  death 
was  attributed.  The  prisoner,  although  not  intending  to  destroy  life,  was 
convicted  of  murder.  A  midwife  was  convicted  of  a  similar  crime._  (Reg. 
V.  Cartledge,  Manchester  Wint.  Ass.,  1877.)  The  evidence  showed  that  the 
prisoner  had  introduced  an  instrument  for  the  purpose  of  procuring  abor- 
tion. Inflammation  followed,  and  the  woman  died  in  three  days  from 
peritonitis  and  gangrene. 

A  method  much  resorted  to  in  the  metropolis  is  to  rupture  the  mem- 
branes by  the  insertion  of  a  piece  of  whalebone  or  wire  into  the  mouth  of 
the  womb  till  blood  appears.  Pills  of  oil  of  savin,  sulphate  of  iron,  and 
aloes,  are  then  freely  given  to  aid  in  the  expulsion  of  the  ovum.  A  mis- 
carriage is  frequently  brought  about  by  the  mere  insertion  of  a  male 
catheter  or  bougie  between  the  membranes  and  the  wall  of  the  womb. 
Other  means,  such  as  tents  and  Barnes's  bags,  are  also  resorted  to.  The 
editor  met  in  his  practice  with  the  case  of  a  married  woman  on  whom  an 
unqualified  medical  man  had  successfully  operated  ten  times.  The  same 
woman  had  also  abortion  successfully  induced  on  her  by  a  female  abortion- 
ist.    (Reg.  V.  Sprowle,  C.  C.  C,  Oct.  1884.) 

It  is  to  be  regretted  that  members  of  the  medical  profession  have  on 
several  occasions  misused  their  professional  knowledge  and  have  exposed 
themselves  to  prosecutions  for  this  crime.  Sometimes  it  is  probable  the 
charge  has  been  raised  falsely  or  through  misapprehension  on  the  part  of 
the  woman  ;  at  others,  the  evidence  has  left  it  very  clear  that  the  charge 
was  well  founded.  Of  late  years  medical  men  have  rather  freely  used  the 
speculum.  When  this  instrument  has  been  improperly  or  unnecessarily 
used  on  a  pregnant  woman,  a  charge  of  attempted  abortion  by  instruments 
may  be  easily  raised  against  a  medical  practitioner.  A  trial  took  place 
(Reg.  V.  Griffin  and  Venn,  Exeter  Lent  Ass,  1854)  in  which  it  was 
charged  that  the  accused  Venn  (a  surgeon)  had  feloniously  used  an  in- 
strument with  the  intent  to  procure  a  miscarriage  of  a  woman.  Accord- 
ing to  the  evidence,  Yenn  had  on  several  occasions  passed  a  round  polished 
instrument  into  her  body,  once  in  a  coppice  and  at  another  time  in  a  field. 
The  defence  was  that  the  surgeon  had  merely  used  a  speculum  to  ascertain 
whether  the  girl  was  pregnant  in  order  to  know  how  to  prescribe  for  her; 
and  that  it  was  absurd  to  suppose  that  he  had  ever  intended  to  procure 
abortion,  for  this  had  not  followed,  and  it  might  have  been  easily  produced 
by  him  at  any  period  of  pregnancy,  if  he  had  wished  it.  On  this  evidence 
the  prisoners'were  acquitted.  Admitting  the  statements  of  the  girl  and 
the  prisoner  to  be  correct,  it  may  be  remarked  that  medical  practitioners, 
in  the  lawful  exercise  of  their  profession,  do  not  commonly  use  a  speculum 
in  open  fields  or  coppices  to  determine  whether  a  Avoman  is  pregnant  or 
not ;  and  it  is  a  well-known  fact  that  a  speculum  is  not  necessarily  required 
for  determining  the  question  of  pregnancy. 

Medicinal  ^Stihstances.  Emmenagogues.  Ecbolics. — These  are  fre- 
quently resorted  to  for  inducing  criminal  abortion  ;  but  they  rarely  answer 
the  intended  purpose,  and,  when  abortion  follows,  it  is  often  at  the  ex- 
pense of  the  life  of  the  woman.  Mineral  poisons  have  been  ignorantly 
employed  for  this  nefarious  object,  and  often  with  a  fatal  result.     Among 


USE    OF    MEDICINAL    SUBSTANCES.  617 

these  substances  may  be  mentioned  arsenic,  corrosive  sublimate,  bichromate 
of  potassium  (Yierteljahrsschr.  iiir  Gerichtl.  Med.,  1862,  2,  p.  113),  sul- 
phate of  copper,  copperas  or  sulphate  of  iron,  perebloride  of  iron,  and  other 
irritants  Metallic  mercu7-y,  which  is  generally  reputed  to  be  innocent, 
has  been  given  for  the  purpose  of  procuring-  abortion.  In  a  case  recorded 
by  Gribb  (Lancet,  1873,  i.  p.  339),  it  produced  no  effect  on  the  womb,  but 
caused  some  severe  nervous  symptoms,  which  would  justify  the  application 
of  the  terra  "  noxious"  to  this  substance. 

Solutions  of  perchloride  of  iron  (steel  drops)  have  frequently  caused 
severe  symptoms,  and  seriously  injured  health  without  producing  abor- 
tion. In  a  case  in  which  the  author's  evidence  was  required  (Reg.  v. 
Rumble,  Lincoln  Sum.  Ass.,  1863),  it  was  proved  that  this  compound  of 
iron  had  been  given  in  large  doses  daily  to  a  pregnant  woman  for  the 
purpose  of  exciting  abortion.  It  had  not  this  effect,  but  it  had  seriously 
injured  the  health  of  the  woman.  The  prisoner  also  gave  to  her  canthari- 
des  in  pill.  The  defence  was  that  these  were  proper  medicines  for  the 
treatment  of  amenorrhcea,  under  which,  it  was  alleged,  she  was  laboring. 
The  large  doses  administered,  and  the  secrecy  with  which  the  medicines 
were  supplied,  proved  that  they  had  been  given  unlawfully  and  with 
criminal  intent;  and  the  chemist  who  supplied  them,  knowing  the  purpose 
for  which  they  were  required,  was  convicted.  In  1878,  a  chemist  pleaded 
guilty,  on  the  analysis  of  the  editor,  of  administering  large  doses  of  tincture 
of  iron  and  aloes  to  a  woman  with  the  view  of  procuring  abortion.  The 
method  failed,  and  the  woman  was  afterwards  operated  on  by  a  qualified 
medical  man,  with  fatal  result.  (Reg.  v.  Darley  and  Moon,  Lewes  Sum. 
Ass.,  1878.) 

Arsenic,  corrosive  sublimate,  and  other  mercurial  compounds  may  cause 
daath  without  in  any  way  exciting  the  womb  to  expel  its  contents.  In 
July,  1815,  a  woman  who  had  passed  the  fifth  month  of  her  pregnancy, 
took  a  large  dose  of  arsenic,  as  it  was  alleged,  for  the  purpose  of  abortion. 
She  died  in  less  than  seven  hours,  having  suffered  during  that  time  from 
severe  vomiting  and  purging ;  yet  abortion  did  not  take  place.  Such 
powerful  poisons  as  strychniue  have  failed  to  effect  it.  A  girl,  set.  IT, 
who  was  pregnant,  swallowed  the  contents  of  a  packet  of  Battle's  vermin- 
killer.  The  usual  symptoms  followed,  with  tetanic  spasms  and  opisthot- 
onos.    She  recovered,  and  went  her  full  time   without  aborting. 

Drugs,  such  as  croton-oil,  elateriura,  gamboge,  colocynth,  hellebore,  and 
other  drastic  purgatives,  have  been  used  with  criminal  intent  without 
causin:^  abortion.  Aloes  and  two  of  its  compounds — hiera  picra,  a  mix- 
ture of  aloes  and  canella  bark,  and  Filacotia  (pilulse  coccise),  sometimes 
called  "  pill  cochia,"  a  mixture  of  aloes  and  colocynth — are  much  used  as 
purgatives  among  the  poor.  In  large  or  repeated  doses  they  are  supposed 
to  have  the  power  of  exciting  the  womb,  and  are  secretly  employed  for 
the  purpose  of  abortion.  Although  not  poisons  in  the  strict  sense  of  the 
word,  it  may  be  observed  of  these  drugs,  and  of  all  purgatives  which 
cause  much  straining,  or  specially  affect  the  rectum,  that  they  may  readily 
bring  on  abortion  in  the  advanced  stages  of  pregnancy,  while  they  fail  in 
the  earlier  stages.  The  herbs  which  have  acquired  a  popular  repute  as 
abortives,  in  the  form  of  powdered  leaves,  infusion,  or  decoction,  are  very 
numerous.  Some  are  innocent — such  as  pennyroyal,  broom,  and  fern ; 
others  are  pernicious — such  as  white  and  black  hellebore,  yew,  and  labur- 
num.    A  decoction  of  broom  simply  acts  as  a  diuretic 

The  medicinal  substances  above  described,  if  they  have  any  effect,  exert 
an  indirect  action  on  the  womb  by  producing  a  shock  to  the  general  sys- 
tem.     But  there  is  another  class  of  bodies  which  are  considered  to  act  on 


518  EMMENAGOGUES    AND    ECBOLICS. 

the  womb  direct!}^.  These  are  classed  under  the  names  of  emmenagogues 
and  ecbolics.  As  in  trials  for  criminal  abortion  some  confusion  has  arisen 
in  the  application  of  these  terms  (Reg.  v.  Wallis,  Winchester  Sum.  Ass., 
1871,  see  p.  548),  it  will  be  necessary  to  state  here  what  is  understood  by 
them.  Emmenagogues  (from  ^^jajjna,  the  menstrual  discharge,  and  dyujyoj, 
exciting)  signify  those  medicines  which  excite  or  promote  the  menses. 
Pereira  enumerates  among  these  savin,  black  hellebore,  aloes,  gamboge, 
rue,  madder,  stinking  goosefoot  {Ghenopodium  oliduvt),  gin,  borax,  and 
for  the  most  part  substances  which  when  taken  in  large  doses  act  as  dras- 
tic purgatives  or  stimulating  diuretics.  When  amenorrhoea  coexists  with 
anaemia,  the  most  eft'ectual  emmenagogues  are  chalybeates,  the  prepara- 
tions of  iron,  including  compound  iron  or  Griffith's  mixture.  EchoHcs 
(from  sxSo'Kr],  expulsion),  substances  which  cause  the  expulsion  of  the 
foetus,  imply  medicines  which  operate  directly  as  abortives.  Thej  excite 
uterine  contractions,  and  thereby  promote  the  expulsion  of  the  contents  of 
the  womb,  such  as  the  foetus,  the  placenta,  hydatids,  clots  of  blood,  etc. 
The  number  of  ecbolics  known  is  very  small.  Indeed,  the  only  known 
unequivocal  agent  of  this  kind  is  ei^got.  The  ergot  in  ordinary  use  is  that  of 
rye ;  but  the  ergot  of  wheat  is  said  to  be  equally  efiectual,  and  the  same 
perhaps  may  be  stated  of  the  ergots  of  all  grasses. 

Tincture  of  cotton-wood  bark  is  also  a  reputed' abortifacient,  or  ecbolie, 
and  has  the  repute  of  being  commonly  used  for  purposes  of  abortion  by 
the  blacks  of  the  United  States.  Its  use  has  been  a  matter  of  investiga- 
tion in  one  criminal  trial  in  this  country.  (Reg.  v.  Hardie,  C.  C.  C,  Dee. 
1883.)  Black  snake-root  (Actaea  racemosa)  is  also  another  ecbolie  of 
some  repute. 

In  addition  to  these,  there  are  other  substances  derived  from  the  vege- 
table, animal,  and  mineral  kingdoms  which  have  been  employed  for  pro- 
curing abortion,  and  on  the  specific  effects  of  these  agents  when  adminis- 
tered to  pregnant  women  medical  opinions  may  be  required.  Such  are 
yew  leaves,  grains  of  paradise,  tansy,  white  and  black  hellebore,  squills, 
pennyroyal,  cantharides,  sulphate  of  potassium,  borax,  Griffith's  mixture, 
and  iron  filings.  The  English  herbs  on  which  medical  opinions  may  be 
required  are  chiefly  rue,  pennyroyal,  savin,  and  tansy. 

Bue  {Biiia  graveolens). — This  common  garden  plant  has  been  much 
used  in  the  form  of  decoction.  Tardieu  has  reported  three  eases  in  which 
a  strong  decoction  of  rue  produced  abortion  at  the  fourth,  fifth,  and  about 
the  sixth  month  of  pregnancv  respectively,  and  the  women  recovered. 
(Ann.  d'Hyg.,  1855,  t.  1,  p.  403.) 

Pennyroyal  (Ilentha  pnlegium). — This  is  a  variety  of  mint.  The  infu- 
sion, under  the  name  of  pennyroyal  tea  or  pennyroyal  water,  is  used  as  a 
popular  remedy  for  obstructed  menstruation,  and  it  has  also  been  used  for 
the  purpose  of  abortion  ;  but  it  has  neither  emmenagogue  nor  ecbolie 
properties,  and  it  is  not  now  employed  for  any  purpose  by  medical  practi- 
tioners. Any  notice  of  this  substance  here  would  have  been  quite  un- 
necessary, but  for  the  fact  that  in  a  trial  for  criminal  abortion  (Reg.  v. 
AA^'allis,  1871),  strongly  abortive  properties  were  incorrectly  assigned  to 
it ;  and  it  was  described  as  a  highly  noxious  substance.  Pennyroyal  in- 
fusion or  tea  has  no  more  effect  on  the  Avomb  than  peppermint,  spearmint, 
or  camphor  water.  A  medical  witness  at  the  trial  above  referred  to  stated 
that  pennyroyal  would  produce  abortion,  but  admitted  in  cross-examina- 
tion that  he  had  had  no  practical  knowledge  of  its  properties,  and,  unless 
taken  for  some  time  and  of  consideral)le  strength,  it  would  have  no  effect. 

Medical  witnesses  should  l)e  cautious  in  giving  evidence  on  these  occa- 
sions in  reference  to  the  properties  of  drugs.     They  have  to  consider  seri- 


SAVIN    AS    AN    ABORTIVE.  519 

ously,  in  all  cases  of  allep-ed  criminal  abortion  by  clrug-.s,  wliether  the  sub- 
stance is  noxious,  and  whether  it  is  an  ennueuagog'ue  or  really  an  ecbolic. 
They  should  base  their  opinions  either  on  actual  personal  experience  or 
ou  the  authority  of  those  who  have  practically  studied  the  etiects  of  the 
drug's,  otherwise  the  court  may  be  greatly  misled,  as  in  the  case  of  Reg*,  v. 
"Wallis  (see  p.  518).  Pennyroyal  is  not  described  by  any  authority  as  an 
emmenag'-ogue  or  ecbolic,  or  as  a  substance  having  any  abortive  or  nox- 
ious properties. 

Saain  Juniperus  Sahina.  Oil  of  Savin. — The  properties  of  this  sub- 
stance as  a  vegetable  irritant  poison  have  been  elsewhere  described  {ante, 
p.  1G5).  Writers  on  Materia  Medica  ascribe  to  it  em menagogue  proper- 
ties, i.  e.  that  it  is  an  excitant  to  the  bloodvessels  of  the  womb  and  is 
useful  in  certain  cases  of  disordered  menstruation,  but  it  does  not  excite  - 
uterine  contractions  like  the  ergot  of  rye,  and  it  is  not  used  for  the  pur- 
pose of  aiding  parturition.  It  should  not  be  givfen  to  a  woman  in  the 
pregnant  state,  for  its  operation  as  an  irritant  might  affect  the  womb  in- 
directly and  lead  to  abortion.  It  has  been  long  known  and  employed  as 
a  popular  abortive,  the  tops  being  used  in  the  form  of  infusion  or  decoc- 
tion, or  the  oil  is  g-iven  to  aid  instrumental  interference.  (Reg.  v.  Phillips 
and  Cay  ley,  C  CO.,  Fe)).  1885.)  Under  these  circumstances  it  com- 
monly acts  only  as  an  irritant  poison,  causing  severe  pain,  with  vomiting 
and  purging.  One  case  of  its  fatal  action  when  used  for  procuring  abor- 
tion was  referred  to  the  author  in  1845.  (Lond.  Med.  Gaz.,  xxxvi.  p. 
646.)  A  woman  may  die  undelivered,  or  the  foetus  may  be  expelled  dead, 
and  the  woman  afterwards  die  from  the  irritant  effects  produced  on  the 
stomach  and  bowels.  The  powdered  leaves  of  this  plant  are  frequently 
employed  as  a  popular  abortive  ;  they  are  readily  obtainable  in  gardens. 
They  may  be  given  in  the  form  of  infusion  or  decoction.  The  former  is 
the  most  powerful.  Savin  may  also  be  given  as  a  tincture  or  as  an 
essential  oil.  In  any  of  these  forms,  when  given  in  large  or  frequently 
repeated  doses,  it  has  an  irritant  action.  The  powdered  leaves  are  not 
used  in  medical  practice.  The  dose  as  an  emmenagogue  would  be  from 
five  to  fifteen  grains — the  medicinal  dose  of  the  oil  is  from  two  to  six 
minims,  and  of  the  tincture  (Tinctura  sahinse,  B.  P.)  from  twenty 
minims  to  one  fluid  drachm.  This  holds  the  oil  and  resin  dissolved.  The 
leaves  of  savin  may  be  identified  by  their  peculiar  odor  when  rubbed,  and 
also  by  their  appearance  under  the  microscope  (see  ante,  p.  165.) 

Reported  cases  in  which  the  oil  of  savin  has  been  administered  for  the 
purpose  of  abortion  are  not  very  common.  In  Reg.  v.  Pascoe  (Cornwall 
Lent  Ass.,  1852),  a  medical  man  was  convicted  of  administering  oil  of 
savin  to  a  woman  with  intent  to  procure  miscarriage.  The  proof  of 
intent  rested  partly  on  medical  and  partly  on  moral  circumstances.  It 
appeared  that  the  prisoner  had  given  fourteen  drops  of  the  oil,  divided 
into  three  doses,  daily — a  quantity  which,  according  to  the  medical  evi- 
dence at  the  trial,  was  greater  than  should  have  been  prescribed  for  any 
lawful  purpose.  The  medicinal  dose,  as  an  emmenagogue,  on  the  author- 
ity of  Christison,  is  from  two  to  five  viinims,  and  according  to  Pereira 
from  two  to  six  dropsy.  The  quantity  given  by  the  prisoner,  although  a  full 
dose,  was  not,  therefore,  greater  than  these  authorities  recommend ;  and 
his  criminality  appears  to  have  rested,  not  so  much  on  the  doses  given,  as 
on  the  question  whether  he  knew,  or  as  a  medical  man  had  reason  to  sus- 
pect, that  the  woman  for  whom  he  prescribed  it  was  pregnant.  No  med- 
ical authority  would  recommend  oil  of  savin  in  full  doses  for  pregnant 
women  ;  and  with  regard  to  the  existence  or  non-existence  of  pregnancy 
in  a  special  case,  medical  men   are  reasonablv  presumed  to  have  better 


520  SPECIFIC    ABORTIVES  —  ERGOT    OF    RYE. 

means  of  satisfying  tbemselv^es  than  non-professional  persons.  The  pris- 
oner's innocence,  therefore,  rested  on  the  presumption  that  he  implicitly 
believed  what  the  woman  told  him  regarding  her  condition  ;  that  he  had 
no  reason  to  suspect  her  pregnancy,  and  therefore  did  not  hesitate  to 
select  and  prescribe  a  medicine  which  certainly  has  an  evil  reputation,  and 
is  rareh^  used  by  regular  practitioners.  According  to  the  evidence  of  the 
woman,  she  informed  the  prisoner  that  she  had  disease  of  the  heart  and 
liver,  and  nothing  more  was  the  matter  with  her.  It  is  absurd  to  sup- 
pose that  oil  of  savin  would  be  prescribed  by  a  medical  man  for  such  a 
disease  as  this.  The  prisoner,  on  the  hypothesis  of  innocence,  must  have 
intended  that  the  medicine  should  act  on  the  womb,  and  must  have  in- 
ferred the  existence  of  an  obstruction  to  menstruation  from  natural  causes 
irrespective  of  pregnane}'.  The  jury  do  not  appear  to  have  given  him 
credit  for  such  ignorance  of  his  profession,  and  this  probably  led  to  bis 
conviction.  There  can  be  no  doubt  that  the  oil  was  administered  with  a 
guilty  intention.  Every  qualified  practitioner,  acting  honoL  fide,  would 
undoubtedly  satisfy  himself  that  a  young  woman  w-hose  menses  were 
obstructed,  was  not  pregnant  before  he  prescribed  full  doses  of  this  oil 
three  times  a  day,  or  he  would  fairly  lay  himself  open  to  a  suspicion  of 
criminality.  If  pregnancy — a  frequent  cau.se  of  obstructed  menstruation 
— wei'e  only  suspected,  this  Avould  be  sufficient  to  deter  a  practitioner  of 
common  prudence  from  prescribing,  in  any  dose,  a  drug  which  may  exert 
a  serious  action  in  the  uterine  system.  (Med.  Times  and  Gaz.,  1852,  i.  p. 
104.)  On  the  XortLern  Circuit,  Dec.  1853  (Reg.  i;.  Moore),  a  man  was 
convicted  of  administering  oil  of  savin  to  a  pregnant  woman.  It  made 
her  very  ill,  but  did  not  produce  al)ortion.  (See  also  Reg.  v.  Phillips  and 
Cayley,"  C.  C.  C,  Feb.  1885.) 

The  oil  of  savin  is  obtained  by  the  distillation  of  the  tops,  in  the  pro- 
portion of  about  3  per  cent,  by  weight.  It  has  a  yellowish  color,  and  the 
peculiar  terebinthinate  odor  of  the  plant,  by  which  alone  it  may  be  recog- 
nized. It  may  be  separated  from  the  contents  of  the  stomach  by  agitat- 
ing them  with  ether,  in  which  the  oil  is  very  soluble.  The  ether  may  be 
afterwards  removed  by  distillation.  The  odor  of  the  oil  has  been  per- 
ceived after  death  in  the  blood  and  in  the  cavities  of  the  body.  This  may 
be  regarded  as  a  test  of  its  presence.  (Yierteljahrsschr.  fiir  Gerichtl.  Med., 
1866,  1,  p.  241.)  The  oil  of  savin  forms  a  turbid  mixture  with  rectified 
spirit  of  wine.  When  treated  with  an  equal  volume  of  sulphuric  acid,  it 
acquires  a  dark-brown  color  ;  and  when  this  mixture  is  added  to  distilled 
water  a  dense  white  precipitate  is  separated. 

Tansy.  Oil  of  Tansy. — Hartshorne  states  that  in  the  United  States 
the  oil  of  tansy  has  acquired  the  character  of  a  popular  abortive,  and  has 
caused  death  in  several  instances.  In  England  this  oil  and  the  herb  have 
been  chiefly  employed  for  the  purpose  of  expelling  worms. 

Safi'ron  in  the  form  of  a  decoction  of  the  dried  stigmas  of  safTron 
(Crocus  sativus)  has  been  used  as  a  popular  abortive.  Thomsen  has 
reported  a  ease  in  which  abortion  occurred  in  a  w^oman  who  had  taken 
repeated  doses  of  a  decoction  of  saffron  with  starch.  There  was  reason 
to  believe,  however,  that  manipulations  per  vaginam  had  also  been  re- 
sorted to,  and  these  may  have  had  the  principal  share  in  bringing  about 
the  result.  (Yierteljahrsschr.  fiir  Gerichtl.  Med.,  1864,  ii.  p.  315.)  Ac- 
cording to  Pereira,  although  saffron  was  formerly  used  as  an  emmenagogue 
to  promote  uterine  contractions,  it  was  not  established  by  any  trustworthy 
observations  that  it  possesses  any  medicinal  properties. 

Specific  Ahorlives.  Echolics.  Ergot  of  Bye.  Spurred  Bye  (Secale 
cornutum). — The  substance  called  Ergot  is  a  diseased  growth  on  the  grain 


SPECIFIC    ABORTIVES  —  ERGOT    OF    RYE.  621 

or  seed  of  rye,  caused  by  a  parasitic  fungus.  In  powder,  infusion,  or 
tincture,  it  has  been  for  some  time  used  by  medical  practitioners  to  excite 
the  action  of  the  womb  and  aid  parturition.  It  is  also  used  for  a  similar 
purpose  on  animals  in  veterinary  practice.  The  properties  of  ergot  as  an 
abortive  are  well  known,  and  it  is  often  criminally  administered  by  mid- 
wives  to  pregnant  women.  In  one  case  it  was  proved  that  it  bad  been 
supplied  in  large  quantities  to  a  midwife,  and  further,  that  the  death  of  a 
pregnant  woman  from  hemorrhage  had  been  accelerated  by  the  use  of 
large  doses  of  this  drug.  (Pharm.  Jour.,  Dec.  1878,  p.  541.)  A  trial 
which  took  place  (Reg.  t\  De  Baddeley  and  Wife,  C.  C.  C,  July,  1871) 
shows  also  that  "herbalists"  and  "spiritualists"  are  well  acquainted  with 
the  properties  of  ergot  as  an  abortive,  and  are  ready  to  supply  it  in  secrecy. 
The  prisoners  in  this  case  were  indicted  for  unlawfully  supplying  a  certain 
noxious  drug — namely,  ergot  of  rye,  knowing  that  it  was  intended  to 
procure  abortion.  They  inserted  an  advertisement  in  a  spiritualistic  jour- 
nal, inviting  people  to  consult  at  that  house  "  Madame  de  Baddeley,  the 
celebrated  clairvoyante."  From  what  was  alleged  to  be  transacted  there, 
the  police  were  induced  to  send  a  woman  to  consult  the  prisoners,  and  to 
concoct  a  story  which  might  elicit  their  "spiritual"  mode  of  procedure. 
After  being  put  into  a  state  of  so-called  "clairvoyance,"  the  female  pris- 
oner advised  the  applicant  what  to  do  in  the  case  of  a  young  woman  whom 
she  had  mentioned,  and  gave  her  a  quantity  of  ergot  of  rye  to  procure 
abortion.  The  drug  was  at  once  handed  over  to  the  police.  They  were 
found  guilty. 

Ergot  of  rye  has  been  found  to  bring  on  contractions  of  the  womb  at  an 
advanced  stage  of  gestation,  or  when  efforts  at  parturition  had  already 
commenced.  There  is,  however,  some  difference  of  opinion  respecting  its 
specific  eebolic  properties.  According  to  Lee,  it  has  no  effect  in  the  early 
stages  of  gestation,  although  given  in  large  doses.  (Lond.  Med.  Gaz., 
vol.  XXV.  p.  10  ;  see  also  Edin.  Med.  and  Surg.  Jour.,  vol.  liii.  p.  2T.) 
Beatty  states  that  when  used  in  obstetric  practice  it  is  liable,  by  absorp- 
tion into  the  system  of  the  mother,  which  may  take  place  within  two 
hours,  to  endanger  the  life  of  the  child.  (Dub.  Med.  Jour.,  1844,  p.  202.) 
This  question  was  referred  by  the  French  Government  to  the  Academy 
of  Medicine  in  1845,  as  there  was  reason  to  think  that,  under  its  employ- 
ment in  the  practice  of  midwifery,  children  were  frequently  born  dead. 
(Ann.  d'Hyg.,  1846,  t.  1,  204;  see  also  Lond.  Med.  Gaz.,  vol.  xlvi.  p. 
680.)  In  confirmation  of  Beatty 's  statement,  McClintock  and  Hardy 
report  that  out  of  thirty  cases  in  which  it  was  administered,  twenty 
children  were  born  dead.  (Practical  Observations,  p.  95.)  Ramsbotham 
considered  that  the  drug  might  operate  fatally  on  a  child,  according  to  the 
circumstances  under  which  it  was  administered ;  but  that,  unless  it  excited 
the  expulsive  action  of  the  womb,  it  had  no  effect  on  the  child's  system. 
(Op  cit.,  p.  319;  also  cases  by  Paterson,  Edin.  Med.  Surg.  Jour.,  vol. 
liii.  p.  142.)  According  to  Millet,  in  commencing  or  imminent  parturi- 
tion, ergot  procures  a  safe  and  prompt  termination  ;  and  he  never  met 
with  a  case  in  which  it  injured  the  child.  (Med.-Chir.  Rev.,  1855,  ii.  p. 
41.)  This  is  also  the  result  of  the  experience  of  Uvedale  West,  contained 
in  a  paper  read  before  the  Obstetrical  Society  (July,  1861).  Between 
December,  1855,  and  June,  1861,  he  had  attended  734  labors,  in  172  of 
which  ergot  was  given.  Including  one  case  of  twins,  173  children  were 
born  under  the  effects  of  ergot,  of  which  number  only  five  were  stillborn. 
These  facts  appear  to  show  that  ergot,  as  a  rule,  does  not  exert  those 
noxious  effects  on  the  child  which  have  been  attributed  to  it  by  some 
obstetric  writers. 


522  ACTION    OF    ERGOT    OF    RYE. 

On  trials  for  criminal  abortion,  perpetrated  or  attempted,  a  medical  wit- 
ness must  be  prepared  for  a  close  examination  on  the  ecboiic  properties  of 
the  ergot  of  rye  on  the  womb,  as  well  as  its  general  action  as  a  poison  on 
the  woman  and  child.  A  case  which  occurred  some  years  since  (Reg.  v. 
Calder,  Exeter  Lent  Ass.,  1844)  has  been  reported,  with  comments  on  this 
subject,  by  Shapter.  (Prov.  Med.  Jour.,  April  10,  1844.)  It  was  alleged  on 
this  occasion  that  savin,  cantharides,and  ergot  had  been  re.spectiveh^  given 
by  the  prisoner,  a  medical  man,  for  the  purpose  of  procuring  miscarriage. 
The  Avoman  on  whose  evidence  the  case  rested  was  of  notoriously  bad 
character,  and  the  prisoner  was  acquitted.  There  were  three  medical 
witnesses,  who  agreed  that  savin  and  cantharides  were  only  likel}^  to  occa- 
sion abortion  indirectly,  i.  e.  by  powerfully  affecting  the  system— the  view 
commonly  entertained  by  professional  men.  Some  difference  of  opinion 
existed  with  regard  to  ergot,  but  the  balance  of  evidence  was  decidedly  in 
favor  of  its  specific  action  as  a  direct  uterine  excitant ;  and,  according  to 
Griffiths,  this  is  so  well  known  to  the  inhabitants  of  the  United  States  that 
it  is  there  in  frequent  use  as  a  popular  abortive. 

A  case  occurred  at  Brighton  in  1864,  in  Avhich  a  question  arose  respect- 
ing the  fatal  effect  of  this  drug  on  a  woman  who  had  taken  it  for  a  long 
period,  obviously  with  a  view  to  procure  abortion.  She  died,  however, 
without  abortion  having  taken  place ;  and  the  question  at  issue  was 
whether  this  drug  had  or  had  not  caused  her  death.  The  dose  taken  was 
about  a  teaspoonful  of  the  tincture  of  ergot  three  times  a  day  for  a  period 
of  eleven  weeks.  On  inspection,  patches  of  inflammation  were  found  on 
the  mucous  membrane  of  the  stomach.  No  other  cause  for  death  was 
apparent,  and  one  medical  witness  assigned  it  to  the  poisonous  irritant 
action  of  the  ergot,  as,  at  the  early  stage  of  pregnancy  which  she  had 
reached  (the  third  month),  this  substance  would  not  be  likely  to  act  as  an 
abortive.  Another  medical  man  who  gave  evidence  at  the  inquest  asserted 
that  death  could  never  be  primarily  caused  by  ergot  of  rye.  The  qualifi- 
cation introduced  into  this  medical  opinion  is  of  small  importance.  The 
deceased  woman  is  reported  to  have  taken  a  large  portion  of  the  tincture, 
and  it  is  quite  immaterial  whether  the  drug  killed  her  by  a  primary  or 
secondary  operation.  Tardiea  describes  the  case  of  a  woman,  set.  24,  who 
aliorted  in  the  fourth  month  of  pregnancy  as  a  result  of.  the  administra- 
tion of  ergot  in  powder:  she  died  from  peritonitis  in  about  twenty-four 
hours.  Ergot  was  found  in  fragments  in  the  lower  third  of  the  bowels. 
(Ann.  d'Hyg.,  1855,  t.  i.  p.  404.)  At  the  same  time  he  states  that,  in 
his  opinion,  ergot  of  rye  has  no  direct  action  as  an  abortive ;  in  fact,  that 
it  is  not  an  ecboiic.  (Ann.  d'Hyg.,  1865,  t.  1,  p.  139.)  The  numerous 
cases  showing  its  efficacy,  and  its  extensive  use  in  midwifery  practice,  are 
sufficient  to  prove  that  this  opinion  is  not  borne  out  by  facts.  In  respect 
to  its  operation,  it  may  be  observed  that  the  effects  produced  by  its  admin- 
istration are  not  such  as  readily  to  excite  suspicion.  It  neither  causes  the 
decided  symptoms  of  irritation  observed  in  the  action  of  savin,  nor  the 
nervous  symptoms  which  are  usually  produced  by  rue.  In  medicinal 
doses,  given  at  proper  intervals,  the  only  marked  effect  which  it  produces 
on  a  pregnant  woman  is  a  lowering  of  the  pulse.  Sometimes  other  symp- 
toms of  a  severe  character  have  presented  themselves.  (Ann.  d'Hyg,  1856, 
t.  1,  p.  140  )  If  a  person  dies  from  the  effects  of  this  drug,  the  results  are 
legally  the  same,  A\'hether  its  operation  as  a  noxious  substance  is  of  a 
primary  or  secondary  kind.  It  must  be  borne  in  mind  that  ergot  is 
largely  used  in  medical  practice  to  check  Hemorrhage 

Action  of  Ergot.  Doses.  Analysis. — In  doses  of  from  half  a  drachm 
to  two  drachms,  ergot  in  powder  has  caused  nausea,  vomiting,  dryness  of 
the  throat,  great  thirst,  aversion  to  food,  pain   in  the  abdomen,   slight 


ABORTION    FROM    LOCAL    APPLICATIONS. 


523 


purging^  pain  in  the  head,  stupor,  and  dilatation  of  the  pupils.  (Pereira.) 
The  medicinal  doije  of  the  powder  in  uterine  diseases  is  Irom  5  to  15 
grains.  It  is  employed  in  a  larger  dose  (from  20  to  GO  grains  at  intervals 
of  half  an  hour)  to  excite  uterine  action  either  for  abortion  or  i)arturition. 
The  dose  of  the  tincture  is  one  drachm  (a  teaspoonful)  ;  this  is  equivalent 
to  15  grains  of  the  powder.  The  dose  of  the  ethereal  tincture,  when  em- 
ployed for  the  purpose  of  exciting  uterine  action,  is  three  or  four  doses  of 
one  drachm  every  half-hour.  Ergot  must  be  regarded  as  a  noxious  sub- 
stance, and  by  some  authorities  it  is  ranked  among  narcotico-irritant  poi- 
sons. Under  the  Pharmacy  Act,  1868,  it  is  placed  in  the  first  part  of  the 
schedule  of  poisons,  and  can  only  be  sold  under  certain  restrictions,  with 
the  word  "  Poison  "  attached  to  it.  It  does  not  easily  cause  death  in  one 
large  dose,  but  its  fatal  operation  appears  to  be  more  strikingly  developed" 
b}^  its  long-continued  use  in  small  or  medicinal  doses. 

The  form  and  characters  of  the  ergot  in  mass  are  well  known  to  pro- 
fessional  men.      It   consists   of 

grains    varying  in  length   from  Fig.  49. 

half  an  inch  to  an  inch  and  a 
quarter,  and  the  breadth  of  about 
the  eighth  of  an  inch.  The  grain 
is  cylindrical,  blunt  at  the  ends, 
and  curved  like  the  spur  of  a 
cock.  The  outer  coat  is  of  a 
dark  purple  color,  almost  black, 
irregularly  fluted  on  the  surface, 
which  is  often  cracked  and 
fissured.  In  Fig.  49,  1,  1,  rep- 
resent the  ergot  of  rye  as  it  is 
usually  seen.  The  smaller  of 
the  two  grains  represents  the 
average  size  ;  2,  2,  are  sections  of  the  grains  ;  and  3  represents  a  transverse 
section  magnified  thirty  diameters.  The  spongy  character  of  the  substance 
of  the  ergot  is  here  more  distinctly  seen. 

The  powder  of  ergot  has  a  faint  fishy  odor  of  trimethylamine  ;  this  is 
especially  observed  when  it  is  rubbed  wath  a  solution  of  potash.  This 
alkali  dissolves  the  powder  in  part,  and  the  solution  acquires  a  dingy-red 
color.  In  the  form  of  tincture,  alcoholic  or  ethereal,  the  peculiar  fishy 
odor  of  the  extract  when  treated  with  potash  is  well  marked.  It  may, 
however,  be  concealed  by  other  odors.  Sometimes  small  particles  of  ergot, 
presenting  a  pink-red  color  in  the  dark  external  coat,  may  be  detected  in 
the  sediment  by  the  microscope.  When  ergot  has  been  taken  in  powder, 
fragments  of  it  may  be  found  scattered  over  the  lining  membrane  of  the 
stomach  or  bowels ;  these  may  be  identified  by  the  characters  above  de- 
scribed. The  ethereal  tincture  of  ergot,  evaporated  to  an  extract,  yields 
a  yellowish-colored  oil,  which,  if  any  of  the  coloring-matter  of  ergot  is 
present,  acquires  a  reddish  color  when  heated  with  a  solution  of  potash. 

In  examining  the  body  of  a  person  to  whom  ergot  is  alleged  to  have 
been  given,  the  medical  jurist  must  rely  upon  the  physical  properties  of 
the  fungus  if  he  can  obtain  any  of  it. 

Local  Applications.  Injections. — In  a  case  which  occurred  in  France, 
it  was  proved  that  abortion  had  been  caused  by  the  injection  of  some 
corrosive  and  irritating  substance  into  the  vagina.  The  genital  organs, 
as  well  as  the  abdominal  viscera,  were  found  in  a  high  state  of  inflamma- 
tion. (Lond.  Med.  Gaz.,  vol.  xxxvii.  p.  171.)  This  is  a  mode  of  perpe- 
trating the  crime  which  can  hardly  escape  detection.  An  analysis  of  the 
tissues  might  be  required  in  order  to  determine  the  nature  of  the  sub- 


The  Ergot  of  Ej-e. 


524  SIGNS    OF    ABORTION    IN    THE    LIVING    AND    DEAD. 

Stance  used.  It  appears  from  a  trial  that  this  mode  of  attempting  to  pro- 
cure criminal  abortion  has  been  the  subject  of  a  prosecution  in  this  countrv. 
It  was  established  by  the  medical  evidence  that  some  liquid  was  injected 
into  the  vagina  by  a  syringe,  but  there  was  no  proof  of  the  nature  of  this 
liquid  ;  and  as  it  was  not  shown  to  be  of  a  noxious  nature,  the  judge  who 
tried  the  case  directed  an  acquittal.  (York  Sum.  Ass.,  ]85o;  Lancet, 
1858,  ii.  p.  89.)  It  is  proper  to  state,  however,  that  the  mere  mechanical 
effect  of  an  innocent  liquid,  frequently  applied,  may  be  more  effectual  in 
])roducing  abortion  or  premature  labor  than  the  use  of  any  irritating  liquid, 
lu  medical  practice  tepid  water  has  been  employed  as  an  injection  for  the 
purpose  of  inducing  premature  labor  in  advanced  pregnancy.  Lazarewitch 
has  published  twelve  cases  in  which  the  injection  of  water  at  95  F.  caused 
the  womb  to  contract  and  expel  its  contents.  (Trans.  Obst.  Soc,  vol.  ix. 
p.  161.)  The  earliest  period  at  which  Lazarewitch  employed  water  was 
in  the  thirtieth  week  of  pregnancy.  In  most  of  the  cases  the  women 
had  reached  the  thirty-sixth  week  of  pregnane}'.  This  is  much  later  than 
the  usual  period  at  which  abortion  is  commonly  attempted  for  criminal 
pui'poses,  namely,  the  eighth  to  the  twentieth  week.  At  the  same  time, 
it  proves  that  an  innocent  injection  may  be  used  to  produce  abortion,  and, 
according  to  the  judicial  decision  above  given,  the  use  of  such  a  liquid 
would  not  render  a  person  criminally  liable.  The  words  of  the  statute, 
however,  "  other  means  whatsoever,  "  appear  sufficiently  comprehensive 
to  include  the  use  of  a  non-noxious  liquid,  and,  according  to  a  judicial 
opinion  given  in  one  case  (Reg.  v.  Wallis,  pp.  518,  528),  it  is  not  mate- 
rial to  prove  that  the  liquid  employed  is  of  a  "noxious"  nature.  In 
general,  when  the  criminal  means  taken  to  procure  abortion  are  effectual 
in  causing  the  expulsion  of  the  child,  it  comes  into  the  world  dead ;  but  it 
may  be  born  alive  and  die  after  its  birth.  Under  these  circumstances, 
although  no  violence  is  applied  directly  to  the  body  of  the  child,  but  its 
death  is  simply  the  result  of  immaturity  or  the  feeble  state  in  which  it  was 
born,  the  person  causing  such  abortion  might  render  himself  liable  to  an 
indictment  for  murder. 

Signs  of  Abortion  in  the  Living  and  Dead. — These  are  practically 
the  same  as  those  elsewhere  described  as  the  signs  of  delivery.  (See 
ante,  pp.  500,  505.)  The  examination  may  extend  to  the  woman,  either 
living  or  dead.  In  the  former  case  there  will  be  some  difficulty  if  the 
abortion  has  occurred  at  an  early  period  of  gestation  and  several  days 
have  elapsed  before  the  examination  is  made  ;  in  the  latter  case  the  inves- 
tigation's not  always  free  from  difficulty.  Shortt,  who  has  had  much 
experience  on  this  suljject,  thus  summarizes  the  symptoms  which  he  met 
with  in  numerous  cases  Avhich  came  before  him  cfficialh'.  In  the  Madras 
Presidency  alone  there  were  306  cases  in  two  j'Cars.  In  the  cases  which 
he  examined  up  to  a  fortnight,  or  a  little  later,  after  the  abortion,  the 
vulva  and  passages  were  relaxed,  the  mouth  of  the  womb  patulous,  and 
in  the  early  stage  there  was  a  lochial  secretion,  replaced  in  later  cases  by 
a  white  mucous  secretion,  having  the  peculiar  smell  common  to  women  in 
the  puerperal  state.  Among  other  symptoms  were  a  distention  of  the 
breasts,  a  flow  of  milk  on  pressure,  and  a  knotty  feeling  in  them.  There 
was  a  general  anaemic  or  bloodless  condition  of  the  body,  with  sunken 
eyes,  an  excited  pulse,  and  dry  skin.  In  multiparous  women,  the  womb 
was  more  patulous,  and  the  neck  was  not  distinguishable  ;  but  in  primi- 
jiarous  women  the  mouth  of  the  womb,  although  patulous  to  a  small 
extent,  still  had  the  neck  protuberant.     (Obst.  Trans.,  vol.  ix.  p.  9.) 

It  is  believed  by  many  physiologists  that  menstruation  is  a  state  in 
some  measure  vicarious   to  conception,  and   the  appearances  presented 


F3IGNED    ABORTION — LEGAL    RELATIONS.  525 

by  the  generative  organs  during  the  menstrual  period  are  somewhat 
similar  to  those  which  are  observed  after  conception  in  its  early  stage. 
Whitehead  remarks  that  in  women  who  died  while  the  menses  were 
flowing,  the  uterine  walls  were  thickened  and  spongy,  and  the  mucous 
lining  was  more  or  less  swollen  and  sufl'used.  The  neck  and  lips  of  the 
Avomb  were  swollen,  the  orifice  was  open,  and  the  vaginal  membrane 
and  clitoris  involved  in  the  increased  action.  One  of  the  ovaries  was 
found  larger  and  more  congested  than  usual,  presenting  evidence  of  the 
recent  escape  of  an  ovum  (p.  501,  ante).  Unless  these  facts  are  attended 
to,  an  examiner  may  form  an  erroneous  opinion  respecting  the  chastity  of 
a  deceased  woman.  (For  the  mode  of  conducting  the  examination  of  the  *• 
woman,  and  of  the  embryo  or  foetus  in  cases  of  abortion,  see  Ann.  d'Hvg., 
1856,  t.  1,  pp.  149,  153.)  "      - 

Important  questions  may  arise  when  it  is  alleged  that  abortion  has 
been  caused  by  the  use  of  instruments,  and  death  is  referred  to  peri- 
tonitis as  the  result  of  their  employment.  In  these  cases  a  medical 
opinion  should  not  be  based  upon  the  statements  either  of  the  woman 
or  of  her  friends,  but  upon  some  distinct  and  satisfactory  medical  proofs 
that  mechanical  violence  has  been  done  to  the  womb,  its  contents,  or  its 
appendages.  Peritonitis  or  inflammation  of  the  lining  membrane  of  the 
abdomen  may  arise  from  a  variety  of  causes.  If  we  assign  it  to  a  par- 
ticular cause,  and  thus  implicate  another  in  a  felonious  charge,  we  should 
do  this  only  upon  medical  facts  obtained  by  an  examination  of  the  dead 
body ;  we  should  deal  with  such  cases  as  if  we  knew  nothing  of  their 
previous  history. 

A  druggist  was  charged  with  using  instruments  to  cause  abortion 
which  had  led  to  the  death  of  a  woman  from  peritonitis.  It  appeared 
also  that  he  had  given  to  her  doses  of  tincture  of  perchloride  of  iron. 
The  woman  w^as  delivered  of  a  dead  foetus  at  about  the  fifth  month,  and 
she  herself  died  shortly  afterwards.  There  was  nothing  in  the  bod}"  of 
the  woman  or  of  the  foetus  to  show  that  instruments  had  been  used,  but 
it  was  quite  clear  that  peritonitis  was  the  cause  of  death.  One  medical 
witness  thought  that  an  operation  had  been  performed  on  her  body,  but 
it  was  admitted  that  peritonitis  might  arise  from  a  variety  of  causes  in  a 
woman  w^ho  had  had  a  miscarriage.  (Pharm.  Jour.,  1811,  p.  256.)  On 
the  diagnosis  of -abortion  and  its  causes,  see  a  paper  by  Lex.  (Yiertel- 
jahrsschr.  fur  Geriehtl.  Med.,  1866,  1,  179.) 

Feigned  Abortion. — For  various  motives,  into  the  consideration  of 
w^hich  it  is  unnecessary  to  enter,  a  woman  may  charge  another  with 
having  attempted  or  perpetrated  the  crime  of  abortion.  Such  a  charge 
is  not  common,  because  if  untrue  its  falsity  may  be  easily  demonstrated. 
A  young  woman  in  Guy's  Hospital,  in  1846,  charged  a  policeman  (who, 
according  to  her  statement,  had  had  forcible  intercourse  with  her)  with 
having  given  her  some  substance  to  produce  abortion,  and  having  subse- 
quently effected  this  mechanically.  She  was  not  examined  until  nearly 
two  months  after  the  alleged  perpetration  of  the  crime,  when  Lever  found 
that  there  was  no  reason  to  believe  that  she  had  ever  been  pregnant. 
This  was  a  case  of  feigned  abortion.  When  charges  of  this  serious  kind 
are  brought  forward  they  are  always  open  to  the  greatest  suspicion  unless 
made  immediately  after  the  alleged  attempt,  as  it  is  then  only  that  an 
examination  can  determine  whether  they  are  true  or  false.  If  so  long 
delayed,  as  in  this  instance,  without  any  satisfactory  reason,  the  presump- 
tion is  that  they  are  false. 

Legal  Relations. — In  the  statute  for  the  consolidation  of  the  criminal 
law  (24  and  25  Yict.,  c.  100,  ss.  58  and  59),  the  nature  of  this  crime  and 


526  LEGAL    RELATIONS. 

the  medical  proofs  required  to  establish  it  have  been  more  explicitly 
stated  than  in  former  Acts.  By  s.  58  (on  attempts  to  procure  abortion) 
it  is  enacted  that  "Every  woman  being  with  child,  who,  with  intent  to 
procure  her  own  miscarriage,  shall  unlawfully  administer  to  herself  any 
poison  or  other  noxious  thing,  or  shall  unlawfully  use  any  instrument  or 
other  means  whatsoever  with  like  intent,  and  whosoever,  with  intent  to 
procure  the  miscarriage  of  any  woman,  ivhetJier  she  he  or  be  not  with 
child,  shall  unlawfully  administer,  etc.,  shall  be  guilty  of  felony."  As  in 
every  case  a  woman  must  be  accessoi'y  to  this  crime  upon  herself,  it  leads 
to  the  difficulty  that  her  evidence,  uncorroborated  by  circumstances,  may 
not  be  received  by  the  court. 

[Abortion  has  been  legally  d'^fined  thus :  Any  person  who  does  any  act 
calculated  to  prevent  a  child  being  born  alive  is  guilty  of  abortion  : 
Abrams  v.  Foshee,  3  Iowa,  218  ;  Cotton  v.  Cotton,  5  Martin  (La.),  95. 

At  common  law,  if  the  act  be  done  with  the  mother's  consent  before  the 
child  quickened,  it  was  not  a  punishable  offence,  nor  was  it  a  felony  at 
common  law  to  take  the  life  of  the  child  at  any  period  of  gestation,  even 
in  the  very  act  of  delivery:  Hines,  J.,  in  Mitchell  v.  Com.,  78  Ky. 
204;  s.  c.  39  Amer.  Rep.  227  ;  Com.  v.  Bangs,  9  Mass.  387  ;  Com.  v.  Parker, 
9  Mete.  (Mass.)  263;  s.  c.  Am.  Dec.  396;  Smith  v.  State,  33  Me.  48; 
State  V.  Cooper,  22  N.  J.  L.  52;  s.  c.  51  Am.  Dec.  248;  State  v.  Slagle, 
82  N.  Car.  653;  People  v.  Sessions,  26  N.  W.  Eep.  (Mich.)  291  ;  Ann 
V.  State,  11  Humph.  (Tenn.)  150;  Abrams  ij.  State,  3  Iowa,  274;  s.  c. 
Am.  Dec.  77;  Halfield  v.  Gano,  15  Tow^a. 

A  contrary  view  was  taken  in  Pennsvlvania  by  the  Supreme  Court  of 
that  State:  Yid.  Mills  v.  Com.,  13  Pa.'St.  633;  Com.  v.  Demain,  6  Pa. 
Law  Jour.  29  ;  s.  c.  Brightly,  441. 

If  death  ensues  in  consequence  of  the  means  used  to  secure  an  abortion, 
then  the  offence  is  murder  at  common  law  ;  but  in  some  of  the  American 
States  it  is  in  such  case  declared  to  be  manslaughter  :  4  Blacks.  Com. 
201 ;  1  Bishop  Crim.  Law,  328;  State  v.  Moore,  25  Iowa,  128;  State  v. 
Dickinson.  41  Wis.  299. 

The  intention  constitutes  the  crime,  not  the  means  employed.  The  drug 
used  mav  even  be  harmless  :  State  v.  Owens,  22  Minn.  238  ;  Wilson  v.  State, 
2  Ohio  St.  219  ;  State  v.  Fitzgerald,  49  Iowa,  260  ;  s.  c.  31  Am.  Rep.  148. 

A  woman  is  "quick  with  child"  from  the  period  of  conception  and  the 
commencement  of  gestation,  but  is  only  "pregnant  with  a  quick  child" 
when  the  child  has  become  quickened  in  the  womb:  Evans  v.  People, 
49  X.  Y.  86 ;  R.  v.  Wvcherly,  8  C.  &  P.  262.  This  is  disputed  in  State 
V.  Cooper,  2  Zab.  (N.  J.)  52. 

The  testimony  of  the  physician  who  attended  the  woman  subsequent 
to  the  procuring  of  abortion  is  not  admissible  in  New  York,  even  when 
he  was  sent  by  the  public  prosecutor  to  make  an  examination  of  the 
woman:   People  v.  Murphy,  101  N.  Y.  126. 

The  phvsician  who  makes  the  post-mortem  may  testify  :  People  v. 
Sessions,  26  K  W.  Rep.  (Mich.)  291;  Com.  v.  Browne,  14 'Gray  (Mass.), 
419.] 

In  two  cases  tried  at  the  Lewes  Sum.  Ass.,  1878  (Reg.  v.  Brown),  the 
woman  charged  with  this  crime  was  acquitted  under  the  direction  of  the 
judge,  because  there  was  no  corroboration  of  the  evidence  of  the  two 
women  on  whom  the  crime  had  been  perpetrated.  In  one,  the  drugs  pre- 
scribed by  the  prisoner  produced  no  effect ;  she  went  her  full  time,  and 
was  delivered.  In  the  other  case,  the  woman  was  so  ill  that  she  could 
not  appear  as  a  witness,  and  it  was  admitted  by  counsel  that  he  could  not 
corroborate  the  evidence  of  either. 


CRIMINAL    ABORTION — NOXIOUS    SUBSTANCES.  627 

It  will  be  observed  that  the  means  employed,  whatever  their  nature, 
must  have  been  used  with  aa  intent  to  procure  the  miscarriage  of  a  woman 
— a  point  which  will  be  sufficiently  established  by  a  plain  medical  state- 
meat  of  the  means  employed.  Supposing  that  a  drug-  has  been  used,  the 
witness  may  be  further  required  to  state  whether  it  is  "  a  poison  or  other 
noxious  thing-."  We  must  refer  the  reader  to  what  has  been  said  else- 
where (ante,  p.  13),  in  order  that  he  may  be  able  to  judge  how  far  the 
substance  administered  would  fall  under  the  description  above  given. 
Whether  the  substance  would  or  would  not  have  the  effect  intended,  i.  e. 
of  inducing  abortion,  is  immaterial. 

Noxious  Substances. — Is  it  necessary  to  prove  that  the  substance  pro- 
cured or  administered  is  of  a  noxious  nature?  Some  uncertainty  may 
exist  as  to  the  strict  meaning  of  the  word  "  noxious."  All  will  allow  that, 
the  word  implies  something  injurious  to  the  body,  but  a  difference  of 
opinion  may  arise  among  medical  witnesses  with  respect  to  its  application 
to  the  substance  under  discussion — as,  for  example,  with  respect  to  rue  or 
savin.  A  substance  must  be  regarded  as  injurious  to  the  body,  or  noxious, 
either  according  to  the  form,  quantity,  or  frequency  with  which  it  is  ad- 
ministered. Sivin,  ergot,  and  rue  are  irritant ;  and  they  become  noxious 
when  given  in  large  doses,  or  in  small  doses  frequently  repeated.  Aloes 
and  castor-oil  are  innocent  when  taken  in  small  doses;  but  they  acquire 
noxious  or  injurious  properties  when  administered  frequently,  or  in  large 
quantity,  to  a  pregnant  woman.  To  confine  the  term  "  noxious,"  there- 
fore, to  what  is  strictly  speaking  a  poison  per  se,  would  be  giving  a 
latitude  to  attempts  at  criminal  abortion  which  would  render  the  law 
inoperative.  (Kej;.  v.  Stroud,  Abingdon  Sura.  Ass.,  1846.)  The  small 
quantity  of  the  substance  taken  at  once  does  not  affect  the  question,  pro- 
vided the  dose  be  frequently  repeated.  A  case  in  which  the  author  was 
consulted  by  Reynolds  was  tried  at  the  Exeter  Wint.  Ass.,  1844.  Two 
powders,  weighing  each  one  drachm,  were  prescribed  by  a  prisoner;  one 
consisted  of  colocynth,  the  other  of  gamboge,  and  with  them  was  half  an 
ounce  of  a  liquid  (balsam  of  copaiba).  They  were  to  be  mixed  together, 
and  a  fourth  part  to  be  taken  four  mornings  following.  Reynolds  said, 
in  answer  to  the  question  whether  such  a  mixture  was  noxious  or  in- 
jurious, that  each  dose  would  be  an  active  purgative,  and  might  thereby 
tend  to  excite  abortion.  One  dose  would  not  be  productive  of  mischief  in 
a  healthy  countrywoman,  but  its  frequent  repetition  might  lead  to  serious 
consequences  in  a  pregnant  woman.  In  another  trial  (Reg.  v.  Whisker, 
Norwich  Lent  Ass.,  1846),  it  was  proved  that  the  prisoner  had  caused  to 
be  taken  by  a  woman  a  quantity  of  lohite  hellebore  in  powder,  for  the 
purpose  of  procuring  abortion.  One  medical  witness  said  he  considered 
hellebore  to  be  noxious  to  the  system,  but  he  knew  of  no  case  in  which  it 
had  produced  death  ;  and,  under  these  circumstances,  he  did  not  consider 
himself  justified  in  calling  it  a  poison.  Another  medical  witness  stated, 
in  his  opinion,  it  belonged  to  the  class  of  poisons.  The  judge,  in  summing 
up,  told  the  jury  that  tho,t  was  to  be  regarded  as  a  poisonous  drug  which, 
in  common  parlance,  was  generally  understood  and  taken  to  be  such  ;  and 
ho  thoui^ht  the  medical  evidence  sufficiently  strong  to  bring  hellebore 
within  the  meaning  of  the  statute.  The  jury  found  the  prisoner  guilty, 
alleging  that  in  their  belief  white  hellebore  was  a  poison.  (Lond.  Med. 
Graz.,  vol.  xxxvii.  p.  830.)  Tiie  only  circumstance  calling  for  remark  in 
this  case  is  that  any  doubt  should  have  been  entertained  by  a  medical 
practitioner  respecting  the  poisonous  properties  of  white  hellebore.  It  is 
a  powerful  vegetable  irritant  and  has  caused  death  in  several  instances. 

Medical  proof  of  the  nature  of  the  substance  administered,  and  that  it 


628  CRIMINAL    ABORTION — NOXIOUS    SUBSTANCES. 

was  noxious,  was  formerly  required  on  these  occasions.  In  Reg.  v.  Taylor 
(Exeter  Wint.  Ass.,  1859),  some  powders  had  been  given  by  the  prisoner 
to  a  girl  with  a  view  of  inducing  abortion.  JS^o  portion  of  the  powders 
could  be  obtained  for  examination  ;  but  two  medical  men  who  heard  the 
evidence  deposed  that  in  their  opinion  the  powders  were  of  a  noxious 
nature.  In  the  defence,  it  was  urged  that  this  had  not  been  proved  by  a 
chemical  analysis.  The  jury  adopted  this  view,  and  returned  a  verdict  of 
acquittal.  In  Reg.  v.  Wallis  (Winchester  Aut.  Ass.,  1871;  see  p.  555, 
ante),  Brett,  J.,  in  addressing  the  grand  jury,  called  their  attention  to  the 
words  of  the  statute,  v/hich  declares  that  where  any  person  shall  unlaw- 
fully administer  a  poison  or  some  other  noxious  thing,  or  shall  unlawfuliy 
use  any  instrument  or  other  means  whatsoever,  with  intent  to  procure 
miscarriage,  he  shall  be  guilty  of  felony,  and  said  that,  having  regard  to 
the  words  "  other  means  whatsoever,"  though  there  might  be  some  doubt 
as  to  the  construction  of  the  statute,  he  should  direct  that  in  one  count  of 
the  indictment  the  word  "noxious"  should  be  omitted,  and  he  should  hold 
that,  if  the  person  accused  did  administer  some  drug  or  something  which 
he  thought  would  procure  miscarriage  with  that  intent,  although  the 
thing  itself  would  not  procure  that  miscarriage,  he  would  nevertheless  be 
guilty  of  the  offence,  and  they  ought  to  find  a  true  bill.  According  to  this 
judicial  dictum,  it  would  appear  that  it  is  not  in  all  cases  necessary  to 
prove  by  medical  evidence  that  the  substance  procured  or  administered 
was  of  a  noxious  nature.  The  words  of  s.  59,  as  to  procuring  a  noxious 
thing,  or  any  instrument  or  "  thing  whatsoever,"  strictly  interpreted, 
would  include  all  substances,  noxious  and  innoxious.  If  this  view  be 
generally  adopted,  medical  evidence  will  be  much  simplified.  Counsel 
will  not  be  under  the  necessity  of  cross-examining  medical  witnesses  on 
the  strict  meaning  of  the  word  "  noxious."  In  Reg.  v.  Wallis,  the  sub- 
stances procured  by  the  accused  were  not  noxious,  but  the  jury  acquitted 
the  prisoner  apparently  on  the  ground  that  he  did  not  actually  administer 
the  drugs ;  hence  the  question  of  noxiousness  did  not  formally  arise. 
From  the  ruling  in  this  case,  it  would  appear  that  if  a  person  procured  or 
administered  castor-oil  oi"  camphor-julep,  M'ith  intent  to  procure  mis- 
carriage, and  with  a  belief  that  the  substance  would  produce  it,  he  would 
be  found  guilty  of  the  offence.  This  being  so,  the  use  of  the  words 
"poison"  and  "noxious  thing"  in  the  statute  is  surplusage,  and  tends 
only  to  cause  confusion  in  the  medical  evidence. 

In  Reg.  V.  Newton  (Lewes  Sum.  Ass.,  1873),  it  was  proved  that  the 
prisoner  had  given  to  a  girl  who  was  pregnant  by  him  some  pills  and  a 
powder,  which  made  her  very  sick.  A  witness  was  called,  who  described 
himself  as  a  laboring  man,  and  stated  that  the  prisoner  obtained  the 
medicine  from  him,  that  he  had  taken  some  of  the  pills  himself,  that  they 
were  antibilious  pills,  and  that  the  powder  was  rhubarb.  Under  these 
circumstances,  counsel  for  the  defence  submitted  that  there  was  no  evi- 
dence that  the  medicine  administered  was  "  a  noxious  thing"  within  the 
meaning  of  the  statute  which  created  the  offence,  citing  the  case  of  Reg.  v. 
Isaacs,  32  Law  Jour.,  M.C.  Martin,  B.,  however,  overruled  the  objection, 
and  the  prisoner  was  found  guilty.  A  much  stricter  meaning  is  attached 
to  the  word  "'noxious"  by  judij^es  when  the  substance  has  been  given  for 
procuring  abortion,  than  where  the  intention  has  been  to  aggrieve  or 
annoy,  under  the  statute  on  poisoning.  (See  Reg.  v.  Hennah,  Cornwall 
Lent  Ass.,  1877.)  In  this  case,  cantharides  were  held  not  to  be  noxious 
unless  administered  in  a  quantity  to  produce  certain  effects  on  the  body. 

In  reference  to  the  medical  proofs  of  this  crime,  it  is  not  required  that 
any  specific  injury  should  have  been  done  to  the  woman,  or  that  abortion 
should  have  followed,  in  order  to  complete  the  offence.     It  is  not  even 


MEDICAL  PROOFS  REQUIRED.  529 

necessary  to  prove  that  she  was  with  child,  or  that  the  aborted  substance 
was  a  foetus  or  child.  It  mig-ht  be  a  mass  of  blood,  a  mole,  or  a  group  of 
hydatids.  The  crime  is  frequent,  but  its  perpetration  is  secret.  Applica- 
tions are  frequently  made  to  medical  men  and  druggists  by  the  lower  class 
of  people  for  drugs  for  this  purpose  ;  the  applicants  appear  to  have  no 
idea  of  the  criminality  of  the  act.  Under  the  name  of  "female  pills"  or 
"drops,"  medicines  are  thus  dispensed  in  secrecy,  and  those  who  supply, 
as  well  as  those  who  receive  them,  appear  to  have  no  idea  that  they  are 
exposing  themselves  to  a  criminal  prosecution.  In  one  case  a  bottle  con- 
taining a  liquid  supposed  to  have  been  used  for  the  purpose  of  abortion 
was  sent  to  the  author  for  examination.  It  was  labelled  "  Persian  Otto 
of  Roses."     It  contained  a  strong  ethereal  tincture  of  ergot  of  rye. 

On  one  trial  for  criminal  abortion,  the  medical  evidence  went  far  beyond 
its  customary  boundary.  It  appeared  that  the  prisoners  had  applied  to  a 
medical  man  to  supply  them  with  drugs  for  procuring  abortion.  The 
medical  man,  mistaking  his  duty  under  such  circumstances,  gave  informa- 
tion to  the  police,  and,  acting  under  their  advice,  supplied  some  drug  which 
could  do  no  injury.  The  prisoners  were  thus  led  to  the  commission  of  a 
felony,  and  at  the  trial  the  medical  man  appeared  in  the  capacity  of 
informer  as  well  as  expert — a  circumstance  which  led  to  some  severe  ob- 
servations from  the  judge.  When  such  an  application  is  made  to  a  pro- 
fessional man,  there  is  no  objection  to  the  fact  being  made  known  to  the 
police  or  magisterial  authorities,  but  be3^ond  this  he  should  not  go.  He 
should  refuse  to  supply  the  applicants  with  drugs  or  lend  himself  in  any 
way  as  a  detective  for  the  purpose  of  a  prosecution.  The  act  was  no 
doubt  done  with  a  good  intention  to  protect  the  public,  but  under  a  mis- 
taken sense  of  duty. 

On  inducing  Premature  Labor.  Medical  Besponsibility. — It  may  be 
proper  to  offer  here  a  few  remarks  upon  the  common  practice  of  inducing 
premature  labor,  as,  e.g.  in  certain  cases  of  disease,  of  deformity  of  the 
pelvis,  and  in  cases  of  excessive  vomiting  from  pregnancy.  This  practice 
has  been  condemned  as  immoral  and  illegal  ;  but  it  is  impossible  to  admit 
that  there  can  be  any  imriiorality  in  performing  an  operation  to  give  a 
chance  of  saving  the  life  of  a  woman,  when,  by  neglecting  to  perform  it, 
it  is  almost  certain  that  both  herself  and  the  child  will  perish.  (See,  on 
the  morality,  safety,  and  utility  of  the  practice,  Ramsbotham's  Obst.  Med., 
p.  328,  5th  ed.)  Any  question  respecting  its  illegality  cannot  be  enter- 
tained; for  the  means  are  administered  or  applied  with  the  bona  fide  hope 
of  benefiting  the  female,  and  not  with  any  criminal  design.  It  is  true 
that  the  law  makes  no  exception  in  favor  of  medical  men  who  adopt  this 
practice,  nor  does  it  in  the  Stutute  on  Wounding  make  any  exceptions  in 
favor  of  surgical  operations  ;  but  that  which  is  performed  bona  fide  would 
not  be  held  to  be  unlawful.  The  necessity  for  the  practice  ought  to  be 
apparent :  thus,  for  instance,  it  should  bo  shown  that  delivery  was  not 
likely  to  take  place  naturally  without  seriously  endangering  the  life  of  a 
woman.  It  is  questionable  whether,  under  any  circumstances,  it  would 
be  justifiable  to  bring  on  premature  expulsion  merely  for  the  purpose  of 
attempting  to  save  the  life  of  a  child,  since  the  operation,  even  when 
performed  with  care,  is  accompanied  with  risk  to  the  life  of  the  mother. 
Hence  a  cautious  selection  of  cases  should  be  made,  as  the  operation  is 
necessarily  attended  with  some  risk  to  both.  All  that  we  can  say  is  that, 
according  to  the  general  professional  experience,  it  should  place  the  woman 
in  a  better  position  than  she  would  be  if  the  case  were  loft  to  itself.  Be- 
fore a  practitioner  resolves  upon  performing  an  operation  of  this  kind,  he 
should  hold  a  consultation  with  others:  and.  before  it  is  nerformed  he 
34 


530  CHEMICAL    EVIDENCE. 

should  feel  assured  that  natural  delivery  cannot  take  place  without  greater 
risk  to  the  life  of  the  woman  than  the  operation  would  itself  create. 
These  rules  may  not  be  observed  by  obstetric  experts  in  large  practice ; 
but  the  non-observance  of  them  is  necessarily  attended  with  some  respon- 
sibility to  a  general  practitioner.  In  the  event  of  the  death  of  a  woman  or 
child,  he  exposes  himself  to  a  prosecution  for  a  criminal  offence,  from  the 
imputation  of  which  even  an  acc^uittal  will  not  always  clear  him  in  the 
eyes  of  the  public.  If  the  child  were  born  alive  and  died  merely  as  a 
result  of  its  immaturity,  this  might  give  rise  to  a  charge  of  manslaughter. 
Several  practitioners  have  been  tried  upon  charges  of  criminal  abortion 
— whether  justly  or  unjustly  it  is  not  necessary  to  consider;-  but  they 
had  obviously  neglected  to  adopt  those  simple  measures  of  prudence,  the 
observance  of  which  would  have  been  at  once  an  answer  to  a  criminal 
charge.  Because  one  obstetric  practitioner  of  large  experience  may  have 
frequently  and  successfully  induced  premature  labor  without  observing 
these  rules,  and  without  any  imputation  on  his  character,  this  cannot  shield 
another  who  may  be  less  fortunately  situated. 

CJiewdcal  Evidence.  Blood  in  Abortion.  Liquor  Amnii — In  the  event 
of  an  abortion  having  taken  place,  stains  produced  by  blood  or  by  the 
waters  (licjuor  amnii)  may  be  found  on  the  linen  of  a  woman,  and  a 
practitioner  may  be  required  to  say  whether  these  stains  are  of  a  nature 
to  throw  any  light  upon  the  perpetration  of  the  crime.  A  woman  who 
has  aborted  may  allege  that  the  stains  are  those  of  the  menstrual  discharge. 
Speaking  generally,  there  is  no  practical  distinction  between  menstrual 
and  other  blood  (see  ante,  p.  284).  The  menstrual  blood  contains  less 
fibrin,  is  commonly  acid  and  watery  from  admixture  with  the  mucous 
di.scharges,  and  when  examined  by  the  microscope  it  presents  epithelial 
.scales  or  cells  derived  from  the  mucous  membrane.  These  scales  or  cells 
are  columnar.  (See  Rape,  post.)  Not  much  reliance  can  be  placed  upon 
their  discovery,  since  the  mucous  membrane  of  the  organs  of  respiration  is 
lined  with  similar  cells.  Hence  expectorated  blood  might  be  mistaken  for 
menstrual.  Cells  of  a  similar  shape  line  the  whole  of  the  mucous  mem- 
brane from  the  stomach  to  the  anus.  The  blood  of  piles  might  thus  be 
confounded  with  menstrual  blood.  The  blood  discharged  in  abortion  will 
present  the  usual  characters  of  blood,  elsewhere  described  {ante,  p.  271, 
et.  esq.)  ;  but  it  may  be  diluted  with  the  waters  simultaneously  discharged. 
This  question  received  the  special  attention  of  the  French  Academy  in 
reference  to  the  crime  of  abortion  ;  and  the  report  made  was  to  the  effect 
that,  in  the  present  state  of  science,  there  was  no  certain  method  by  which 
the  blood  of  menstruation  could  be  practically  distinguished  from  the 
blood  discharged  from  a  woman  in  a  case  of  abortion  or  from  blood  in 
infanticide.  (Ann.  d'llyg.,  1846,  t.  1,  181.)  In  another  recent  case, 
Devergie  and  Chevallier  were  required  to  state  whether  certain  stains  on 
the  dress  of  a  woman  supposed  to  have  aborted  were  or  were  not  caused 
by  the  waters  (liquor  amnii).  A  chemical  analysis  merely  revealed  the 
presence  of  an  albuminous  liquid.  The  most  elaborate  experiments  satis- 
fied the  reporters  that  neither  by  the  odor  nor  by  any  other  process  could 
the  liquor  amnii,  dried  on  linen,  be  identified.  (Ann.  d'Hyg.,  1852.  t.  2, 
414.)  It  may,  however,  be  of  importance  to  observe  that  this  liquid 
slijrhtly  discolors  and  stiffens  the  fibre  of  the  .stuff  on  which  it  has  been 
effused,  and  that  it  can  be  readily  extracted  by  cold  water.  The  solution 
contains  albumen.  The  amount  of  albumen  contained  in  the  liquor 
amnii  decrea.=es  as  gestation  advances.  Chevallier's  experiments  show 
that  the  amniotic  liquid  has  all  the  usual  chemical  properties  of  a  very 
dihjte  solution  of  albumen,  containing  also  urea.  (Ann.  d'Hvg.,  1856,  t. 
1.  156.J 


INFANTICIDE — NATURE    OF    THE    CRIME.  631 


INFANTICIDE. 


CHAPTER    XLVII. 

NATURE    OF    THE    CRIME. MEDICAL    EVIDENCE    AT    INQUESTS. UTERINE    AGE    OR     MATURITY 

OF    THE    CHILD. CHARACTERS    OF    THE    CHILD    FROM    THE  SIXTH    TO  THE  NINTH  MONTH. 

SIGNS  OF  MATURITY. KU^iES  FOR  INSPECTING  THE  BODY. 

By  infanticide  we  are  to  understand,  in  medical  jurisprudence,  the 
murder  of  a  newborn  child.  The  English  law,  however,  does  not  regard 
child-murder  as  a  specific  crime  ;  it  is  treated  like  any  other  case  of  murder, 
and  is  tried  by  those  rules  of  evidence  which  are  admitted  in  cases  of 
felonious  homicide.  In  stating  that  "  infanticide"  is  the  term  applied  to 
the  murder  of  a  newborn  child,  it  is  not  thereby  implied  that  the  wilful 
killing  should  take  place  within  any  particular  period  after  birth.  Pro- 
vided it  be  proved  that  the  child  has  actually  died  from  violence,  it  matters 
not  whether  it  has  been  destroyed  within  a  few  minutes  or  not  until 
several  days  after  its  birth.  According  to  a  return  of  the  Registrar- 
General,  it  appears  that  out  of  202  murders,  120  were  perpetrated  on 
children  under  one  month.  In  the  greater  number  of  cases  of  infanticide, 
however,  we  find  that  the  murder  is  commonly  perpetrated  either  at  the 
time  of  birth  or  within  a  few  hours  afterwards.  Although  the  law  of 
England  treats  a  case  of  infanticide  as  one  of  ordinary  murder,  yet  there 
is  a  difference  in  the  nature  of  the  medical  evidence  required  to  e.-^tablish 
the  murder  of  a  newborn  child.  It  is  well  known  that  many  children 
come  into  the  world  dead,  and  that  others  die  from  various  causes  soon 
after  birth  ;  and  in  the  latter,  the  signs  of  their  having  lived  are  frequently 
indistinct.  Hence,  to  provide  against  the  danger  of  erroneous  convictions, 
the  law  humanely  assumes  that  every  newborn  child  has  been  born  dead, 
until  the  contrary  appears  from  the  medical  or  other  evidence.  The  onus 
of  proof  that  a  living  child  has  been  destroyed  is  thereby  thrown  on  the 
prosecution  ;  and  no  evidence  imputing  murder  can  be  received  unless  it 
be  first  made  certain,  by  medical  or  other  facts,  that  the  child  survived  its 
birth,  and  was  legally  a  living  child  when  the  alleged  violence  was  offered 
to  it.  Hence  there  is  a  most  difficult  duty  cast  upon  a  medical  witness  on 
these  occasions.  In  the  greater  number  of  cases  the  woman  is  delivered 
in  secrecy,  and  no  one  is  present  to  give  evidence  respecting  the  birth  of 
the  child.  It  is  under  these  circumstances  that  medical  evidence  is  espe- 
cially required.  For  reasons  elsewhere  assigned,  a  medical  man  should  be 
cautious  in  putting  questions  to  a  M-oman  charged  with  this  crime. 

Uterine  Age  or  Maturity  of  the  Child.  Viability. — One  of  the  first 
questions  which  a  witness  has  to  consider  in  a  case  of  alleged  child-murder 
is  that  which  relates  to  the  age  or  probable  degree  of  maturity  which  the 
deceased  child  may  have  attained  in  vtero.  The  reason  for  making  this 
inquiry  is  that  the  chances  of  natural  death  in  all  newborn  children  are 
great  in  proportion  to  their  immaturity ;   and  that,  supposing  them  to 


632  INFANTICIDE  —  UTERINE    AGE. 

have  survived  birth,  the  signs  of  their  having  breathed  are  commonlj  ob- 
scure .  It  is  found  that  the  greater  number  of  children  v^^bo  are  the  sub- 
jects of  these  investigations  have  reached  the  eighth  or  ninth  month  of 
gestation ;  yet  charges  of  murder  might  be  extended  to  the  wilful  destruc- 
tion of  children  at  the  seventh  montb  or  under,  provided  the  evidence  of 
life  after  birth  was  clear  and  satisfactorj". 

The  following  are  the  characters  whereby  we  may  judge  of  the  uterine 
age  of  a  child  from  the  sixth  to  the  ninth  month  of  gestation,  a  period 
which  may  be  considered  to  comprise  cases  of  abortion  as  well  as  child- 
murder  : — 

1.  Between  the  sixth  and  seventh  months. — The  child  measures,  from 
the  vertex  to  the  sole  of  the  foot,  from  ten  to  twelve  inches,  and  weighs 
from  one  to  three  pounds.  The  head  is  large  in  proportion  to  the  trunk  ; 
the  eyelids'  are  adherent,  and  the  pupils  are  closed  by  membranes  (mem- 
Ijranse  pupillares).  The  skin  is  of  a  reddish  color,  and  the  nails  are  slightly 
formed ;  the  hair  loses  the  silvery  lustre  which  it  previously  possessed,  and 
becomes  darker.  Ossification  proceeds  rapidly  in  the  chest-bone  and  in 
the  bones  of  the  foot;  the  brain  continues  smooth  on  its  surface;  there  is 
no  appearance  of  convolutions.  In  the  male  the  testicles  will  be  found  in 
the  abdominal  cavity,  lying  upon  the  psoas  muscles,  immediately  below  the 
kidneys.  In  March,  1885,  a  primiparous  married  woman  was  delivered 
in  Guy's  hospital,  after  severe  puerperal  convulsions.  The  foetus  (male) 
was  dead,  but  the  foetal  heart  had  been  heard  by  Horrocks  a  week  before. 
The  foetus  was  fifteen  inches  and  a  half  long,  and  weighed  two  pounds 
only.  There  were  points'of  ossification  in  the  upper  portion  of  the  ster- 
num ;  none  in  the  astragalus,  or  in  the  lower  sacral  vertebra.  Hence  the 
uterine  age  of  the  child  was  judged  to  be  six  months.  Nevertheless,  both 
testicles  were  found  in  the  scrotum. 

2.  Between  the  seventh  and  eighth  months. — The  child  measures  be- 
tween thirteen  and  fourteen  inches  in  length,  and  weighs  from  three  to 
four  pounds.  The  skin  is  thick,  of  a  more  decidedly  fibrous  structure,  and 
covered  with  a  white  unctuous  matter  which  now  appears  for  the  first 
time.  Fat  is  deposited  in  the  cellular  tissue,  M^hereby  the  body  becomes 
round  and  plump  ;  the  skin  previously  to  this  is  of  a  reddish  color,  and 
commonly  more  or  less  shrivelled  ;  the  nails  which  are  somewhat  firm,  do 
not  quite  reach  to  the  extremities  of  the  fingers ;  the  hair  is  long,  thick, 
and  colored  ;  ossification  advances  throughout  the  skeleton  ;  valvulse  con- 
niventes  appear  in  the  small  intestines,  and  meconium  is  found  occupying 
the  caecum  and  colon.  The  testicles  in  the  male  about  this  period  com- 
mence their  descent  towards  the  scrotum.  The  time  at  which  these 
organs  change  their  situation  is  probably  subject  to  variation.  According 
to  Hunter,  the  testicles  are  situated  in  the  abdomen  at  the  seventh,  and  in 
the  scrotum  at  the  ninth  month.  Burns  believes  that  at  the  eighth  month 
they  will  commonly  be  found  in  the  inguinal  canals.  The  observation  of 
the  position  of  these  organs  in  a  newborn  male  child  is  of  considerable  im- 
portance in  relation  to  maturity,  and  it  may  have  an  influence  on  ques- 
tions of  legitimacy  as  well  as  of  child-murder.  Curling  thus  describes  their 
change  of  position  :  At  different  periods  between  the  fifth  and  six  months 
of  foetal  existence,  or  sometimes  even  later,  the  testicle  begins  to  move 
from  its  situation  near  the  kidney  towards  the  abdominal  ring,  which  it 
usually  reaches  about  the  seventh  month.  During  the  eighth  month  it 
generally  traverses  the  inguinal  canal,  and  by  the  end  of  the  ninth  arrives 
at  the  bottom  of  the  scrotum,  in  which  situation  it  is  commonly  found  at 
birth.     (Dis.   of  the  Testis,   2d  edit.,   p.    17.)     Their  absence  from  the 


SIGNS    OF    MATURITY    IN    THE    CHILD.  633 

scrotum  does  not  necessarily  indicate  that  the  child  is  immature,  because 
these  organs  sometimes  do  not  reach  the  scrotum  until  after  birth. 

3.  Between  the  eighth  and  ninth  months. — The  child  is  from  fifteen  to 
sixteen  inches  in  length,  and  weighs  from  four  to  five  pounds.  The  eye- 
lids are  no  longer  adherent,  and  the  membrane  pupillares  have  disap- 
peared. The  quantity  of  fat  deposited  beneath  the  skin  is  increased,  and 
the  hair  and  nails  are  well  developed.  The  surface  of  the  brain  is  grooved 
or  fissured,  but  presents  no  regular  convolutions  :  and  the  gray  matter  is 
not  yet  apparent.  The  meconium  fills  almost  entirely  the  large  intestines  ; 
and  the  gall-bladder  contains  some  traces  of  a  liquid  resembling  bile.  The 
testicles  in  the  male  may  be  found  occupying  some  part  of  the  inguinal 
canal,  or  they  may.  be  in  the  scrotum.  The  left  testicle  is  sometimes  in 
the  scrotum,  while  the  right  is  situated  about  the  external  ring. 

4.  Ninth  llonth.  Sigyis  of  Ilaturiti/. — At  the  ninth  month  the  average 
length  of  the  body  is  about  eighteen  to  twenty  inches,  and  its  weight  from 
six  to  seven  pounds  ;  the  male  child  is  generally  rather  longer,  and  weighs 
rather  more  than  the  female.  Extraordinary  deviations  in  length  and 
weight  are  occasionally  met  with.  Owens  has  recorded  a  case  in  which  a 
child  at  delivery  measured  twenty-four  inches  in  length,  and  weighed 
seventeen  pounds  twelve  ounces  (Lancet,  Dec.  1838),  and  Meadows  has 
reported  another  in  which  a  child  measured,  after  death,  thirty -two  inches, 
and  weighed  eighteen  pounds  two  ounces.  It  survived  four  hours.  (Med. 
Times  and  Gaz.,  1860,  ii.  p.  105.)  In  one  case  which  the  author  ex- 
amined, the  child,  a  male,  measured  twenty-two  inches,  and  weighed 
twelve  pounds  and  a  half.  Davies  had  a  case  in  which  a  child  was  born 
alive,  weighing  nineteen  pounds  two  ounces,  probably  the  heaviest  new- 
born child  on  record.  (Med.  Times  and  Gaz,,  1860,  ii.  p.  249.)  (For 
some  practical  remarks  on  this  subject,  by  Ellsasser,  see  Henke's  Zeits- 
chrift,  1841,  Bd.  2,  p.  235.)  According  to  Duncan,  the  length  and  weight 
of  a  child  vary  according  to  the  age  of  the  mother.  They  are  greatest 
among  children  when  the  mother  is  from  25  to  29  years  of  age  ;  but  the 
facts  collected  do  not  support  this  statement ;  for  the  child  of  a  woman  at 
22  weighed  seven  pounds  three  ounces,  and  that  of  a  woman  of  30,  seven 
pounds  seven  ounces.  The  length  varied  in  a  less  degree,  being  for  the 
different  ages  at  or  about  nineteen  inches.  (Edin.  Month.  Jour.,  1864,  ii. 
p.  500.) 

At  the  full  period,  the  head  of  a  child  is  large,  and  forms  nearl}'-  one- 
fourth  of  the  whole  length  of  the  body.  The  cellular  tissue  is  filled  with 
fat,  so  as  to  give  considerable  plumpness  to  the  whole  form,  while  the 
limbs  are  firm,  hard,  and  rounded  ;  the  skin  is  pale  ;  the  hair  is  thick, 
long,  and  somewhat  abundant ;  the  nails  are  fully  developed,  and  reach  to 
the  end  of  the  fingers — an  appearance,  however,  which  may  be  sometimes 
simulated  in  a  premature  child  by  the  shrinking  of  the  skin  after  death. 
The  testicles  in  the  male  are  generally  within  the  scrotum.  Ossification 
will  be  found  to  have  advanced  considerably  throughout  the  skeleton. 
The  surface  of  the  brain  presents  convolutions,  and  the  gray  matter  begins 
to  show  itself.  The  internal  organs,  principally  those  of  the  chest,  undergo 
marked  changes  if  the  act  of  respiration  has  been  performed  by  the  child 
before,  during,  or  after  its  birth.  The  external  auricle  now  measures  an 
inch  and  a  quarter  to  an  inch  and  a  half  in  length,  seven-eighths  of  an 
inch  to  one  inch  in  width,  and  varies  little  in  children  of  very  varied  sizes. 
Medical  jurists  place  great  stress  on  the  presence  of  a  point  of  ossification 
in  the  lower  epiphysis  of  the  thigh-bone  (femur)  in  its  bearings  upon  the 
maturity  of  the  foetus.  This  point  usually  first  makes  its  appearance  at 
the  36-37th  week;  at  the  37-38th  week  it  is  commonly  the  size  of  the 


634  INFANTICIDE SUMMARY. 

head  of  a  house-fly  ;  and  at  the  full  period  it  is  of  one-fourth  to  one-third 
of  an  inch  in  diameter.  When  this  point  of  ossification  is  one-third  of  an 
inch  in  diameter  it  maybe  confidently  affirmed  that  the  foetus  has  reached 
the  full  period ;  but  where  the  point  is  only  one-fourth  of  an  inch  in  diam- 
eter it  cannot  be  positively  asserted  that  the  child  is  mature,  though  it 
is  probable  that  such  is  the  case. 

The  characters  which  have  been  here  described  as  belonging  to  a  child 
at  the  different  stages  of  gestation  must  be  regarded  as  representing  an 
average  statement.  They  are  open  to  numerous  exceptions;  for  some 
children  at  the  ninth  month  are  but  little  more  developed  than  others  at 
the  seventh.  Twins  are  generally  smaller  and  less  developed  than  single 
children  ;  the  average  weight  of  a  twin  child  is  not  more  than  five  pounds, 
and  very  often  below  this.  The  safest  rule  to  follow  in  endeavoring  to 
determine  the  uterine  age  of  a  child  is  to  rely  upon  a  majority  of  the 
characters  which  it  presents.  That  child  only  can  be  regarded  as  mature 
which  presents  the  greater  number  of  the  characters  described  as  met  with 
in  children  at  or  about  the  ninth  month  of  gestation. 

Trotsch  has  pointed  out  that  the  size  of  the  external  ear  furnishes  a 
good  test  of  the  age  of  the  child,  and  the  editor  has  confirmed  his  observa- 
tions. Trotsch  measured  both  the  length  and  breadth  of  the  external 
auricle,  but  it  usually  suffices  to  take  the  greatest  length  only.  The  fol- 
lowing are  the  usual  extreme  lengths  of  the  external  ear  in  the  foetus : — 

5  months 0  31  to  0.41  inch. 

6  " 0.55  to  0.67  " 

7  " 0.63  to  0.96  " 

8  " 1.02 

9  " 1.02  to  1.10  " 

After  birth 1.30  to  1.42  " 

It  is  convenient  to  remember  that  the  length  of  the  child  in  inches  is, 
during  the  later  stages  of  pregnancy,  double  the  intra-uterine  age  in  months. 

If  the  age  of  the  child  has  been  determined,  whether  it  be  under  or  over 
the  seventh  month,  the  rules  for  a  further  investigation  will  be  the  same. 
Should  the  child  be  under  the  seventh  month,  the  medical  presumption 
will  be  that  it  was  born  dead ;  but  if  it  has  arrived  at  the  full  period,  then 
the  presumption  is  that  it  was  born  alive. 

Conclusions. — The  following  may  be  taken  as  the  editor's  summary  of 
the  principal  facts  upon  which  our  opinion  respecting  the  uterine  age  of  a 
child  may  be  based  : — 

1.  At  six  months. — Length,  from  eight  to  twelve  inches;  weight,  one 
to  two  pounds  ;  eyelids  agglutinated  ;  pupils  closed  by  membranse  pupil- 
lares  ;  testicles  not  apparent  externally  in  the  male  ;  ossification  in  pubes 
and  OS  calcis. 

2.  At  seven  months. — Length,  from  twelve  to  fifteen  inches;  weight, 
two  to  four  pounds;  eyelids  not  adherent;  membrauae  pupillares  disap- 
pearing ;  nails  imperfectly  developed  ;  testicles  not  apparent  externally  in 
the  male  ;  ossification  in  four  divisions  of  sternum. 

8.  A%  eight  months. — Length,  from  fourteen  to  eighteen  inches  ;  weight, 
from  four  to  five  pounds  ;  membrance  pupillares  absent ;  nails  perfectly 
developed,  and  reaching  to  the  ends  of  the  fingers  ;  testicles  in  the  inguinal 
canals;  ossification  in  last  sacral  vertebra. 

4.  At  nine  months. — Length,  from  sixteen  to  twenty  inches  ;  weight, 
from  five  to  nine  pounds  ;  membranse  pupillares  absent ;  head  well  covered 
with  fine  hair ;  testicles  in  the  scrotum  ;  skin  pale ;  the  finger-nails  well 


INSPECTION    OF    THE    BODY.  535 

formed  and  reaching-  to  the  ends  of  the  fingers;  the  features  perfect — 
these  and  the  body  are  well  developed  even  when  the  length  and  vvcig-ht 
of  the  child  are  less  than  those  above  assigned.  The  external  auricle 
measures  an  inch  to  an  inch  and  an  eighth  or  more  in  length,  and  seven- 
eig-hths  of  an  inch  to  an  inch  in  breadth. 

Inspecticji  of  the  Body. — The  questions  which  a  medical  jurist  has  to 
solve,  in  examining  the  body  of  a  newborn  child,  are:  1.  To  determine 
its  age,  or  the  stage  of  uterine  life  which  it  has  reached.  2.  Whether  it 
has  lived  to  breathe.  3.  Whether  it  has  been  born  alive.  4.  The  period 
of  time  which  has  elapsed  since  its  death.  5.  The  cause  of  death,  whether 
violent  or  natural. 

Hence,  before  commencing  the  inspection,  note — 

1.  The  length  (measured  from  the  summit  of  the  head  to  the  sole  of  the 
foot)  and  weight  of  the  body.  2.  The  presence  or  absence  of  external 
fcetal  peculiarities,  3.  Any  peculiar  marks  or  indications  of  deformity 
whereby  identity  may  be  sometimes  established.  4.  All  marks  of  violence, 
in  the  shape  of  wounds,  bruises,  or  lacerations,  and  the  kind  of  instru- 
ment or  weapon  by  which  they  were  probably  produced.  5.  Whether 
the  navel-string  has  been  cut  and  tied,  or  lacerated  ;  the  appearance  of  the 
divided  vessels,  and  the  length  of  that  portion  which  is  still  attacked  to 
the  body  of  the  child.  6.  The  presence  or  absence  of  vernix  caseosa 
about  the  g-roins,  armpits,  or  neck — the  presence  of  this  substance  proving 
that  a  child  has  not  been  washed  or  attended  to.  1.  It  will  be  necessary 
to  state  whether  there  are  about  the  body  any  marks  of  putrefaction,  indi- 
cated by  a  separation  of  the  cuticle,  change  of  color  in  the  skin,  or  offen- 
sive odor.  It  is  obvious  that,  unless  the  circumstances  are  noticed  before 
the  inspection  is  commenced,  they  may  be  entirely  lost  as  evidence. 

A  medical  man  cannot  be  too  careful  in  noticing  upon  the  body  of  the 
child  any  special  characters  which  may  serve  as  proofs  of  identity.  He 
must  remember  that  the  defence  may  be  that  the  child  is  not  that  of  the 
woman  charged  with  murder.  This  observation  applies  especially  to  the 
examination  of  the  bodies  of  children  that  may  have  survived  their  birth 
for  some  days.  The  body  may  be  found  wrapped  in  paper  or  in  some 
article  of  clothing  which  may  Iielp  to  establish  identity.  If  the  child  has 
survived  its  birth  it  would  be  well  to  form  an  opinion  as  to  how  many 
days  it  has  lived.  The  state  of  the  navel-string,  or,  if  separated,  whether 
the  part  of  the  abdomen  to  which  it  was  attached  is  in  the  process  of  heal- 
ing or  already  healed, — are  facts  which  may  help  a  medical  opinion  re- 
specting the  date  of  birth.  In  addition  to  these  points,  the  sex  of  the 
child  and  the  color  of  the  hair  should  be  noted,  as  well  as  any  particular 
marks  on  the  skin,  nsevi  (mother's  marks)  or  moles,  and,  of  course,  all 
wounds  or  Oiher  injuries — their  probable  cause  or  mode  of  production, 
and  their  situation.  ' 


636  PROOFS    OF    LIFE    BEFORE    RESPIRATION. 


CHAPTEE   XLYIII. 

EVIDENCE    OF    LIFE     BEFOKE     KESPIKATION. PDTREFACTION    IN    UTEKO. EVIDENCE    OF    LIFE 

AFTER     RESPIKATION. COLOR,    VOLUME,    CONSISTENCY. PRESENCE     OF     DEVELOPED     AIR- 
CELLS,    AND    ABSOLUTE    WEIGHT    OF    THE  LUNGS. STATIC    TEST. WEIGHT    INCREASED    BY 

RESPIRATION. 

The  question  whether  a  child  was  or  was  not  torn  alive  is  of  great  im- 
portance in  a  case  of  alleged  child-murder  ;  and  it  is  unfortunatel}^  one 
which,  in  respect  to  the  proofs  upon  which  medical  evidence  is  commonly 
founded,  has  given  rise  to  considerable  controversy.  "When  it  is  stated 
that  in  most  cases  of  alleged  infanticide  which  end  in  acquittals  in  spite 
of  the  strongest  moral  presumptions  of  guilt,  the  proof  fails  on  this  point 
only,  it  must  be  obvious  that  this  question  especially  claims  the  attention 
of  a  medical  jurist.  The  medical  evidence  of  a  child  having  been  alive, 
wher^  violence  was  offered  to  it  at  its  birth  or  afterwards,  may  be  divided 
into  two  parts  :  first,  that  which  is  obtainable  Ijefore  the  act  of  respir- 
ation is  performed  ;  and  second,  that  which  is  obtainable  afterwards.  At 
present  we  shall  confine  our  attention  to  the  question  whether  the  child  was 
leii'ally  living  when  it  was  maltreated, — the  fact  of  its  having  been  horn 
alive  will  be  a  matter  for  future  consideration.  These  two  questions  have 
been  frequently  bat  improperly  associated,  thus  rendering  the  subject  con- 
fused ;  but  it  must  be  so  obvious  as  scarcely  to  require  stating,  that 
violence  of  a  murderous  kind  may  be  ofl'ered  to  a  living  child  before  it  is 
entirely  born  ;  and  that  owing  to  this  violence  it  may  come  into  the  world 
dead. 

Proofs  of  Life  before  Res^piration. — It  was  formerly  supposed,  if  the 
lungs  contained  no  air,  that  the  child  could  not  have  breathed,  and  must  have 
been  born  dead  ;  but  this  is  now  known  to  be  an  error.  Children  are  able 
to  breathe  feebly  and  continue  in  existence  many  hours  without  visibly 
distending  the  cells  of  the  lungs  with  air  ;  the  absence  of  air  from  the 
lungs,  therefore,  furnishes  no  proof  either  that  respiratien  has  not  been 
performed,  or  that  the  child  has  not  lived  after  birth.  The  restoration  of 
many  children  apparently  born  dead  is  in  itself  a  clear  proof  that  many 
are  born  living  who  might  be  pronounced  dead,  simply  because  "breath- 
ing" and  "life"  have  been  erroneously  considered  as  synonymous  terms. 
That  our  law  authorities  will  admit  evidence  of  life  in  a  child  before  the 
establishment  of  respiration  is  clear  from  the  decision  in  Rex  v.  Brain,  in 
which  the  judge  said  that  a  child  might  be  born  alive,  and  not  breathe  for 
some  time  after  its  birth  (Archbold,  Crim.  Plead.,  367) ;  as  also  from  the 
charge  of  Coltman,  J.,  in  the  case  of  Rex  v.  Sellis  (Norfolk  Spr.  Circ, 
1837).  In  this  instance  it  was  alleged  that  the  prisoner  had  murdered 
her  child  by  cutting  off  its  head.  The  judge  directed  the  jury,  that  if  the 
child  was  alive  at  the  time  of  the  act  it  was  not  necessary,  in  order  to 
constitute  murder,  that  it  should  have  breathed.  In  fact,  it  would  appear 
that  respiration  is  regarded  as  only  one  proof  of  life  ;  and  the  law  will, 
therefore,  receive  any  other  kind  of  evidence  which  may  satisfactorily 
show  that  a  child  has  lived,  and  make  up  for  the  proof  commonly  derived 
from  the  state  of  the  lungs. 

In  these  cases  it  will  be  first  necessary  for  a  medical  practitioner  to 
prove  that  the  child  under  examination  has  recently  died,  or,  in  other 


EVIDENCE    FROM    MARKS    OF    VIOLENCE    ON    THE    BODY.       537 

words,  that  there  are  good  grounds  for  believing  it  to  have  been  recently 
living.  Hence,  if  the  body  is  highly  putrefied,  either  from  the  child 
having  died  in  the  womb  some  time  before  birth  or  from  its  having  been 
born  and  its  body  not  discovered  until  putrefaction  had  far  advanced  both 
internally  and  externally,  the  case  is  beyond  the  reach  of  evidence.  A 
medical  witness  will  in  general  be  compelled  to  almndon  the  investigation 
because  the  body  can  furnish  no  evidence  whatever  of  life  after  birth.  The 
examination  of  the  thoracic  organs  would  throw  no  light  on  the  case,  for 
here  we  are  assuming  that  the  lungs  are  in  an  unexpanded  condition. 

E vidence  from  Mark.s  of  Violence  on  the  Body. — It  has  been  proposed 
to  seek  for  evidence  of  life  under  these  circumstances  by  observing  the 
characters  presented  by  marks  of  violence  on  the  body.  In  general  when 
children  are  murdered  the  amount  of  violence  inflicted  is  considerably, 
greater  than  that  which  is  required  to  destroy  them,  whereby  satisfac- 
tory proof's  of  the  crime  are  occasionally  obtained.  On  the  other  hand, 
the  body  of  a  stillborn  child,  dead  from  natural  causes,  is  often  covered 
wnth  lividities  and  ecchymoses;  and  as  the  blood  of  the  foetus  or  child 
does  not  coagulate  with  the  same  firmness  as  that  of  the  adult,  the  evi- 
dence derivable  from  the  extent,  situation,  and  characters  of  marks  of 
violence  is  often  of  too  vague  and  uncertain  a  kind  to  allo\v  of  the  ex- 
pression of  a  medical  opinion  that  the  child  was  living  when  the  violence 
was  offered  to  it.  The  characters  which  have  been  already  described  as 
peculiar  to  wounds  and  contusions  inflicted  during  life  (pp.  241,  244)  may 
be  met  with  in  the  body,  whether  the  child  has  breathed  or  died  without 
breathing.  So,  again,  these  characters  are  open  to  the  exceptions  there 
pointed  out ;  for  they  will  be  equally  present,  supposing  the  wounds  to 
have  been  inflicted  immediately  after  the  cessation  of  respiration  or  cir- 
culation in  the  child  or  after  the  cessation  of  circulation  only — if  the  act 
of  respiration  has  not  been  performed.  But  marks  of  violence  on  the 
body  of  a  child  that  had  died  in  iitero  twenty-four  or  forty-eight  hours 
before  it  was  born  would  not  present  the  characters  of  injuries  inflicted 
on  a  living  child.  There  would  be  no  ecchymosis  and  no  effused  coagula 
of  l)lood.  These  marks  when  they  exist,  although  they  may  establish 
that  a  child  was  either  living  or  but  recently  dead  at  the  time  they  were 
inflicted,  cannot  show  that  it  was  born  alive.  Injuries  met  with  on  the 
bodies  of  children  alleged  to  have  been  born  dead  ought,  however,  to  be 
of  such  a  nature  as  to  be  readily  explicable  on  the  supposition  of  their 
having  arisen  fi'om  accident.  If  from  their  nature,  extent,  or  situation 
they  are  such  as  to  evince  a  wilful  or  intentional  design  to  injure,  it  is  a 
fair  ground  for  a  jury,  not  for  a  medical  witness,  to  inquire  why  these 
extensive  wounds  or  other  marks  of  violence  were  inflicted  on  a  child  if, 
as  it  is  alleged,  it  was  really  born  dead.  It  must  be  confessed  that  in 
such  a  case  there  would  be  a  strong  moral  presumption  of  murder,  although 
medical  proof  of  life  or  of  actual  live  Ijirth  might  totally  fail. 

As  a  summary  of  these  remarks  it  may  be  observed  that  although 
physiologically  a  child  may  live  for  a  certain  period  after  its  birth  with- 
out breathing — and  legally  its  destruction  during  this  period  would  amount 
to  murder — yet  there  are  at  present  no  satisfactory  medical  data  to  enable 
a  witness  to  express  a  positive  opinion  on  this  point  in  the  majority  of 
cases.  If  other  evidence  were  adduced  of  a  child  having  lived  and  been 
destroyed  under  these  circumstances — as  where,  for  example,  a  woman 
causes  herself  to  be  delivered  in  a  bath  of  water,  or  an  accomplice  covers 
the  mouth  of  an  infant  in  the  act  of  birth  or  immediately  after  it  is  born — 
a  medical  witness  would  be  justified  in  asserting  that  the  absence  of  the 
signs  of  respiration  in  the  lungs  was  no  proof  that  the  child  had  been 


538  PROOFS    OF    LIFE    BEFORE    RESPIRATION. 

born  dead.  Indeed  it  is  apparent  that  breathing  could  not  be  established 
owing  to  the  criminal  means  actually  employed  to  prevent  it.  The 
absence  of  air  from  the  lungs  may,  therefore,  really  be  the  result  of  the 
forcible  prevention  of  respiralion  during  the  act  of  birth.  There  cannot 
be  any  doubt  that  living  children  are  occasionally  thus  destroyed:  they 
die,  not  from  the  actual  infliction  of  violence,  but  because  either  through 
design  or  accident  the  performance  of  that  act  which  is  necessary  to  main- 
tain existence  when  the  child  is  born  is  prevented.  Whether  a  jury  would 
convict  under  these  circumstances  is  doubtful;  but  this  is  of  no  impor- 
tance to  the  witness,  for  his  statements  ought  always  to  be  made  accord- 
ing to  correct  and  well-ascertained  medical  principles  and  not  for  the 
purpose  of  procuring  either  the  conviction  or  acquittal  of  persons  accused 
of  crime.  In  general  those  cases  in  which  questions  relative  to  life  before 
respiration  might  arise,  are  stopped  in  the  coroner's  court,  the  usual 
practice  being  when  the  signs  of  respiration  are  absent  or  imperfect  to 
pronounce  that  the  child  was  born  dead.  If  the  lungs  sank  in  water  the 
presence  of  marks  of  violence  on  the  body  would  be  considered  as  fur- 
nishing no  evidence  ;  for  the  sinking  of  the  lungs  would  in  general  be 
taken  as  a  proof  that  the  child  was  born  dead  and  that  there  could  have 
been  no  murder. 

This  subject  has  been  fulh'  considered  by  Causae.  (Des  Preuves  de  la 
Tie  en  Matiere  d'lnfanticide :  Ann.  d'Hyg.,  1878,  t.  2,  p.  471.)  After 
denouncing  it  as  a  great  error  to  assert  and  act  upon  the  principle  that 
life  and  respiration  are  synonymous  (  Vivre,  c^ed  respii'er),  he  quotes 
many  instances  in  which  chilclren  have  been  born  living  and  survive 
birth  for  some  time  without  breathing.  It  is  during  this  period  that  an 
act  of  murder  may  be  perpetrated,  and  satisfactory  proofs  of  the  crime 
may  be  frequently  obtained  by  an  examination  of  the  body,  irrespective 
of  the  condition  of  the  lungs.  In  such  children  the  heart  continues  to 
pulsate,  and  the  circulation  is  carried  on  by  the  foramen  ovale  and  the 
ductus  arteriosus,  as  in  the  foetal  state.  The  proof  of  this  is  seen  in  the 
fact  that  these  children  may  be  roused  and  made  to  breathe  many  minutes 
and  even  a  quarter  of  an  hour  after  birth.  Causae  contends  that  if  any 
ecchymosis  is  found  on  the  skin  of  a  newborn  child  this  is  a  proof  that  the 
blood  was  at  the  time  circulating  in  the  body  of  the  child  and  that  it  had 
been  extravasated,  as  it 'would  be  from  violence  applied  to  the  living 
body..  Such  extravasations  indicate  the  movement  of  blood  towards  the 
parts  affected,  and  thereb}^  furnish  a  proof  of  the  existence  of  life  at  the 
time  when  the  violence  was  inflicted.  This  proof  would  be  strengthened 
in  cases  in  which  the  blood  was  found  coagulated  and  the  cellular  mem- 
brane or  fractured  bones  largely  infiltrated.  These  are  the  essential 
characters  of  injuries  inflicted  on  a  living  body,  and  they  carry  with  them 
proofs  of  life  from  circulation  as  strongly  as  the  presence  of  air  in  the 
lungs  indicates  life  from  respiration.  The  same  remarks  may  be  made 
respecting  burns,  attended  with  blisters  containing  serum  or  a  line  of 
redness  (see  p.  869).  Assuming  the  child  to  have  been  born  dead,  these 
acts  of  violence  could  not  have  produced  similar  appearances  on  the  body. 

Causse  is  supported  by  Pevergie  in  considering  respiration  as  only  one 
sign  of  life,  and  that  it  may  be  absent  in  a  child  living  for  a  quarter  of  an 
hour  or  longer  after  birth.  The  foetal  circulation  of  the  blood  is  equally  a 
sign  of  life  after  birth,  indicated  by  the  marks  of  contusions,  ecchymoses, 
and  coagulation  of  the  l)lood.  In  a  case  which  occurred  to  Devergie,  there 
were  severe  contusions  with  ecchymosis  about  the  head  of  the  child  ;  the 
temporal  muscles  were  deeply  ecchymosed,  and  blood  was  infiltrated  in 
the  muscular  fibres.    The  lungs,  entire  and  divided,  sank  in  water.    They 


PROOFS  OF  LIFE  AFTER  RESPIRATION.  539 

contained  no  air,  and  there  was  no  evidence  of  lireathing.  The  conclusions 
drawn  by  him  were  that  tliis  child  had  lived  and  been  destroyed  by  vio- 
lence to  the  head.  The  injuries  were  the  result  of  violence  api)lied  durinf^ 
life,  and  could  not  have  been  produced  on  the  body  of  the  child  while  in 
the  womb.     (Ann.  d'Hyg;.,  1887,  t.  1,  p.  407.) 

In  order  to  justify  any  inference  respecting-  the  life  of  a  newborn 
child  under  these  circumstances,  the  wounds  or  injuries  should  have  those 
well-marked  characters  which  have  been  elsewhere  assigned  to  wounds  on 
the  living  body  (p.  241)",  and  they  should  be  of  such  a  nature  that  they 
could  not  have  been  produced  on  the  child  by  any  accident  when  in  the 
womb. 

There  is  a  class  of  eases  in  which  a  child  is  born  alive,  but  its  lungs 
remain  in  the  fcetal  condition,  i.  e.  they  present  no  appearance  of  having 
received  air  by  the  act  of  breathing.  These  are  cases  of  atelectasis  (p.  544). 
The  appearances  in  the  body  are  the  same  as  in  stillborn  children.  Bon- 
ders, who  met  with  one  of  these  cases  in  which  he,  in  ignorance  of  the 
facts,  pronounced  a  child  to  be  stillborn  when  it  was  distinctly  proved 
that  it  had  lived  twelve  hours,  says :  "  Where  the  sign  of  an  extra-uterine 
life,  which  does  not  betray  itself  by  air  in  the  lungs,  are  to  be  found, 
futurity  must  declare." 

Proofs  of  Life  after  Be^piration. — There  is  no  doubt  that  the  proof  of 
the  act  of  respiration  furnishes  the  best  and  strongest  evidence  of  a  child 
having  lived  at  or  about  the  time  it  was  born.  It  does  not,  however,  show 
that  a  child  has  been  bo7^7i  alive.  The  physical  changes  in  the  bodv  of  a 
child  which  result  from  the  establishment  of  this  process  take  place  in 
the  lungs  immediately,  and  in  the  heart  and  its  appendages  more  slowly. 
It  is,  therefore,  chiefly  to  the  lungs  that  a  medical  witness  looks  for  proofs 
of  respiration.  Sometimes,  however,  these  organs  are  found  in  their  foetal 
condition,  or  nearly  so  ;  for,  although  a  child  may  have  survived  its  birth 
many  hours,  there  may  be  no  evidence  of  the  fact  from  the  state  of  the 
lungs.  To  such  cases  the  remarks  now  about  to  be  made  cannot,  of 
course,  apply ;  the  proofs  of  life  must  then  be  sought  for  elsewhere,  and, 
if  none  can  be  found,  the  case  is  beyond  the  reach  of  medical  evidence. 
But  it  is  obvious  that  the  occasional  occurrence  of  cases  of  this  description 
can  present  no  objection  to  our  still  seeking  for  proofs  of  life  in  the  state 
of  the  lungs,  any  more  than  the  fact  of  poison  not  being  always  discovered 
in  the  body  of  one  who  has  died  from  poisoning  would  be  a  bar  to  our 
seeking  for  the  proofs  of  poison  in  any  unknown  case  which  presented  itself. 
It  is  the  more  necessary  to  insist  upon  this  point,  because  some  have  held 
that,  as  we  cannot  always  derive  proofs  of  life  from  an  examination  of  the 
lungs  of  newborn  children,  we  should  abandon  al}i  evidence  of  this  de- 
scription and  leave  the  case  in  its  original  obscurity.  The  very  object  of 
medical  jurisprudence  is  to  endeavor  to  remove  these  difficulties,  and  to 
show  in  every  department  of  the  science  the  degree  to  which  we  may 
safely  trust  the  medical  proofs  of  crime,  however  insufficient,  inconsistent, 
or  contradictory  they  may  at  first  sight  appear. 

Examination  of  the  Lungs. — The  cavity  of  the  chest  may  be  conve- 
niently laid  open  by  carrying  incisions  from  below  the  davicles'downwards 
on  each  side  from  about  half  the  length  of  the  ribs  backwards.  The  dia- 
phragm should  be  separated  from  the  cartilages  without  opening  the  abdo- 
men ;  the  ribs  sawn  or  cut  through,  and  the  flap  formed  by  the  front  of 
the  chest  turned  upwards — though  some  prefer  to  turn  the  flap  downwards. 
The  differences  in  the  relative  positions  of  the  organs  of  the  chest  before 
and  after  respiration  may  be  thus  stated  :  1.  If  a  child  has  vot  hreathed, 
the  thymus  gland,  as  large  as  the  heart,  will  be  found  occupying  the  upper 


54.0  CHARACTERS    OF    THE    LUNGS    AFTER    RESPIRATION. 

and  middle  portions  of  the  chest ;  the  heart,  within  its  membrane  (peri- 
cardium), is  situated  in  the  lower  and  middle  portion,  and  is  rather 
inclined  to  the  left  side.  The  lungs  are  placed  quite  in  the  back  part  of 
the  chest,  so  as  often  to  give  the  impression  that  they  are  wanting.  In 
some  instances  they  project  slightly  forwards  by  their  anterior  margins, 
but  in  no  instance,  unless  congested,  infiltrated,  or  otherwise  diseased,  do 
they  cover  and  conceal  the  heart.  The  thymus  gland  is  sometimes  of  a 
pale  fawn  color,  at  others  of  a  deep  livid  hue:  but  there  is  no  perceptible 
difference  in  this  organ  in  newborn  children  before  or  after  the  perform- 
ance of  the  respiration.  2.  On  the  other  hand,  when  a  child  has  fully 
breathed,  the  most  striking  differences  will  be  observed  in  the  color  and 
prominence  of  the  lungs.  They  are  of  a  light-red  hue,  project  forwards — 
appear  to  fill  the  entire  cavity  of  the  chest,  and  cover  and  in  great  part 
conceal,  by  their  anterior  margins,  the  heart  and  its  membrane.  We  may 
meet  with  every  variety  in  the  appearances  between  these  two  extremes; 
for  the  process  of  respiration  often  requires  a  considerable  time  in  order 
that  it  should  be  fully  established,  especially  in  children  which  are  of  a 
weakly  constitution  or  prematurely  born.  Hence  the  lungs  will  be  found 
to  occupy  their  respective  cavities  to  a  greater  or  less  extent,  and  to  cover 
the  pericardium  more  or  less,  not  according  to  the  length  of  time  which  a 
child  has  lived,  but  according  to  the  perfection  with  which  respiration 
has  been  performed.  Although,  as  a  general  rule,  the  lungs  are  more  per- 
fectly filled  with  air  in  proportion  to  the  time  during  which  a  child  sur- 
vives its  birth,  yet  this  is  open  to  numerous  exceptions. 

Color. — The  color  of  the  lungs  before  resjjiradon  is  bluish-red  or  deep 
violet,  but  it  is  subject  to  variation.  Some  njedical  jurists  have  compared 
it  to  the  color  of  the  spleen,  others  to  that  of  the  liver.  A  short  exposure 
to  air  will  materially  brighten  the  color  in  the  parts  exposed,  so  that  it 
should  be  observed  and  recorded  immediately  on  opening  the  chest.  After 
respiration  the  lungs  acquire  a  light-red  hue  in  proportion  to  the  degree 
in  which  the  process  has  been  performed.  If  imperfectly  established,  they 
will  be  mottled  or  marbled,  general]}^  about  the  anterior  surfaces  and  mar- 
gins, the  patches  of  light  red  being  intermixed  with  the  livid  foetal  hue, 
and  being  slightly  raised,  as  if  by  distention,  above  the  general  surface  of 
the  organs.  The  light-red  tint  changes,  after  a  short  exposure  to  air,  to 
a  bright  scarlet. 

Volume. — Before  respiration,  the  lungs  are  in  general  scarcely  visible, 
unless  forcibly  dra^yn  forwards  in  the  chest.  When  it  has  been  perfectly 
accomplished,  the  volume  is  so  much  increased  that  the  bag  of  the  heart 
(pericardium)  is  almost  concealed  by  them.  Respiration  must,  however, 
have  been  perfectly  pei'formed  in  order  that  this  condition  should  exist  to 
the  full  extent  described. 

Consistency. — The  lungs,  before  respiration,  feel  like  the  liver,  or  any 
other  of  the  soft  organs  of  the  body.  They  are  firm  under  the  finger,  but 
their  substance  may  be  lacerated  by  violent  compression.  After  respira- 
tion has  been  fully  performed  there  is  a  distinct  sensation  of  what  is  termed 
crepitation  on  compressing  them,  i.  e.  air  is  felt  within  them.  If  a  thin 
section  of  the  lung  be  submitted  to  examination  with  a  low  power  of  the 
microscope — before  respiration  it  will  present  a  solid  appearance — after 
respiration  air-cells  will  be  distinctly  seen  in  it.  These  conditions  of  the 
lungs  must,  of  course,  depend  on  the  degree  to  which  respiration  has  been 
carried.  The  lungs  of  children  that  have  lived  for  a  considerable  time 
after  birth  will  sometimes  give  no  feeling  of  crepitation  under  the  finger. 
Generally  speaking,  lungs  of  this  kind  present  the  other  fcetal  characters ; 


ABSOLUTE    -WEIGHT    OF    THE    LUNGS.  6rtl 

thus  they  are  small  and  of  a  livid  color,  and  no  air-cells  may  be  detected 
on  a  microscopical  examination. 

'Development  of  Air-cells. — On  the  right  lung,  and  especially  on  the 
edges  and  concave  surface  of  its  upper  lobe,  the  first  appearances  of  respi- 
ration may  be  visible,  even  when  the  rest  of  the  lungs  retain  their  foetal 
condition.  Here  it  is  that  the  highly  characteristic  developed  air-cells  are 
first  visible.  These,  if  the  lungs  are  fresh  and  full  of  blood,  take  the  form 
of  bright  vermilion  spots  ;  but  if  the  lungs  contain  less  blood,  or  are  ex- 
amined some  davs  after  death,  the  spots  are  of  a  lighter  tint,  (Gruy  and 
Ferrier's  For.  Med.,  5th  edit.,  p.  104.)  The  form  and  arrangement  of 
these  cells  are  also  characteristic — they  are  angular,  and  are  not  percepti->. 
bly  raised  above  the  surface  of  the  lung.  They  may  be  either  irregularly 
g-rouped  or  arranged  in  sets  of  four,  and  their  outline  is  distinctly  polygoual.- 
They  are  best  seen  with  the  naked  eye,  or  at  most  with  a  lens  of  low 
power.  Their  form,  their  immobility  when  the  finger  is  passed  over  the 
surface  of  the  lung,  their  color,  and  the  fact  that  they  are  not  raised  above 
the  surface  of  the  lung,  render  a  mistake  of  these  cells  for  the  minute  bullae 
of  putrefaction,  melanotic  spots,  or  minute  ecchymosos,  impossible,  if  ordi- 
nary care  be  exercised.  The  same  development  of  air-cells  may  be  brought 
about  by  artificial  respiration.  Nevertheless,  these  air-cells  are  of  great 
value  as  proving  either  respiration  or  artificial  respiration. 

Absolute  Weight  of  the  Lungs.  The  Static  Test. — The  absolute  weight 
of  the  lungs  before  respiration  is  less  than  that  which  they  have  after  the 
establishment  of  the  process.  From  this  an  inference  has  been  drawn  that 
the  absolute  weight  of  the  lungs  in  an  unknown  case,  compared  with  cer- 
tain averages,  will  aid  the  inquirer  in  ascertaining  whether  respiration  has 
or  has  not  been  performed.  In  order  to  determine  the  weight  of  the  lungs, 
these  organs  should  be  carefully  separated  by  dissection  from  the  heart 
and  thymus  gland  and  removed  with  the  windpipe  and  bronchi  attached. 
Previously  to  their  removal  ligatures  should  be  placed  on  the  pulmonary 
vessels,  so  that  no  blood  may  escape  from  the  lungs.  They  should  now 
be  weighed,  and  the  weight  accurately  noted.  The  average  weight  before 
respiration,  derived  from  nine  cases,  was  found  to  be  649  grains.  Ac- 
cording to  Traill,  the  weight  varies  from  4.30  to  600  grains.  It  is  of  im- 
portance, in  taking  the  weight  of  these  organs,  to  observe  whether  the 
child  is  at  or  near  maturity,  and  whether  its  body  is  fully  developed,  or 
of  about  the  average  size  and  loeight ;  owing  to  a  neglect  of  this  rule,  it 
is  highly  probable  that  comparisons  have  been  made  of  the  absolute  weight 
of  the  lungs  in  children  of  different  ages,  which  a  full  statement  of  the 
facts  would  not  have  justified.  If  it  is  small  and  immature,  or  unusually 
large,  the  lungs  will  weigh  either  less  or  more  than  the  average.  The 
average  weight  of  the  lungs,  after  respiration,  derived  from  three  cases, 
was  927  grains  ;  but  in  making  an  estimate  of  this  kind,  much  will  de- 
pend upon  the  degree  to  which  respiration  has  been  carried.  In  three 
cases,  in  which  the  children  lived  half  an  hour,  six  hours,  and  twenty-four 
hours  respectively,  the  process  had  been  so  imperfectly  performed  that  the 
lungs  varied  but  little  in  weight  from  the  average  before  respiration. 
(Guy's  Hosp.  Rep.,  183Y,  ii.  p.  318.)  The  truth  is,  we  cannot  compare 
the  lungs  of  children,  as  to  weight,  by  the  time  which  they  may  have  sur- 
vived birth,  but  rather  by  the  degree  to  which  the  lungs  have  been  pene- 
trated by  air.  Another  circumstance  must  also  be  considered  in  basing 
an  opinion  on  the  absolute  weight  of  the  lungs.  Although  there  does 
not  appear  to  be  any  strict  normal  relation  between  the  weights  of  the 
body  and  lungs  in  newborn  children,  yet  it  is  certain  that,  in  the  bodies 
of  children  of  unusual  weight,  the  lungs  will  be  found  much  heavier  than 


542  SPECIFIC    GRAVITY    OF    THE    LUNGS. 

the  average,  whether  the  child  has  breathed  or  not.  The  body  may  vary 
from  six  to  eig-hteen  pounds ;  and  the  lungs  under  these  circumstances  will 
also  differ  in  weight. 

The  healthy  lungs  of  mature  newborn  children  become  heavier  after 
respiration,  and  according  to  its  degree  ;  and  where  a  deviation  from  this 
rule  is  observed,  it  may  probably  be  explained  by  the  circumstance  that 
the  lungs  of  an  immature  have  been  compared  with  those  of  a  mature 
child — the  lungs  of  an  undeveloped  twin  with  those  of  one  not  a  twin,  or 
the  lungs  of  one  which  has  breathed  imperfectly  with  those  of  another  in 
which  respiration  has  become  well  established. 

It  is  very  well  known  to,  and  admitted  by,  all  medical  jurists,  that  there 
are  some  instances  in  which  the  fact  of  rei-piration  cannot  be  determined 
by  the  application  of  the  static  or  any  other  test  to  the  lungs,  simply 
because  they  contain  no  air.  Increased  weight,  therefore,  is  only  one 
among  several  circumstances  to  which  a  medical  jurist  should  attend. 

Great  weight  of  the  lungs  can  obviously  furnish  no  proof  of  respiration 
unless  this  is  accompanied  by  the  other  physical  changes  indicative  of  the 
process  ;  as,  for  example,  increase  in  volume  from  the  presence  of  air,  crepi- 
tation, and  the  detection  of  air-cells.  If  the  lungs  are  heavy,  and  at  the 
same  time  contain  little  or  no  air,  the  increase  of  weight  must  depend 
upon  disease  or  other  abnormal  causes,  not  upon  respiration.  In  one  case 
the  lungs  were  large,  and  weighed  upwards  of  1200  grains.  They  con- 
tained no  air  ;  when  divided  into  thirty  pieces,  not  one  portion  floated, 
nor  could  any  air  be  seen  on  the  closest  examination.  It  was  therefore 
clearly  impossible  to  ascribe  a  weight  so  much  above  the  average  to  the 
effects  of  respiration.  On  the  other  hand,  in  another  case,  the  lungs  of  a 
newborn  child  apparently  full-grown,  although  fully  distended  with  air, 
weighed  only  626  grains.  In  this  case  the  body  of  the  child  weighed  only 
six  pounds,  and  a  quantity  of  blood  had,  no  doubt,  escaped  from  the  lungs, 
owing  to  the  pulmonary  vessels  not  having  been  tied  before  their  removal 
from  the  chest.  It  must  not  be  forgotten  that  all  the  physical  characters 
presented  by  lungs  that  have  respired  are  liable  to  fallacies  ;  but  these 
may  be  removed,  or  the  force  of  the  objection  diminished,  by  not  basing 
an  opinion  ou  one  or  two  conditions  only.  We  should  take  the  whole 
combined;  for  it  would  be  as  wrong  to  regard  great  v.^eight  in  the  lungs 
token  alone  as  an  absolute  proof  of  respiration,  as  it  would  be  to  draw  the 
same  inference  from  a  mere  change  in  the  color,  volume,  or  consistency  of 
the  organs. 

Ploucquet  proposed  to  determine  whether  the  act  of  respiration  had 
taken  place  or  not  by  a  comparison  of  the  absolute  weight  of  the  lungs 
with  the  weight  of  the  body  of  a  child.  This,  which  has  been  called  the 
test  of  Ploucquet,  is  based  on  the  fallacy  that  there  is  an  invariable 
relation  between  the  weights  of  the  lungs  and  bodies  in  newborn  children. 
No  such  relation  exists,  and  this  method  of  arriving  at  a  solution  of  the 
question  of  respiration  has  been  abandoned  by  all  medical  jurists. 

The  Specific  Gravity  of  the  Lungs. — The  specific  gravity  of  the  lungs 
is  greater  before  than  after  respiration  ;  for  although  the  organs  become 
absolutely  heavier  by  the  establishment  of  the  process,  this  is  owing,  not 
to  the  air,  but  to  the  additional  quantity  of  blood  received  into  them.  The 
air  thus  received  so  increases  the  volume  of  the  lungs  as  more  than  to 
counteract  the  additional  weight  derived  from  the  blood,  and  thus  appar- 
ently to  diminish  their  specific  gravity.  Under  these  circumstances  they 
readily  float  on  water.  The  specific  gravity  of  the  lungs  before  respira- 
tion, i.e.  in  the  foetal  condition,  varies  from  1.04  to  1.05.  They  are  about 
one-twentieth  part  heavier  than  their  bulk  of  water.     After  respiration, 


THE    HYDROSTATIC    TEST.  543 

the  specific  gravity  of  the  lungs,  with  the  air  contained  in  them  is  0.94  ; 
i  e.  the  organs  are  about  one-seventeenth  part  lighter  than  their  bulk  of 
water.  The  introduction  of  a  very  small  quantity  of  air  will  render  the 
lungs  buoyant  in  water,  and  an  alteration  in  their  volume  sufficient  for 
this  purpose  would  not  be  perceptible  to  the  eye.  It  will  be  understood 
that  the  specific  gravity  of  the  substance  of  the  lungs  is  unchanged;  the 
organs  are  rendered  only  apparently  lighter  by  the  air  contained  in  their 
cells,  on  the  same  principle  as  a  bladder  filled  with  air.  Hence  it  follows 
that  the  apparent  diminution  of  specific  gravity  will  take  place  whether 
the  air  is  derived  from  respiration,  artificial  inflation,  or  putrefaction.  It 
is  on  this  property  of  the  lungs  that  the  application  of  what  is  termed  the 
hydrostatic  test,  or  the  docimasia  pulmonaris,  is  founded — a  subject  which 
may  be  appropriately  considered  in  another  chapter. 

Conclusions. — The  general  conclusions  which  may  be  drawn  from  the 
contents  of  this  chapter  are  : — 

1.  That  a  child  may  be  born  alive  and  be  criminally  destroyed  before  it 
has  breathed. 

2.  That  the  presence  of  any  marks  indicative  of  putrefaction  while 
the  child  was  in  the  womb  proves  that  it  must  have  come  into  the  world 
dead. 

3.  That  there  are  no  certain  medical  signs  by  which  a  child  that  has  not 
breathed  can  be  proved  to  have  been  living  when  it  was  maltreated. 

4  That  a  newborn  child  may  be  destroyed  by  the  prevention  of  respira- 
tion during  delivery. 

5.  That  by  taking  together  the  color,  volume,  consistency,  absolute 
"w^eight,  and  buoyancy  of  the  lungs,  and  the  presence  in  them  of  developed 
air-cells,  we  may  be  able  to  draw  an  inference  whether  the  child  has  or  has 
not  breathed. 

6.  That  the  lungs  increase  in  weight  according  to  the  degree  to  which 
respiration  is  established,  and  not  necessarily  according  to  the  period  which 
the  child  has  survived  birth. 

7.  That  no  reliance  can  be  placed  upon  the  test  of  Ploucquet,  or  the 
proportionate  weight  of  the  lungs  to  the  body. 


CHAPTER  XLIX. 

THE    HYDROSTATIC    TEST.— SINKING    OF    THE    LUNGS    FROM   DISEASE    OR-  ATELECTASIS  — LIFE 

WITH    PERFECT    ATELECTASIS    OR  ENTIRE  ABSENCE  OF  AIR    FROM  THE    LUNGS. ERRONEOUS 

MEDICAL     INFERENCE     FROM     SINKING    OF    THE     LUNGS. FLOATING    OF    THE    LONGS    FROM 

PUTREFACTION. EFFECTS  OF  PL'TREFACTION  ON  THE  LUNGS. 

The  Hi/drostatic  Test. — The  mode  of  employing  this  test  is  extremely 
simple.  Having  removed  the  lungs  from  the  chest,  they  should  be  placed, 
still  connected  with  the  air-tubes,  upon  the  surface  of  distilled  or  river 
water.  If  they  sink,  it  should  be  noted  whether  the  sinking  takes  place 
rapidly  or  slowly.  If  they  both  sink,  the  two  lungs  should  be  tried  sepa- 
rately ;  for  it  is  sometimes  found  that  one,  commonly  the  right,  will  float, 
while  the  other  will  sink.  Supposing  that  both  lungs  sink,  they  should 
be  divided  each  into  twelve  or  fifteen  pieces,  and  these  pieces  placed  sepa- 
rately on  water.  If  after  this  they  all  sink,  the  inference  is  that,  although 
the  child  may  have  lived  and  survived  its  birth,  there  is  no  evidence  of  its 


544  SINKING    OF    THE    LUNGS    FROM    DISEASE. 

having  breathed.  On  the  other  hand,  the  organs  when  placed  on  water 
may  float ;  it  should  then  be  noticed  whether  they  float  high  above  the 
surface,  or  at  or  below  the  level  of  the  water ;  sometimes  they  indifferently 
float  or  sink.  These  differences  will  lead  to  a  conclusion  respecting  the 
degree  to  which  respiration  has  taken  place.  It  will  now  be  proper  to 
separate  the  lungs,  and  determine  whether  the  buoyancy  is  due  to  one  or 
both.  Each  lung  should  be  divided  as  before,  and  each  piece  separately 
tried.  If  all  the  pieces  float,  even  aftei'  firm  compression,  we  have  good 
evidence,  cseteris  paribus,  that  respiration  has  been  very  perfectly  per- 
formed. Should  any  of  the  divided  portions  sink  in  water,  either  before 
or  after  compression,  our  opinion  should  be  modified  accordingly.  Some 
have  recommended  that  the  lungs  should  be  placed  on  water  with  the 
heart  and  thymus  gland  attached ;  but  there  appears  to  be  no  good  reason 
for  this,  since  it  is  as  easy  to  form  an  opinion  of  the  degree  of  buoyancy 
possessed  by  the  lungs,  from  the  readiness  with  which  they  float,  as  by 
observing  whether  or  not  they  have  the  power  to  support  these  two 
organs. 

With  regard  to  the  inference  derivable  from  the  use  of  this  test,  it  should 
be  observed  that  the  floating  of  the  lungs  in  water  is  not,  as  it  is  often  in- 
correctly represented  to  be,  a  proof  that  a  child  has  been  born  alive ;  nor 
is  the  fact  of  their  sinking- in  water  any  proof  that  a  child  was  born  dead. 
The  floating,  under  the  limitations  to  be  described,  proves  only  thjit  a 
child  has  breathed  ;  the  sinking,  either  that  it  has  not  breathed  or  breathed 
but  imperfectly.  The  fact  of  a  child  having  been  bo7^n  living  or  dead  has, 
strictly  speaking,  no  relation  to  the  employment  of  the  h3^drostatic  test. 
There  are  cases  of  infanticide  which  may  be  readily  established  without 
resorting  to  this  test,  and  others  which  cannot  be  proved  by  its  use  ;  all 
that  the  law  requires  is  proof  that  a  child  has  been  born  living,  and 
whether  this  proof  be  furnished  by  the  state  of  the  lungs  through  the 
hydrostatic  test,  or  in  any  other  manner,  is  of  no  moment.  The  signs  of 
life  are  commonly  sought  for  in  the  lungs,  because  it  is  in  these  organs 
that  the  changes  produced  by  a  new  state  of  existence  are  most  distinctly 
perceived;  but  this  examination  may  be  dispensed  with  when  the  woman 
confesses  that  the  child  was  born  alive,  when  others  have  seen  it  manifest 
life  by  motion  or  other\Yise  after  its  birth,  or,  lastly,  in  cases  where,  with- 
out being  seen,  it  has  been  heard  to  cry.  The  crying  of  a  child  has 
been  admitted  as  evidence  of  live  birth  on  several  trials  for  infanticide; 
although,  as  it  is  elsewhere  stated,  a  child  may  utter  a  cry  and  die  befoi'e 
its  body  is  entirely  born.  Among  the  objections  which  have  been  urged 
to  the  employment  of  the  hydrostatic  test,  we  have  first  to  consider  those 
which  conc'ern  the  sinking  of  the  lungs  in  water. 

Sinking  of  the  Lungs  from  Disease,  or  Atelectasis. — It  is  said  that  the 
hydrostatic  test  cannot  show  whether  a  child  has  or  has  not  survived  its 
birth,  because  the  lungs  of  children  that  have  lived  for  a  considerable 
period  have  been  observed  to  sink  entirely  in  water.  In  some  instances 
this  may  depend  on  disease,  tending  to  consolidate  the  air-cells,  as  hepa- 
tization or  scir7^h\is;  in  others,  on  oedema  or  congestion  ;  but  these  cases 
can  create  no  difficulty,  since  the  cause  of  the  lungs  sinking  in  water  would 
be  at  once  obvious  on  examination.  The  hepatized  portion  of  lung  may 
be  known  by  the  firmness  with  which  it  resists  cutting  with  a  knife,  as 
also  by  the  fact  that  it  is  impossible  to  distend  it  artificially  with  air.  On 
the  other  hand,  there  are  cases  in  which  the  lungs  appear  healthy  and  un- 
affected— all  that  we  can  perceive  is  that  they  retain  their  foetal  condition. 
This  is  a  very  different  state  from  that  of  hepatization,  because  the  lungs,  in 
this  unexpanded  condition,  may  be  made  to  receive  air  by  artificial  inflation. 


ATELECTASIS.  545 

It  is  remarkable  that  life  should  continue  for  many  hours,  and  sometimes 
even  for  days,  under  such  a  condition  ;  but  the  occasional  existence  of  this 
state  of  the  lungs  in  a  living  child  is  placed  beyond  all  dispute;  the  ex- 
planation of  the  causes  upon  which  it  depends — how  it  is  that  a  child  may 
live  for  hours  or  days,  and  no  signs  of  respiration  be  discovered  in  its 
body  after  death — is,  however,  involved  in  difficulty.  The  lungs  appear 
to  be  simply  unexpanded,  or  to  retain  their  foetal  condition  ;  a  state  to 
which  the  name  of  atelectasis  has  been  given.  This  condition  may  be 
found  to  affect  the  whole  or  a  part  of  the  organs.  Albert  met  with  a  case 
in  which  a  child  died  thirty-six  hours  after  its  birth,  having  been  attacked 
by  convulsions  at  intervals  during  that  time.  On  inspection,  the  whole 
of  the  right,  and  the  lower  portion  of  the  left  lung,  were  found  to  be  in 
their  foetal  condition,  and  they  immediately  sank  when  immersed  in 
water.  There  was  no  diseased  appearance  in  the  organs,  and  the  undis- 
tended  portions  were  easily  filled  by  blowing  air  into  them.  (Hencke's 
Zeitschrift,  183T,  2,  p.  422.)  Ddpaul  found  in  many  cases  in  which 
children  had  died  suddenly  after  breathing  for  several  hours  or  days,  that 
the  only  unusual  appearance  in  the  body  was  an  unexpanded  condition  of  a 
large  portion  of  the  lungs.     (Lond.  Med.  Gaz.,  vol.  xxxix.  p.  283.) 

It  is  necessary  for  a  medical  jurist  to  be  aware  that  the  state  of  the 
lungs  which  is  here  called  atelectasis  is  by  no  means  unfrequent  among 
newborn  children.  When  no  portion  of  air  is  found  in  the  lungs  of  a 
child,  there  is  no  test  by  which  such  a  case  can  be  distinguished  from  one 
in  which  the  child  has  come  into  the  world  dead.  These  cases  of  atelec- 
tasis are  ordinarily  set  down  as  exceptions  to  a  general  rule  ;  but  they  are 
more  common  than  some  medical  jurists  are  inclined  to  admit.  In  ex- 
amining the  body  of  a  child  the  history  of  which  is  unknown,  it  is  proper 
that  the  possible  occurrence  of  such  cases  should  be  well  borne  in  mind.  It 
appears  not  improbable  that  many  such  come  yearly  before  coroners  in  this 
country  and  that  they  are  dismissed  as  stillborn  children,  notwithstanding 
that  marks  of  violence  are  often  found  upon  the  bodies.  If,  as  it  has 
been  already  observed,  the  lungs  sink  in  water,  this  fact  alone  is  com- 
monly, although  improperly,  regarded  as  sufficient  evidence  of  stillbirth. 
This  is  assuredly  putting  the  most  humane  interpretation  on  the  circum- 
stances, and,  so  far,  the  result  is  not  to  be  objected  to  ;  but  we  should  take 
care,  in  carrying  out  this  principle,  that  we  do  not  throw  obstacles  in  the 
way  of  a  subsequent  judicial  inquiry  and  lead  to  the  concealment  of 
crime.  Bernt  met  with  an  instance  in  which  a  seven  months'  child  died 
two  hours  after  birth;  and  when  its  lungs  were  divided  and  placed  in 
water  every  portion  sank.  Remer  has  reported  another,  in  which  the 
lungs  sank  in  water,  both  entire  as  well  as  when  divided,  although  the 
child  had  survived  its  birth  at  least  four  days.  (Henke,  Lehrb.  der 
Oerichtl.  Med.,  p.  374.)  In  this  case  the  navel-string  had  separated 
naturally  before  death.  Orfila  found  in  a  child  which  had  lived  eleven 
hours  every  portion  of  the  lungs,  when  divided,  sink  on  immersion.  In 
three  other  instances  in  which  the  children  survived  birth  four,  six,  and 
ten  hours,  the  lungs  also  sank  when  divided;  two  of  these  were  mature. 
(Med.  Ldg.,  vol.  1,  p.  375.)  Other  cases  of  a  similar  kind  are  reported 
by  more  recent  writers.     (Ann.  d'Hyg.,  1878,  t.  2,  p.  489.) 

Yernon  attended  a  healthy  woman,  who  was  delivered  of  a  female  child 
at  about  the  sixth  month  of  her  pregnancy.  The  child  was  born  before 
his  arrival  and  he  heard  it  crying  strongly  from  under  the  bedclothes  as 
he  entered  the  room.  After  removal  from  the  mother,  the  child  cried  at 
intervals,  and  it  was  observed  that  its  chest  rose  and  fell  as  in  ordinary 
breathing.  It  lived  five  hours  and  it  then  appeared  to  die  from  feebleness 
35 


546  SINKING    OF    THE    LUNGS    IN    WATER. 

and  exhaustion.  It  was  very  small,  weighing  2  lb.  13  oz.,  and  its  length  was 
12|  inches;  the  eyelids  were  adherent.  The  lungs  were  of  a  purplish-red 
color  and  slightl}'  overlapped  the  bag  of  the  heart ;  they  sank  in  water, 
both  entire  and  when  divided  into  small  pieces,  were  not  crepitant,  and 
broke  down  under  tirm  compression.  There  was  no  appearance  of  air-cells 
in  a  section  of  the  lungs  when  examined  with  the  microscope.  The  ductus 
arteriosus  and  foramen  ovale  were  in  their  foetal  state.  (Lancet,  1855,  i. 
p.  121.)  A  more  remarkable  case  occurred  to  Bonders.  (Rep.  by  Moore, 
Dub.  Med.  Press,  Nov.  22,  1865,  p.  456.)  The  body  of  the  child  was 
sixteen  inches  in  length  and  weighed  nearly  five  pounds.  It  was  probably 
a  seven  months'  child.  The  lungs  were  of  a  brown  color,  and  sank  in 
water,  entire  and  when  divided.  There  was  no  crepitation,  and  on  pres- 
sure only  a  reddish  fluid  without  air  escaped.  The  bladder  was  empty  ; 
there  was  no  food  in  the  stomach,  but  there  was  meconium  in  the  larger 
intestine.  From  this  state  of  facts.  Bonders  concluded  that  the  child  was 
immature,  stillborn,  onl\^  a  short  time  dead,  and  remaining  in  the  womb 
only  a  short  time  after  death.  It  transpired,  however,  that  the  child  had 
been  born  alive,  had  survived  its  birth  twelve  hours,  and  had  cried  dis- 
tinctly after  it  was  born.  As  the  lungs  could  be  readily  inflated  and  as 
the  child  had  cried,  he  concluded  that  air  had  been  received  into  the  lungs, 
and  had  been  again  slowly  expelled,  the  child  dying  in  a  kind  of  asphyx- 
iated state. 

Schworer  delivered  a  woman  in  the  hospital.  The  child  did  not  breathe 
when  born,  but  showed  some  signs  of  life.  Thus  the  pulsations  of  the 
heart  and  navel-string  were  perceptible.  These  gradually  ceased  and  no 
efi'ort  could  restore  the  child.  On  inspection,  the  lungs  were  found  to 
contain  no  air;  there  was  no  crepitation  when  the  substance  of  the  lungs 
was  cut  and  they  sank  in  water,  not  only  in  the  entire  state,  but  Avhen 
divided  into  numerous  pieces.  Poncet  met  with  the  lungs  of  a  foetus  pre- 
maturely born  at  the  Hotel  Bieu.  The  child  had  cried,  breathed,  and 
lived  an  extra-uterine  life  for  ten  hours,  but  the  lungs  sank  completely  in 
water  as  if  no  respiration  had  taken  place.  (Lancet,  1812,  i.  227.)  The 
author  may  add  to  these  instances  two  which  occurred  under  his  own 
observation.  In  one,  the  case  of  a  mature  male  child,  the  lungs  sank  in 
water,  although  the  child  had  survived  birth  for  a  period  of  six  hours.  In 
the  other,  a  case  of  a  female  twin,  the  child  survived  twenty-four  hours; 
and  alter  death  the  lungs  were  divided  into  thirty  pieces,  but  not  a  single 
piece  floated,  showing  therefore  that,  although  life  had  been  thus  protracted, 
not  one-thirtieth  part  of  the  structure  of  the  lungs  had  received,  by  respi- 
ration, sufficient  air  to  render  it  buoyant.  (Guy's  Hosp.  Rep.,  1837,  ii. 
pp.  346,  355.)  In  the  latter  instance  no  particular  remark  was  made 
during  life  respecting  the  breathing  of  the  child. 

These  cases  show  clearly  that  buoyancy  of  the  lungs  is  not  a  necessary 
consequence  of  a  child  having  lived  and  breathed  for  sometime  after  birth. 
Probably,  had  they  called  for  medico-legal  inquiry,  the  lungs  would  have 
been  cut  to  pieces;  the  sinking  of  the  divided  pieces  in  water,  either 
before  or  after  compression,  would  have  been  set  down  as  negativing 
the  act  of  respiration,  and,  unless  other  strong  evidence  had  been  forth- 
coming, it  would  have  been  asserted  that  the  children  had  been  born  dead. 
Here,  again,  we  perceive  the  necessity  of  not  hastily  assuming  that  a  child 
has  been  born  dead  because  its  lungs  sivk  in  water.  There  may  be  no 
good  medical  evidence  of  such  a  child  having  lived  after  birth,  but  as- 
suredly the  mere  sinking  of  these  organs  does  not  warrant  the  common 
and  positive  dictum  that  the  child  was  necessarily  dead  when  born. 

It  must  be  apparent,  on  reflection,  that  cases  of  this  description  are 


SINKING    OF    THE    LUNGS.  5i7 

beyond  the  reach  of  the  hydrostatic  as  well  as  of  all  other  tests  applied  to 
the  respiratory  organs  ;  because  the  lungs  do  not  receive  and  retain  a  suffi- 
cient quantity  of  air  to  give  buoyancy  after  death,  although  the  children 
may  have  lived  some  hours.  The  hydrostatic  test  is  no  more  capable  of 
showing  that  such  children  as  these  have  lived,  than  it  is  of  indicating 
fi'om  what  cause  they  have  died.  Facts  of  this  kind  demonstrate  that  a 
passive  existence  may  be  for  some  time  maintained  under  a  state  of  respi- 
ratory process  not  to  be  discovered  after  death.  In  the  opinion  of  some, 
these  cases  form  a  serious  objection  to  the  hydrostatic  test ;  but  it  is 
difficult  to  understand  how  they  can  affect  its  general  application,  or 
why,  because  signs  of  respiration  do  not  always  exist  in  the  lungs  of 
children  that  have  lived,  we  are  not  to  rely  upon  them  when  they  are 
actually  found.  These  exceptional  instances  prove  that  we  are  greatly  in 
want  of  some  fact  to  indicate  life  after  birth  when  the  signs  of  respiration 
are  absent.  Until  we  discover  this  we  must,  of  course,  make  the  best  use 
of  that  knowledge  which  lies  at  our  disposal;  taking  care  to  apply  it  to 
those  cases  alone  to  which  experience  shows  it  to  be  safely  adapted. 

It  has  been  recommended  that  medical  jurists  should  consider  as  dead 
every  child  that  has  not  breathed,  i.  e.  whose  lungs  sink  in  loater  ;  but 
they  who  give  this  advice  at  the  same  time  admit  that  children  may 
come  into  the  world  living  without  breathing,  and  the  law  holds,  under 
the  decision  of  its  expounders,  that  respiration  is  only  one  and  not  an  ex- 
clusive proof  of  life.  In  order  to  establish  life  or  even  live  birth,  respir- 
.ation  need  not  always  be  proved,  either  in  civil  or  criminal  cases  (p.  537.) 
A  medical  jurist  would,  therefore,  be  no  more  justified  in  asserting  that 
all  such  children  were  necessarily  born  dead,  than  that  they  were  born 
living ;  and  in  stating  what  is  plain  and  obvious  it  is  not  possible  that 
this  statement  can  ever  be  the  means  of  involving  an  innocent  person.  It 
is  certain,  however,  in  stating  what  is  contrary  to  well-known  facts,  that, 
when  the  lungs  of  a  child  sink  in  water,  it  is  safe  and  just  to  consider 
such  child  as  having  been  born  dead,  he  is  incurring  the  risk  of  exculpat- 
ing a  really  guilty  person  ;  for  it  cannot  be  too  strongly  borne  in  mind 
that  a  woman  is  not  charged  with  murder  merely  because  the  lungs  of 
her  child  float  in  water,  but  because  there  are  upon  its  body  marks  of  vio- 
lent injuries  apparently  sufficient  to  account  for  its  death,  or  there  are 
strong  moral  presumptions  of  her  guilt.  (See  Ann.  d'Hyg.,  1836,  t.  2,  p. 
362.)  But  there  is  another  aspect  in  which  this  question  should  be 
viewed.  There  may  be  no  marks  of  murderous  violence  on  the  body  of 
the  child,  nor  any  proofs  of  ill-treatment,  yet  a  child  born  under  these 
circumstances  may  have  died  through  the  culpable  neglect  or  reckless 
indifference  of  the  woman.  Moore,  in  reporting  two  cases  of  atelectasis, 
in  one  of  which  a  child  had  survived  its  birth  twelve  hours,  remarks  that 
when  such  a  child  is  deserted  or  exposed,  without  the  necessary  attention 
required  for  its  helpless  state,  the  conditions  are  precisely  fulfilled  to  cause 
its  death  within  a  few  hours  under  a  diminution  of  temperature  and  a  total 
expulsion  of  air  from  the  lungs.  He  has  no  doubt  that  many  a  child  so 
found,  which  had  met  with  its  death  through  want  of  care,  is  looked  upon 
as  not  having  lived.  (Med.  Press,  1865,  p.  458.)  It  will  be  seen  here- 
after that  some  of  our  judges  have  given  a  strong  exposition  of  the  law, 
so  as  to  bring  cases  of  this  description  within  the  crime  of  manslaughter. 

Floating  of  the  Lungs  from  other  causes  than  Respiration. — Another 
series  of  objections  have  been  urged  to  the  h3^drostatic  test,  based  on  the 
fact  that  the  lungs  may  receive  air  and  acquire  buoyancy  from  other 
causes  than  respiration.  These  causes  are  two — putrefaction  and  artificial 
inflation. 


548  PUTREFACTION. 

Putrefaction. — The  lungs  of  a  stillborn  child,  when  allowed  to  remain 
in  the  chest,  are  slow  in  undergoing  putrefaction  ;  but,  nevertheless,  they 
sooner  or  later  acquire  sufficient  air  to  render  them  buoyant  in  water. 
When  the  lungs  are  putrefied  this  will  be  determined,  in  general,  by 
putrefaction  having  extended  throughout  all  the  soft  parts  of  the  body. 
The  organs,  according  to  the  degree  of  putrefaction,  will  be  found  soft,  of 
a  dark-green  or  brown  color,  and  of  a  highly  offensive  odor ;  and  the 
serous  membrane  covering  the  surface  will  be  raised  in  large  visible  vesi- 
cles, from  which  the  air  may  be  forced  out  by  very  moderate  compression. 
It  has  been  remarked  that,  under  the  same  conditions,  gaseous  putrefac- 
tion takes  place  as  rapidly  in  the  liver,  heart,  and  thymus  gland  of  a  new- 
born child,  as  in  the  lungs  ;  we  should,  therefore,  notice  the  general  state 
of  the  body.  The  distention  of  the  lungs  with  gases  from  putreiaction 
cannot  be  easily  overlooked  or  mistaken  for  the  air  of  respiration.  The 
answer  to  any  objection  founded  on  the  putrefied  state  of  these  organs 
must  at  once  suggest  itself.  It  is  impossible  that  any  well-informed  med- 
ical witness  can  expect  to  obtain  satisfactory  evidence  from  experiments 
on  lungs  in  such  a  condition.  He  should  abandon  the  case,  and  declare 
that,  in  regard  to  the  question  of  respiration,  medical  evidence  cannot 
establish  either  the  affirmative  or  the  negative.  The  fact  of  his  not  being 
able  to  give  the  evidence  required  cannot  be  imputed  as  a  matter  of  blame 
to  him,  or  ascribed  to  any  deficiencies  in  the  hydrostatic  test,  but  is  due 
to  purely  exceptional  circumstances. 

In  a  case  reported  by  Henke,  the  lungs  and  other  organs  in  the  body  of 
a  child  were  found  in  an  advanced  state  of  putrefaction.  A  medical  wit- 
ness gave  an  opinion  that  the  child  was  born  dead,  but  the  prisoner  after- 
wards confessed  that  it  has  been  born  living.  The  medical  opinion  could 
have  been  no  more  than  a  conjecture,  the  condition  of  the  body  not  allow- 
ing any  correct  conclusion  to  be  drawn.  This  fact  shows  that  it  is  always 
better  to  leave  a  doubtful  case  as  we  find  it  than  to  express  a  positive 
opinion  that  the  child  has  been  born  either  living  or  dead.  If  on  these 
occasions  a  witness  were  simply  to  assure  a  jury  that  medical  evidence 
could  not  solve  the  question  whether  the  child  had  lived  or  not — if  he 
were  to  assert,  what  is  really  the  fact,  that  his  experiments  would  not 
allow  him  to  say  whether  the  child  had  or  had  not  breathed — it  is  certain 
that  no  innocent  person  would  ever  be  convicted  or  a  guilty  person  ac- 
quitted upon  his  evidence.  It  is  his  duty  to  state  that  doubt,  and  leave 
the  decision  of  guilt  or  innocence  in  the  hands  of  the  court. 

Conclusions. — The  general  conclusions  which  may  be  drawn  respecting 
the  application  of  the  hydrostatic  test  in  cases  of  infanticide  are  the  fol- 
lowing : — 

1.  That  the  hydrostatic  test  can  show  M'hether  a  child  has  or  has  not 
breathed,  but  does  not  enable  us  to  determine  whether  a  child  has  been 
born  living  or  dead. 

2.  That  the  lungs  of  children  that  have  lived  after  birth  may  sink  in 
water,  owing  to  their  not  having  received  air,  or  to  their  being  in  a  dis- 
eased condition. 

3.  That  a  child  may  live  for  some  time  when  only  a  small  portion  of  the 
lungs  has  been  penetrated  by  air. 

4.  That  a  child  may  survive  birth  even  for  twenty-four  hours,  when  no 
part  of  its  lungs  has  been  apparently  penetrated  by  air. 

5.  Hence  the  sinking  of  the  lungs  (whether  whole  or  divided)  in  water 
is  not  a  proof  that  a  child  has  been  born  dead. 

6.  That  the  lungs  of  children  which  have  not  breathed  and  have  been 
born  dead,  may  float  on  water  from  putrefaction. 


ARTIFICIAL    INFLATION    OF    THE    LUNGS.  549 

7.  That  the  lungs,  as  situated  in  the  chest,  undergo  putrefaction  very 
slowly  ;  that  if  but  slightly  putrefied,  the  gases  may  be  easily  forced  out 
by  compression,  and  if  much  putrefied,  either  the  case  must  be  abandoned 
or  other  sources  of  evidence  sought  for. 


CHAPTER   L. 

FLOATING    OF    THE    LUNGS    FROM    ARTIFICIAL    INFLATION. INFLATION    NOT    DISTINGUISHABLE 

FROM  IMPERFECT    RESPIRATION. RESULTS    OP    COMPRESSION.  —  IMPROPER    OBJECTIONS    TO 

THE    HYDROSTATIC    TEST. RESPIRATION    BEFORE    BIRTH. RESPIRATION    A  SIGN    OF    LIFE, 

NOT    OF    LIVE    BIRTH. GENERAL    CONCLUSIONS. 

Artificial  Inflation. — It  has  been  alleged  that  the  lungs  of  a  stillborn 
child  may  be  made  to  assume,  by  artificial  inflation,  i.  e.  by  blowing  air 
into  them,  all  the  characters  assigned  to  those  which  have  undergone 
respiration.  Thus,  it  is  said,  a  child  may  not  have  breathed,  and  yet  the 
application  of  the  hydrostatic  test  would  in  such  a  case  lead  to  the  infer- 
ence that  it  had.  It  will  be  seen  that  the  force  of  this  objection  goes  to 
attack  directly  the  inference  derivable  from  the  discovery  of  air  in  the 
lungs.  There  is  only  one  form  under  which  this  can  be  admitted  as  an 
objection,  namely,  as  it  applies  to  lungs  which  have  been  inflated  while 
lying  in  the  cavity  of  the  chest.  Any  experiments  performed  on  them 
after  their  removal  from  this  cavity  can  have  no  practical  bearing,  since  in 
a  case  of  infanticide  we  have  to  consider  only  the  degree  to  which  the 
lungs  may  be  distended  with  air  by  a  person  w^ho  is  fairly  endeavoring  to 
resuscitate  a  stillborn  child.  Assuming  that  the  experiment  has  been 
successfully  performed,  and  that  the  lungs  have  been  artificially  inflated, 
they  would  resemble,  in  their  partial  distention  with  air  and  other  physical 
characters,  those  of  children  which  had  breathed  imperfectly.  Like  them, 
they  may  float  on  water ;  but  on  cutting  them  into  pieces  some  of  these 
would  be  found  to  sink.  If  the  pieces  which  float  are  firmly  compressed, 
either  by  means  of  a  folded  cloth  or  between  the  fingers,  they  will  lose  air 
and  sink.  When  this  pressure  is  produced  under  water,  it  will  be  seen 
that  bubbles  of  air  escape,  but  mere  pressure  wnth  the  fingers  will  not  in 
general  suffice  to  expel  the  whole.  The  same  result  is  obtained  when  the 
divided  portions  of  lungs  which  have  breathed  imperfectly  are  submitted 
to  pressure.  If,  however,  the  act  of  breathing  has  been  perfectly  per- 
formed, and  the  air-cells  are  well  filled,  the  air  cannot  be  expelled  by 
pressure  or  by  any  force  short  of  the  destruction  of  the  substance  of  the 
lungs.  This  dilference  in  the  effect  of  pressure  has  been  hitherto  regarded 
as  a  criterion  to  distinguish  lungs  that  have  fully  breathed  from  those 
which  have  been  simply  inflated ;  but  Braxton  Hicks  met  with  a  case 
which  show^s  that  pressure  will  not  always  effect  the  expulsion  of  air  arti- 
ficially introduced  into  the  lungs  of  a  child  born  dead  ;  hence,  by  an 
exclusive  reliance  on  this  method,  a  medical-  man  might  be  led  to  infer 
that  a  lung  artificially  inflated  had  received  air  by  respiration.  He  deliv- 
ered a  woman  of  a  full-grown  child;  it  was  stillborn,  and  there  was  no 
eff"ort  at  respiration.  An  attempt  was  made  to  resuscitate  the  child,  but 
unsuccessfully,  by  blowing  air  into  the  lungs  through  a  catheter.  On 
inspection  the  lungs  were  observed  to  be  of  large  size,  but  they  did  not 


650  EVIDENCE    FROM    THE    HYDROSTATIC    TEST. 

present  the  usual  appearance  of  lungs  which  had  breathed.  Although 
about  three-fourths  of  the  organs  had  received  air  by  inflation,  and  they 
Avcre  of  a  pale-fawn  color,  like  the  thymus  gland,  still,  the  air  was  con- 
tained in  the  minute  air-cells.  They  floated  on  water  as  well  as  all  the 
pieces  (fifteen  or  sixteen)  into  which  they  were  divided.  When  compressed 
between  the  fingers  under  water,  small  bubbles  of  air  escaped  ;  but  no 
amount  of  compression  short  of  destroying  their  structure  caused  these 
pieces  to  sink.  A  fact  of  this  kind,  although  perhaps  exceptional,  shows 
that  the  non-expulsion  of  air  from  lungs  by  compression  must  not  be 
regarded  as  an  absolute  proof  of  respiration.  It  must  be  taken  with  other 
circumstances,  e.  g.  absolute  weight,  color,  and  presence  of  developed  air- 
cells,  as  a  fact  to  show  that  the  child  has  either  breathed  or  has  had  its 
lungs  perfectly  inflated  in  a  bona  fide  attempt  to  restore  life  after  birth, 
either  by  the  mother  or  by  some  person  present  at  the  birth.  In  these 
cases,  the  only  course  left  open  to  a  medical  witness  is  to  state  that  the 
evidence  derived  from  experiments  on  the  lungs  left  it  uncertain  whether 
the  child  in  question  had  breathed  or  had  had  its  lungs  artificially  in- 
flated. 

In  concluding  these  remarks  upon  the  objections  to  the  hydrostatic  test, 
it  may  be  observed  that  medical  practitioners  have  differed  much  at  dif- 
ferent times  in  their  ideas  of  what  it  was  fitted  to  prove.  At  the  begin- 
ning of  the  present  century,  it  would  seem  that  the  test  was  regarded  by 
some  as  capable  of  furnishing  evidence  of  murder.  Thus  we  find  W. 
Hunter  asking  the  question,  "How  far  may  we  conclude  that  the  child 
was  born  alive,  avd  prohahly  murdered  hy  its  mother,  if  the  lungs  swim 
in  water?"  From  what  has  already  been  stated,  as  well  as  from  the 
most  simple  reflection  on  the  circumstances  accompanying  the  birth  of  a 
child,  it  must  be  evident  that  the  hydrostatic  test  is  no  more  capable  of 
showing  whether  a  child  has  been  horn  alive  or  dead  than  it  is  of  proving 
whether  it  has  been  murdered  or  has  died  from  natural  causes.  The  test 
merely  serves  to  furnish  in  many  cases  good  proof  of  life  from  the  state 
of  the  lungs ;  and  slight  reflection  will  render  it  apparent  that  in  no  case 
is  it  susceptible  of  doing  more.  Even  their  utility  is  much  restricted  by 
numerous  counteracting  circumstances,  a  knowledge  of  which  is  essential 
to  him  who  wishes  to  make  a  practical  application  of  them. 

If  asked  to  state  in  what  cases  the  pulmonary  tests  are  capable  of  assist- 
ing a  medical  jurist,  the  answer  would  be:  First,  they  will  clearly  show 
that  a  newborn  child  has  lived,  when,  during  its  life,  it  has  fully  and  per- 
fectly breathed.  Cases  of  this  description  form  a  certain  number  of  those 
which  come  before  our  courts  of  assize.  To  them  the  most  serious  ob- 
jections are  not  applicable ;  and  the  few  which  might  be  made  to  the  med- 
ical inferences  are  not  difficult  to  answer.  Second,  they  will  allow  a 
witness  to  sa}^  that  the  lungs  must  have  received  air,  either  by  respira- 
tion or  by  artificial  inflation.  These  are  the  cases  in  which  a  child  has 
died  soon  after  birth,  and  where  the  respiratory  changes  are  but  imper- 
fectly manifested  in  the  lungs.  They  probably  form  a  large  proportion  of 
those  which  fall  under  the  jurisdiction  of  the  criminal  law.  It  might  be 
considered  that  the  qualification  in  the  inference  here  drawn  would  neutral- 
ize its  force ;  but  it  must  be  remembered  that  there  are  few  instances  of 
actual  and  deliberate  child-murder  wherein  artificial  inflation  could  become 
even  a  possible  defence  for  an  accused  person.  So  unusual  is  this  kind  of 
defence,  that  among  the  numerous  trials  for  infanticide  which  have  taken 
plnce  in  this  country  for  many  years  past,  we  have  not  been  able  to  meet 
with  a  single  instance  in  which  it  was  alleged,  as  an  objection  to  the  med- 
ical evidence  derived  from  the  buoyancy  of  the  lungs,  that  the  prisoner 


RESPIRATION    BEFORE    BIRTH.  551 

had  inflated  thera  in  order  to  resuscitate  her  child.  The  reason  is  obvious  : 
Had  such  a  defence  been  attempted,  the  whole  of  the  circumstantial  evi- 
dence would  at  once  have  set  it  aside.  When,  in  the  suspected  murder  of 
an  adult,  a  medical  man  swears  that  a  fatal  wound  was  such  that  the  de- 
ceased mig-ht  have  inflicted  it  on  himself,  or  that  the  prisoner  might  have 
produced  it,  he  is  placing  the  jury  in  a  position  very  similar  to  that  in 
which  he  places  them  in  a  case  of  child-murder,  when  he  says  that  the 
child  might  have  breathed,  or  its  lungs  might  have  been  artificially  in- 
flated. It  is  not  for  him  to  speculate  on  the  probabilities  of  respiration  or 
of  artificial  inflation  ;  but  it  is  for  the  jury  to  consider  whether  the  accused 
was  or  was  not  likely,  under  the  particular  circumstances  of  the  case,  to 
have  resorted  to  an  experiment  of  this  nature.  It  has  been  suggested  that 
some  person  might  inflate  the  lungs  of  a  dead  child  .in  order  to  raise  a 
charge  of  murder  against  its  mother  ;  but  this  suggestion  presupposes,  on 
the  part  of  the  criminal,  a  profound  knowledge  of  the  difficulties  of  medical 
jurisprudence;  and  even  then  the  question  of  murder  does  not  depend 
merely  on  the  presence  of  air  in  the  lungs.  Such  a  case  is  very  unlikely 
to  present  itself.  The  circumstances  of  the  case  will  commonly  furnish  a 
sufficient  answer  to  such  hypothetical  views. 

The  hydrostatic  test  ought  not,  therefore,  to  be  lightly  condemned  or 
rejected  upon  a  speculative  objection,  which,  in  nine-tenths  of  the  cases  of 
child-murder,  could  not  possibly  exist.  Let  it  be  granted  to  the  fullest 
extent  that  a  conscientious  medical  jurist  cannot  always  draw  a  positive 
distinction  between  the  effects  of  respiration  and  artificial  inflation  on  the 
lungs;  still,  a  jury  may  be  in  a  situation  to  relieve  him  from  this  diffi- 
culty. 

We  know  of  only  one  instance  in  which  a  medical  man  declined  to  make 
an  inspection  of  the  body  of  a  newborn  child  for  the  purpose  of  examining 
the  state  of  the  lungs.  (Reg.  v.  Pitt,  Dorset  Sum.  Ass.,  1859.)  The  body 
was  found  much  mutilated  and  with  such  injuries  as  would  fullv  have 
accounted  for  the  death  of  the  child,  assuming  it  to  have  been  born  alive. 
At  the  inquest  the  coroner  suggested  that  a  post-mortem  examination 
should  be  made ;  but  the  chief  medical  witness  declined  to  make  it,  as  he 
did  not  consider  it  to  be  necessary.  He  was  then  asked  bv  the  coroner 
whether  the  floating  of  the  lungs  would  indicate  that  the  child  had  breathed, 
to  which  he  replied  that  that  theory  was  now  exploded.  It  seems  that 
the  death  of  the  child  was  so  recent  that  when  the  body  was  found  it  was 
quite  warm.  It  also  became  rigid  in  the  usual  time.  The  medical  wit- 
ness relied  upon  warmth  and  rigidity  in  the  body  as  proofs  of  the  child's 
having  been  born  alive,  when  it  is  obvious  that  these  conditions  can  prove 
only  that  the  child  has  been  recently  living.  The  neglect  to  examine  the 
body  led  to  an  acquittal.  There  was  no  proof  of  life  as  the  result  of 
breathing,  and  no  evidence  to  show  whether  the  injuries  were  inflicted  be- 
fore or  after  death. 

Respiration  before  or  during  Birth. — It  has  been  already  stated  that 
the  pulmonary  tests  are  fitted  to  prove  whether  a  child  has  or  has  not 
lived  to  breathe.  Neither  the  hydrostatic  nor  any  other  test  can  posi- 
tively show  that  the  body  of  a  child  was  entirely  born  alive  when  the  act 
of  breathing  was  performed.  As  this  is  a  subject  that  generallv  gives 
rise  to  some  discussion  in  cases  of  child-murder,  a  few  remarks  are  here 
made  on  it.  First,  respiration  may  be  performed  while  the  child  is  in  the 
womb,  after  the  rupture  of  the  membranes — the  mouth  of  the  child  being 
at  the  OS  uteri.  This  is  what  is  termed  vogitus:  vterinus;  its  occurrence, 
although  extremely  rare,  rests  upon  undisputed  authority.  Second,  a 
child  may  breathe  while  its  head  is  in  the  vagina,  either  during  a  presen- 


552  RESPIRATION    A    SIGN    OF    LIFE. 

tation  of  the  bead  or  of  the  breech.  This  has  been  termed  vagitus  vagi. 
77alis.  It  is  not  very  common,  but  it  is  a  possible  occurrence.  Third,  a 
child  may  breathe  while  its  head  is  protruding  from  the  outlet ;  in  this 
position  respiration  may  be  as  completeh^  set  up  in  a  few  moments  by  its 
crying  as  we  find  it  in  some  children  that  have  actually  been  born  and 
have  survived  their  birth  for  several  hours.  This  is  the  most  usual  form 
of  respiration  before  birth.  In  the  vagitus  uterinus  or  vaginalis  the  lungs 
receive  but  a  very  small  quantity  of  air ;  in  respiration  after  protrusion  of 
the  head,  the  lungs  may  be  sometimes  found  moderately  well  filled, 
although  never,  perhaps,  possessing  all  the  characteristics  of  those  which 
have  fully  breathed.  The  W'ellknow^n  occurrence  of  respiration  under 
either  of  these  three  conditions  strikingly  displays  the  fallacy  of  making 
this  process  the  certain  boundary  of  extra-uterine  life.  A  child  may 
breathe  in  the  w^omb  or  vagina,  or  with  its  head  at  the  outlet,  and  die  be- 
fore its  body  is  born  ;  the  discovery  of  its  having  respired  w  ould  not, 
therefore,  be  any  sort  of  proof  of  its  having  enjoyed  what  has  been  termed 
"  extra-uterine  life."  (For  a  well-marked  case  of  this  kind  see  Lond.  Med. 
Gaz.,  vol.  xxxviii.  p.  394;  and  another  in  Guy's  Hosp.  Eep.,  1850,  p. 
231.)  The  death  of  a  child  which  has  breathed  in  the  womb,  or  vagina, 
from  natural  causes  before  its  entire  birth,  is  a  possible  occurrence ;  but 
its  death  from  natural  causes  before  birth,  after  it  has  breathed  by  the 
protrusion  of  its  head  from  the  outlet,  is  an  unusual  event.  All  that  we 
can  say  is — it  may  take  place;  but  death  under  these  circumstances  would 
be  the  exception  to  a  very  general  rule.  Oberkamp  states  that,  in  four 
successive  deliveries  of  the  same  woman,  the  children  breathed  during  de- 
livery, but  died  before  they  were  born. 

Eespiration  a  Sign  of  Life,  not  of  Live  Birth.- — The  hydrostatic  test 
is  only  capable  of  determining  that  resrAraiion  has  token  jjlace ;  it  cannot 
show^  whether  this  process  was  established  during  birth  or  aiterwards. 
The  fact  of  a  child  having  the  power  of  breathing  before  it  is  entirely 
born  does  not,  therefore,  constitute  the  smallest  objection  to  its  employ- 
ment, although  upon  this  ground- we  find  the  use  of  it  in  any  case  de- 
nounced by  some  members  of  the  medical  and  legal  professions.  It  is 
obvious  that  most  members  of  the  law^  who  have  treated  this  subject  have 
adopted,  without  sufficient  examination,  the  statements  of  W.  Hunter, 
who  observes:  "A  child  wiir  commonly  breathe  as  soon  as  its  mouth  is 
born  or  protruded  from  its  mother;  and  in  that  case  may  lose  its  life 
before  its  body  be  born,  especially  when  there  happens  to  be  a  consider- 
able interval  between  what  we  may  call  the  birth  of  the  child's  head  and 
the  protusion  of  its  body.  And  if  this  may  happen  where  the  best  assist- 
ance is  at  hand,  it  is  still  more  likely  to  happen  when  there  is  none — that 
is,  where  the  woman  is  delivered  by  herself."  (On  the  Uncertainty  of 
the  Signs  of  Murder  in  the  Case  of  Bastard  Children,  p.  33.)  Hunter 
here  exposes  in  plain  language  the  fallacy  of  trusting  to  the  signs  of  res- 
piration alone  as  evidence  of  a  child  having  been  born  alive.  The  truth 
of  his  remarks  is  in  the  present  day  generally  admitted;  and  if  among 
medical  and  legal  writers  we  find  some  treating  respiration  as  a  certain 
])roof  of  live  birth, ■\t  is  from  their  not  having  sufficiently  considered  the 
])robal)ility  of  a  child  breathing  and  dying  before  its  body  is  entirely 
extruded. 

Althoujrh  the  test  can  prove  no  more  than  that  a  child  has  breathed, 
some  medical  witnesses  in  giving  evidence  in  cases  of  child-murder  have 
fallen  into  the  error  of  assuming  that  the  hydrostatic  test  is  capable  of 
proving  "live  birth."  Medical  jurists  of  repute  have  sanctioned  this 
erroneous  view,  ignoring  the  fact  that  the  child  may  breathe   and  die 


RESPIRATION    A    SIGN    OF    LIFE.  553 

before  the  entire  birth  of  the  body,  while  the  test  cannot  show  whether 
the  act  of  breathing  was  performed  daring  birth  or  afterwards.  Among 
others  Casper  expressed  his  opinion  that  if  we  find  air  in  the  lungs  of  a 
newborn  child,  such  a  child  must  have  been  born  alive.  The  reasoning 
of  Casper  is  as  extraordinary  as  his  conclusion.  He  says:  1.  During  a 
rapid  deliverv  those  conditions  are  wanting  which  lead  to  breathing  in 
utero  or  during  birth.  2.  All  cases  of  secret  delivery  are  rapid,  and  it  is 
in  these  cases  only  that  the  hydrostatic  test  can  be  applied  to  the  lungs; 
hence  the  proof  of  breathing  in  a  secretly  born  child  must  be  regarded  as 
breathing  after  and  not  in  or  during  birth.  (Gerichtl.  Med.)  It  will 
be  seen  that  this  medical  jurist  entirely  ignored  the  facts  pointed  by 
W.  Hunter  more  than  eighty  years  ago,  and  accumulated  by  numerous 
obstetric  authorities  since  that  time.  On  a  trial  for  child-murder,  a 
medical  witness  being  asked  on  what  he  based  his  statement  that  the 
child  had  been  born  alive,  said,  "  The  presence  of  air  in  the  lungs,"  and 
quoted  Casper  as  his  authority.  There  may  be  cases  in  which  the  signs 
of  full  respiration  would  justify  an  opinion  of  live  birth,  but  the  dictum 
of  Casper  is  quite  inadmissible.  The  floating  of  the  lungs  in  water  may 
be  owing  to  air  received  before  or  during  birth,  and  it  cannot  be  admitted 
that  all  cases  of  secret  delivery  are  necessarily  rapid  cases — so  rapid  that 
the  child  has  had  no  time  to  breathe  until  after  entire  birth. 

The  reader  will  find  a  good  summary  of  the  mode  of  applying  the 
hydrostatic  test,  as  well  as  of  the  conclusions  which  may  be  drawn  from 
its  proper  application,  by  Devergie,  in  Ann.  d'Hyg.,  18t2,  t.  2,  p.  169. 
See  also  a  paper  by  Tardieu,  Ann.  d'Hyg.,  1867,  t.  2,  pp.  217  and  365. 

Conclusions. — The  general  conclusions  respecting  the  employment  of 
the  hydrostatic  test,  to  be  drawn  from  the  contents  of  this  chapter,  are — 

1.  That  the  artificial  inflation  of  the  lungs  of  a  child  born  dead  will 
cause  them  to  float  in  water. 

2.  That  lungs  artificially  inflated  while  in  the  chest  resemble  those 
organs  in  which  respiration  has  been  only  imperfectly  established. 

3.  That  in  cases  of  inflation  of  the  lungs  in  the  chest  the  air  may  be 
generally  expelled  from  the  divided  portions  of  lung  by  firm  compression 
so  as  to  cause  them  to  sink. 

4  That  the  same  result  occurs  with  lungs  in  which  respiration  has  been 
imperfectly  established. 

5.  That  when  lungs  have  undergone  perfect  respiration  the  air  cannot 
be  expelled  by  compression  of  the  divided  parts  so  as  to  cause  them  to 
sink. 

6.  That  the  artificial  inflation  of  foetal  lungs  causes  no  alteration  of 
weight,  and  as  the  weight  increases  in  proportion  to  the  degree  of  respi- 
ration, so  in  healthy  lungs  with  great  buoyancy,  there  should  be  great 
weight  if  the  air  has  been  derived  from  respiration. 

7.  That  we  should  base  our  judgment  of  a  child  having  breathed  upon 
great  weight  and  great  buoyancy  of  the  lungs  combined  ;  that  the  one 
condition  without  the  other  is  open  to  the  objection  that  the  air  may  not 
have  been  derived  from  respiration. 

8.  That  the  floating  of  the  lungs  in  water  proves,  cseteris  paribus,  that 
a  child  has  breathed  either  at,  during,  or  after  birth  ;  it  does  not  prove 
that  a  child  was  born  alive  or  that  it  has  died  a  violent  death. 

9.  That  the  sinking  of  the  lungs  as  a  result  of  the  expulsion  of  air 
from  them  by  compression  does  not  necessarily  prove  that  the  child  was 
born  dead.  It  merely  proves  that  the  air  contained  in  them  was  derived 
either  from  artificial  inflation  or  from  the  imperfect  establishment  of  the 
respiratory  process. 


654  PROOFS    OF    LIVE    BIRTH, 

10.  That  the  hydrostatic  test  is  not  applicable  to  determine  the  fact  of 
respiration  or  non-respiration  in  all  cases  of  alleged  child-murder  ;  but  that, 
with  ordinary  precautions,  it  may  be  safely  employed  in  the  majority  of 
such  cases. 

11.  That  a  child  may  breathe  before,  during,  or  after  birth;  but  the 
hydrostatic  test  will  not  enable  us  to  say,  in  the  greater  number  of  cases, 
at  which  of  these  periods  the  act  of  breathing  was  performed. 

12.  That  breathing  is  a  sign  of  life,  and  not  necessarily  of  live  birth. 

13.  Hence,  in  order  to  constitute  murder,  medical  evidence  is  required 
to  show  whether  a  child  had  breathed  after  it  was  entirely  born,  and 
whether  the  act  of  violence  which  caused  its  death  was  applied  to  it  while 
so  breathing. 

Some  of  these  conclusions  may  require  qualification  ;  but  for  the  circum- 
stances which  qualify  them  the  reader  is  referred  to  the  contents  of  the 
chapter. 


CHAPTER    LI. 

ON    THE    PROOFS    OF    A    CHILD    HAVING    BEEN    BORN     ALIVE. EVIDENCE     FROM     RESPIRATION. 

FROM     MARKS     OF    VIOLENCE. FROM     NATURAL    CHANGES     IN    THE    FCETAL    VESSELS. 

FROM    THE    DISCOVERY    OF    AIR    AND    FOOD    IN    THE    STOMACH    AND    BOWELS. EAK-TEST. 

GENERAL    CONCLUSIONS. 

On  a  trial  for  child-murder,  the  important  medical  question  has  hitherto 
been — Was  the  child  completely  born  alive  ?  The  interpretation  set  upon 
these  words  by  all  the  judges  is  that  the  whole  body  of  a  child  should  be 
entirely  delivered  from  the  body  of  the  mother  before  the  question  of  its 
death  from  violence  could  be  entertained.  In  a  case  in  which  death  had 
obviously  taken  place  from  criminal  violence,  the  medical  witness  was 
suddenly  stopped  in  his  evidence  by  being  asked  for  some  infallible  proof 
of  live  birth  in  a  legal  sense.  As  a  medical  man  not  present  at  the  de- 
livery could  rarely  be  in  a  condition  to  offer  such  proof,  the  case  broke 
down,  and  the  accused  was  acquitted. 

By  the  existing  law,  it  is  murder  to  cause  a  child  to  die  after  it  is  born 
by  injuries  inflicted  on  it  before  or  during  birth  ;  but  it  is  no  offence  to  kill 
a  living  child  while  it  is  being  born,  unless  miscarriage  is  caused.  Under 
the  proposed  new  Criminal  Code  there  is  the  following  provision  against 
the  murder  of  imborn  children:  "  Every  one  shall  be  liable  to  penal  ser- 
vitude for  life  who  causes  the  death  of  any  living  child  which  has  not 
proceeded  in  a  living  state  from  the  body  of  its  mother  by  any  act  or 
omission  which  would  have  amounted  to  murder  if  such  a  child  had  been 
fully  born."  For  the  protection  of  medical  men  who  perform  craniotomy,  or 
Avho  otherwise  destroy  an  unborn  child,  it  is  proposed  that  no  one  shall  be 
guilty  of  any  ofTence  who,  by  means  emi>loyed  in  good  faith,  for  the  preserva- 
tion of  the  life  of  the  mother  of  the  child,  and  reasonably  necessary  for  that 
purpose,  causes  the  death  of  any  such  child  or  causes  any  child  to  die  after  it 
isfullyborn  by  any  such  thing  done  before  or  during  its  birth.  Thisproposcd 
change  may  be  objected  to  on  a  technicel  ground — namely,  that  it  creates 
a  difference  in  the  crime  of  murder,  making  it  to  depend,  not  on  the  fact 
of  killing,  liut  on  the  time  at  which  the  killing  takes  place.  The  answer 
to  this  objection  is,  however,  that,  under  the  present  law,  many  escape 


EVIDENCE    FROM    RESPIRATION.  655 

who  deserve  punishment,  and  that  real  cases  of  child-murder  practically 
go  unpunished.  Under  the  proposed  Code,  juries  would  be  less  ready  to 
acquit  women  charged  with  this  crime  when  a  sentence  of  penal  servitude 
can  be  passed  on  them  in  place  of  capital  punishment. 

As  the  question  of  live  birth  must  still,  as  a  rule,  be  put  to  the  witness 
on  charges  of  child-murder,  it  will  be  necessary  to  consider  the  medical 
facts  upon  which  reliance  can  be  placed,  as  furnishing  evidence  of  a  child 
having  come  into  the  world  living,  or  of  its  having  been  born  alive. 

Evidence  from  Respiration. — As  a  general  rule,  there  will  be  no  per- 
ceptible difference  in  the  state  of  the  lungs,  whether  the  act  of  respiration 
is  performed  by  a  child  during  birth  or  after  it  is  born,  provided  that  its 
death  speedily  follows  its  birth.  But  should  we  find  that  this  process  has 
been  perfectly  estoMished,  i.  e.  that  the  lungs  present  all  those  conditions  " 
which  have  been  described  as  characteristic  of  full  and  perfect  breathing, 
there  is  great  reason  to  presume  that  the  process,  even  if  it  had  commenced 
during  birth,  must  have  continued  after  the  child  was  entirely  born.  This 
presumption  becomes  still  stronger  when  the  child  is  immature;  for,  gen- 
erall}'  speaking,  such  children  must  be  born  and  continue  to  breathe  for 
many  hours  after  birth,  in  order  that  their  lungs  should  pre.sent  the  char- 
acters of  complete  respiration.  The  process  is  seldom  so  established 
before  birth  as  to  give  to  these  organs  a  feeling  of  crepitation  under  press- 
ure ;  the  existence  of  this  character  should,  therefore,  be  sought  for.  A 
witness  who  relied  upon  it  as  a  conclusive  proof  of  breathing  cfter  birth, 
might  be  asked  whether  it  were  not  possible  for  some  children  to  remain 
so  long  at  the  outlet  with  the  head  protruding,  as  to  render  the  lungs 
crepitant  from  frequent  respiration  before  birth.  Admitting  the  possibility 
of  this  occurrence,  he  should  endeavor  to  ascertain  whether  there  was  any 
probable  cause  which  could  thus  have  protracted  delivery  while  the  head 
of  the  child  was  in  this  position  ;  as  also  what  natural  cause  could  have 
produced  its  death  when  its  head  was  protruding  and  respiration  had  been 
so  freely  performed  as  to  give  crepitation  to  the  lungs.  The  presence  or 
absence  of  the  usual  scalp-tumor  might  throw  some  light  upon  the  case. 
If,  when  present,  it  did  not  prove  live  birth,  it  might  indicate  protracted 
delivery,  and  show  that  the  child  had  been  recently  living.  Casper  cut 
the  Gordian  knot  of  this  difficulty  by  assuming  that  breathing  before  birth 
takes  place  only  in  protracted  delivery,  in  which  the  assistance  of  an 
accoucheur  is  required.  In  those  cases  which  are  likely  to  give  rise  to 
criminal  investigations,  he  assumed  that  the  birth  of  the  child  takes  place 
quickly,  and  that  in  rapid  delivery  the  child  does  not  breathe  until  after  it 
has  been  born  alive.  Hence  his  conclusion  is — if  in  the  body  of  a  child 
(secretly  disposed  of)  the  lungs  are  found  by  the  hydrostatic  test  to  con- 
tain air,  this  air  did  not  enter  the  lungs  at  or  before  birth,  but  afterwards, 
and  that  the  child  was  born  alive.  (Gerichtl.  Med.)  Such  a  conclusion 
is  not  in  accordance  with  the  facts  ascertained  regarding  the  act  of  respira- 
tion in  newborn  children  ;  it  may  be  that  they  rarely  die  from  natural 
causes  after  they  have  once  breathed,  but  that  they  can  breathe  and  cry 
during  birth  is  a  fact  which  cannot  be  disputed.  Further,  there  is  no  test 
known  by  which  air  received  into  the  lungs  during  birth  can  be  dis- 
tinguished from  that  which  has  entered  these  organs  after  the  child  has 
been  born  alive. 

E vidence  from  Marks  of  Violence. — If  marks  of  violence,  apparently 
inflicted  about  the  same  time,  are  found  on  different  and  remote  parts  of 
the  bodv,  and  these  marks  bear  the  characters  of  those  produced  during 
life,  it  is  rendered  probable  that  the  whole  of  the  body  of  the  child  was 
in  the  world  when  they  were  caused.     Marks  of  great  violence  on  one 


656         CHANGES  IN  THE  BODY  OF  THE  CHILD. 

part,  as  the  head  or  breech,  would  not  always  justify  such  a  presumption, 
because  it  might  be  fairly  objected  that  they  had  been  unintentionally  pro- 
duced by  the  woman  in  her  attempts  at  self-delivery,  and  yet  the  child 
not  have  been  born  alive.  It  would  be  for  a  witness  to  form  an  opinion, 
from  the  circumstances  accompanying  the  particular  case,  whether  they  had 
been  thus  occasioned.  From  this  it  will  be  seen  that,  in  making  an  ex- 
amination after  death,  every  mark  of  injury  on  the  body  of  a  child,  even 
if  slight,  should  be  noted  down.  Abrasions  of  the  skin,  burns,  and  punc- 
tures, should  be  sought  for,  and  the  throat  examined  for  marks  of  pressure 
by  a  cord  or  by  the  fingers. 

E vidence  from  Certain  Changes  in  the  Body. — In  a  child  that  has  been 
born  alive,  or  has  survived  its  birth  for  a  period  of  from  twelve  to  twenty- 
four  hours,  that  portion  of  the  umbilical  cord  (navel-string)  which  is  con- 
tiguous to  the  abdomen  undergoes  certain  changes :  it  dries  and  becomes 
slowly  shrivelled,  and  in  from  three  to  five  or  more  days  it  separates  from 
the  body,  with  or  without  cicatrization. 

The  cord  does  not  separate  at  the  part  which  is  tied,  but  close  to  the 
abdomen.  It  separates  generally  within  five  days  by  a  process  of  slough- 
ing, the  skin  connected  with  the  dead  portion  of  the  cord  presenting  a 
red  line  arising  from  capillary  congestion.  During  the  separation  of  the 
navel-string  the  umbilical  vessels  are  gradually  closed.  According  to 
Billard,  the  obliteration  of  these  vessels  is  effected  in  a  peculiar  manner. 
The  calibre  diminishes  as  a  result  of  a  concentric  thickening  of  the  coats, 
so  that,  while  the  vessel  retains  its  apparent  size,  its  cavity  is  gradually 
blocked  up.  A  quill  would  represent  the  form  of  the  vessel  in  the  foetal 
state,  and  a  tobacco-pipe  in  the  obliterated  state.  It  is  only  by  cutting 
through  the  vessel  that  the  degree  of  obliteration  can  be  determined.  The 
state  of  the  umbilical  cord  has  furnished  good  evidence  of  live  birth  when 
the  other  circumstances  of  the  case  have  yielded  no  information.  The 
changes  in  the  umbilical  cord,  especially  those  indicative  of  its  separation 
and  cicatrization,  clearly  prove  that  a  child  has  survived  its  birth,  whatever 
may  be  the  results  of  experiments  on  the  lungs  ;  but  the  difficulty  is  that 
they  require  some  days  for  their  production,  and  in  practice  it  is  necessary 
to  procure  some  signs  of  survivorship  for  only  a  few  minutes,  or  at 
furthest  for  a  few  hours.  The  same  remark  applies  to  the  exfoliation  of 
the  cuticle  in  a  newborn  child :  such  a  condition  of  the  skin  can  rarely  be 
found  in  cases  of  infanticide.  The  absence  of  meconium  from  the  intes- 
tines and  of  urine  from  the  bladder,  are  not  proofs  of  live  birth,  for  these 
may  be  discharged  during  birth,  and  yet  the  child  not  be  born  alive. 

Slate  of  the  Skin. — In  the  greater  number  of  newborn  children  the  skin 
has  a  dark-red  color,  probably  owing  to  the  first  effect  of  the  atmosphere 
upon  it.  Within  an  hour  it  begins  to  get  of  a  lighter  red,  and  so  it 
remains  for  one  or  two  days.  According  to  Elsasser,  it  becomes  again 
darker  about  the  end  of  the  second  or  on  the  third  day,  and  is  then  of  a 
brownish-red  color.  This  lasts  for  three  or  four  days,  unless  a  yellowness 
appears  from  jaundice.  It  is  about  the  sixth  or  seventh  day  that  the  skin 
acquires  the  reddish-white  color  such  as  it  afterwards  retains,  (Henke's 
Zeitschr.  der.  S.  A.,  1842,  2,  p.  223.) 

Evidence  from  Changes  in  the  Heart  and  Foetal  Vessels.  Docimasia 
Circulationis. — It  has  been  supposed  that  the  state  of  the  ductus  arteriosus, 
ductus  venosus,  and  foramen  ovale  would  aid  a  medical  jurist  in  forming 
an  opinion  whether  a  child  had  survived  its  birth.  In  general,  as  a  result 
of  the  establishment  of  respiration,  it  is  found  that  the  communication 
between  the  auricles  of  the  heart  by  the  foramen  ovale  becomes  closed ; 
and  that  the  two  vessels  or  ducts,   after  gradually  contracting,  become 


DOCIMASIA    CIRCULATIONIS.  557 

obliterated  or  are  converted  into  fibrous  cords.  Whatever  may  be  the  con- 
clusions from  experiments  on  the  lungs,  it  has  been  contended  that  the 
closure  of  the  foramen  and  of  these  vessels  would  infallibly  indicate  that  a 
child  had  breathed.  This  inference,  however,  has  been  too  hastily  drawn. 
Researches  have  shown  that  there  are  some  serious  objections  to  any  con- 
clusions based  on  the  state  of  these  foetal  vessels  ;  their  closure,  as  a  natural 
process,  always  takes  place  slowly  and  sometimes  it  is  not  completed  until 
many  years  after  birth.  Thus,  then,  in  the  generality  of  cases  of  infanti- 
cide, in  which  necessarily  the  child  survives  but  for  a  short  period,  no  evi- 
dence of  the  fact  will  be  procurable  from  an  examination  of  the  heart  and 
foetal  vessels. 

As  a  general  rule,  the  peculiar  parts  of  the  foetal  circulation  are  rarely 
obliterated  by  a  normal  process  before  the  eighth  or  tenth  day  after  birth. 
The  obliteration  follows  no  certain  order.  The  statistical  facts  collected  by 
Elsasser  proved  that  the  vessels  peculiar  to  the  foetal  circulation  remain  open 
as  a  rule  for  some  time  after  birth,  and  that  it  is  not  possible  to  determine 
accurately,  by  days,  the  period  of  their  closure.  The  closure  commenced 
and  was  often  completed  in  the  ductus  venosus  before  it  manifested  itself 
in  the  other  vessels.  The  complete  closure,  in  by  far  the  greater  number 
of  cases,  takes  place  within  the  first  six  weeks  after  birth,  and  the  in- 
stances of  obliteration  before  birth,  or  before  the  period  mentioned  after 
birth,  must  be  regarded  as  rare  exceptions.  (Med.  Times  and  Gaz.,  1853, 
i.  p.  530.) 

From  these  facts,  the  docimasia  circulationis  may  be  considered  as  useless 
to  a  medical  jurist.  It  either  proves  nothing  or  it  may  lead  to  an  error.  It 
is  the  more  necessary  to  point  out  the  fallacies  to  which  it  is  liable,  because 
hitherto  medical  jurists  have  been  disposed  to  place  great  reliance  upon  it 
in  cases  in  which  medical  evidence  from  the  state  of  the  lungs  was  wanting. 

Evidence  fj^om  the  State  of  the  Alimentary  Canal. — The  presence  of 
frothy  air-bubbles  in  the  glairy  contents  of  the  stomach  of  a  newborn  child 
was  thought  by  Tardieu  to  indicate  live  birth  for  ten  or  fifteen  minutes  at 
the  least;  but  the  same  frothy  condition  might  be  produced  by  attempts 
to  inflate  the  lungs.  Breslau  found  that  in  stillborn  children  no  air  is 
found  in  the  stomach  or  intestinal  canal ;  hence  the  stomach  and  bowels 
as  a  whole  sink  in  water.  The  presence  of  air  in  the  stomach  depends  on 
respiration,  and  probably  reaches  the  stomach  with  the  first  attempt  to 
respire.  As  breathing  proceeds,  the  air  finds  its  way  into  the  intestines  ; 
hence  the  stomach  and  bowels  float  in  water  when  the  child  has  re- 
spired. The  lower  the  portion  of  the  bowels  that  floats  in  water,  the 
greater  is  the  probability  that  the  child  survived  its  birth.  (Ann.  d'Hvg., 
1868,  t.  2,  p.  224.) 

Good  evidence  of  live  birth  may  be  sometimes  derived  from  the  dis- 
covery of  certain  liquids  or  solids  in  the  stomach  and  intestines,  such  as 
blood,  milk,  or  farinaceous  or  saccharine  articles  of  food;  for  it  is  not  at 
all  probable  that  these  substances  should  find  their  way  into  the  stomach 
or  intestines  of  a  child  which  was  really  born  dead. 

1.  Starch. — In  the  case  of  a  newborn  child  Geoghegan  discovered  by 
the  application  of  iodine-water  the  presence  of  farinaceous  food  in  the 
contents  of  the  stomach  ;  hence  the  question  of  live  birth  w^as  clearly 
settled  in  the  affirmative.  On  another  occasion  Francis  employed  this 
method  of  testing,  with  satisfactory  results,  in  a  case  in  Avhich  the  inves- 
tigation was  beset  with  unusual  difficulties.  He  was  required  by  the 
coroner  to  examine  the  body  of  a  newborn  child  found  under  suspicious 
circumstances.  The  examination  of  the  lungs  left  no  doubt  that  respiration 
had  taken  place ;  and  the  fact  that  the  child  had  been  born  alive  was  fully 


558 


DETECTION  OF  SUBSTANCES  IN  THE  STOMACH. 


Fig.  50. 


established  by  the  discovery  in  the  stomach  of  a  small  quantity  of  fari- 
naceous food.  On  digesting  in  distilled  water  a  fragment  of  the  pulp 
found  in  this  organ  and  adding  a  drop  of  a  solution  of  iodine  an  intense 
indigo-blue  color  appeared  immediately.  The  application  of  this  chemical 
test,  therefore,  removed  any  doubts  which  might  have  been  entertained 
on  the  cjuestion  of  the  live  birth.  (Lond.  Med.  Gaz.,  vol.  xxxvii.  p.  4G0.) 
The  editor  met  with  a  similar  case.  The  quantity  of  starch  present  may, 
however,  be  too  small  to  produce  with  water  a  solution  which  would  be 
colored  by  iodine  in  the  manner  described.  A  portion  of  the  contents  of 
the  stomach  should  be  placed  on  a  glass  slide,  if  viscid  diluted  with  a  little 
water,  and  examined  under  the  microscope  with  a  power  of  about  300 
diameters.  The  granules  (if  present)  may  then  be  distinctly  seen,  having 
the  shape  peculiar  to  each  variety  of  starch,  and  not  unfrequently  mixed 
with  oil-globules  and  epithelial  scales  derived  from  the  mucous  membrane. 
B}'  the  addition  of  iodine  water  their  shape  and  size  will  be  brought  out 
by  the  blue  color  which  they  acquire.  Blue  fragments  of  an  irregular 
shape  indicate  the  presence  of  bread.  The  annexed  engraving  (Fig.  50) 
represents  two  varieties  of  starch  either  of  which  may  be  found  in  the 

stomachs  of  infants:  in  a  the  rounded  gran- 
ules of  wheat-starch  are  represented;  and 
in  b  the  ovoid  granules  of  arrowroot.  The 
micronietrical  measurements  of  these  gran- 
ules show  for  those  of  wheat,  which  are 
irregularly  spherical,  diameters  varjnng  from 
0.0001  to  0  0009  inch  in  size;  many  have  an 
average  diameter  of  0.00033  inch.  The  ovoid 
granule  of  arrowroot  is  0.0011  inch  in  length 
and  0.0006  inch  in  width. 

2.  Sugar. — In  a  case  which  the  author  was 
required  to  examine,  the  presence  of  sugar 
was  readily  detected  in  the  contents  of  the 
stomach  by  the  application  of  Trommer's 
test.  In  order  to  appl}^  this  test  a  few  drops 
of  a  weak  solution  of  sulphate  of  copper 
should  be  added  to  a  portion  of  the  cold  concentrated  aqueous  extract  of 
the  contents  of  the  stomach.  An  excess  of  a  solution  of  caustic  soda  is 
then  added  and  the  liquid  boiled.  If  grape-sugar  be  present  suboxide  of 
copper  is  immediately  precipitated  of  a  yellowish  or  reddish  color.  With 
white  cane-sugar  the  same  precipitation  is  effected  onl}"  when  the  solution 
is  first  boiled  with  dilute  hydrochloric  acid.  If  starch  only  is  present, 
black  oxide  of  copper  may  be  thrown  down,  but  there  will  be  no  produc- 
tion of  a  red  precipitate.  The  formation  of  the  red  oxide  of  copper  under 
these  circumstances  proves  that  some  saccharine  substance  is  present.  In 
reference  to  the  application  of  the  sugar-test,  however,  it  must  be  remarked 
that  starch  is  easily  convertible  into  malto.se  and  grape-sugar  by  a  chemical 
action  of  saliva  or  mucus,  so  that  the  test  may  appear  to  indicate  sugar 
in  small  quantity,  when  the  result  may  be  really  due  to  the  presence  of 
converted  starch. 

3.  Milk. — This  liquid  may  be  found  in  the  stomach  of  a  newborn  child  ; 
it  may  be  identified  by  the  microscope  in  the  fluids  of  the  stomach  by  the 
numerous  and  well-defined  oil-globules  which  it  contains.  It  is  not  pos- 
sible to  distinguish  human  from  cow's  milk  under  these  circumstances. 
In  both  the  globules  which  are  spherical  in  all  aspects  (Figs.  51  and  52) 
are  remarkable  for  their  transparency  in  the  centre  and  their  dark  margins. 
They  vary  considerably  in  size.     The  author  found  those  of  the  cow  to 


a.  Granules  of       b.  Granules  of 

Water  starch.  Arrowroot. 

Magnified  319  diameters. 


EPITHELIAL    SCALES    IN    THE    STOMACH. 


559 


have  by  measurement  the  following  diameters:  Maximum,  0.00045  inch  ; 
miuinuim,  0.00006  inch;  and  medium  size,  0.00022  inch.  They  are  dis- 
tinguished from  blood-corpuscles  by  their  shape  and  lustre,  and  from 
starch-granules    by   the  fact  that  they  are  not  colored  or  changed  by 


Fi-.  51. 


Fig.  52. 


Oil-globules  of      Oil-globules  of 
Human  Milk.         Cow's  Milk. 
MagQitied  319  diameters. 


Oil-globules  of     Colostrum  with 
Human  Milk,      granular  bodies. 
Maguified  450  diameters. 


iodine-water.  Colostrum  is  the  name  applied  to  the  milk  first  secreted 
after  delivery  ;  it  contains  in  addition  to  oil-glubules  numerous  spherical 
granular  bodies  (Fig.  52,  b).  When  milk  is  present  milk-sugar  is  gene- 
rally found  in  the  contents  of  the  stomach  by  the  appropriate  sugar-test 
(p.  558).  The  casein  of  milk  precipitates  sulphate  of  copper  ;  but  on 
adding  an  excess  of  a  solution  of  soda  the  precipitate  is  redissolved, 
forming  a  purple  or  violet-colored  solution.  It  is  rapidly  coagulated  by 
the  digestive  matter  contained  in  the  gastric  juice,  so  that  the  casein  may 
be  found  in  small  soft  masses  adhering  to  the  lining  membrane  of  the 
stomach.  It  should  be  observed  that  albumen  forms  a  deep  violet-colored 
solution  with  sulphate  of  copper  and  soda,  but  the  red  suboxide  of  copper 
is  not  precipitated  on  boiling  unless  sugar  is  present 

4.  Epithelial  Scales. — The  epithelial  scales  commonly  found  associated 
with  articles  of  food  in  the  stomach  are  of  various  shapes  and  sizes ;  they 
are  flat,  oval  or  rounded,  and  sometimes  polygonal.  They  are  nucleated, 
and  from  their  pavement-like  appearance  they  are  called  "  tessellated."  In 
Fig.  53,  h,  an  epithelial  scale  from  the  mucous  membrane  of  the  inside  of 
the  mouth  is  represented  magnified  570  diameters.  In  the  long  axis 
it  was  0.002  inch,  and  in  the  shortest  0.0011  inch  in  diameter.  The  central 
nucleus  was  0.00025  inch  in  diameter,  and 
the  small  granules  around  it  0.0001  inch. 
These  epithelial  scales  are  very  numerous, 
much  intermixed,  and  so  thin  and  trans- 
parent that  they  are  often  only  distinctly 
seen  at  the  edges,  which  are  occasionally 
folded  or  slightly  turned  over. 

Besides  the  substances  mentioned,  other 
solids  and  fluids,  such  as  blood  and  me- 
conium (the  fecal  discharges  of  the  foetus), 
may  be  found  in  the  stomach  of  a  new- 
born child,  and  a  question  may  arise 
whether  their  presence  indicates  that  the 
child  was  fully  born.  It  is  not  impossible 
that  a  child  might  be  fed  and  might  exert 


Fig.  ^3. 


Tessellated  Epithelial  Scales : 
a,  from  Sharpey ;  b,  from  observation. 


5G0  LIVE  BIRTH — MEDICAL  PROOFS. 

a  power  of  swallowing  when  its  head  had  protruded  from  the  outlet,  and 
its  body  was  still  within  the  body  of  the  mother.  Children  have  been  known 
to  exert  a  power  of  sucking  or  aspiration  under  these  circumstances,  and, 
with  this,  a  power  of  swallowing  might  be  exercised.  In  defending  a 
prisoner  on  a  charge  of  child-murder  counsel  would  scarcely  resort  to  a 
defence  of  thi^  kind.  That  the  starch,  sugar,  or  milk,  etc,,  found  in  the 
stomach  should  have  been  given  to  a  child  when  its  body  was  only  half- 
born,  is  so  improbable  an  hypothesis  that  the  most  inexperienced  lawyer 
would  hardly  resort  to  it  to  account  for  the  presence  of  food  in  this  organ. 
When  the  substances  found  in  the  stomach  are  not  in  the  form  of  food, 
but  are  fluids  connected  with  the  child  or  the  mother,  the  case  is  different. 
These  may  penetrate  into  the  lungs  or  stomach  during  birth,  either  by 
aspiration  or  by  the  act  of  swallowing ;  they  thus  indicate  that  the  child 
was  living,  but  they  do  not  necessarily  show  that  its  body  was  entirely  in 
the  world  when  they  were  swallowed. 

5.  Blood. — An  instance  is  related  by  Doring  in  which  a  spoonful  of 
coagulated  blood  was  found  in  the  stomach  of  a  newborn  child.  The  inner 
surfaces  of  the  gullet  and  windpipe  were  also  covered  with  blood.  Doring 
inferred  from  these  facts  that  the  child  had  been  born  alive  ;  for  the  blood, 
in  his  opinion,  could  have  entered  the  stomach  only  by  swallowing,  after 
the  birth  of  the  child,  and  while  it  was  probably  lying  with  its  face  in  a 
pool  of  blood.  Taken  alone,  however,  such  an  inference  would  not  be 
justifiable  from  the  facts  as  stated.  Blood  might  be  accidentally  drawn 
into  the  throat  from  the  discharges  of  the  mother  during  the  passage  of 
the  child's  head  through  the  outlet,  and  yet  the  child  may  not  have  been 
born  alive.  The  power  of  swallowing  may  be  exerted  by  a  child  during 
birth,  either  before  or  after  the  act  of  breathing.  This  power  appears  to 
be  exerted  even  by  the  foetus  in  utero.  Blood  may  be  recognized  in  the  con- 
tents of  the  stomach,  not  only  by  the  color  which  it  imparts  to  the  mucous 
liquids  present,  but  by  the  aid  of  the  microscope. 

Robinson  finds  that  the  substances  which  naturally  exist  in  the  stomach 
of  a  fcfitus  before  birth  are  of  an  albuminous  and  mucous  nature.  His 
observations  were  made  on  the  stomachs  of  two  human  foetuses,  and  on 
those  of  the  calf,  lamb,  and  rabbit.  The  conclusions  at  which  he  arrived 
were — that  the  stomach  of  the  foetus,  during  the  latter  period  of  its  uter- 
ine existence,  contains  mucous  and  albuminous  matters  derived  from  the 
salivary  secretion  ;  and  that  gastric  juice  is  not  secreted  until  after  respir- 
ation has  been  established.  The  medical  jurist  will  perceive,  therefore, 
that  the  discoveiy  of  farinaceous  food,  milk,  or  sugar  in  the  stomach  will 
furnish  evidence  of  birth,  since  substances  of  this  kind  are  not  found  nat- 
urally in  this  organ. 

6.  Mecovivm. — This  name  is  applied  to  the  excrementitious  matter 
produced  and  retained  in  the  intestines  during  fcetal  life.  It  may  be 
found  in  the  stomach  of  a  newborn  child,  and  a  question  will  thence 
arise  whether  its  presence  there  should  be  taken  as  a  proof  of  entire  live 
birth.  It  may  be  discharged  from  the  child  during  delivery,  in  cases  in 
which  there  is  a  difficult  or  protracted  labor.  During  the  act  of  breathing 
it  may  enter  the  throat  with  other  discharges,  and  thus  be  found  in  the 
stomach.  That  a  breathing  child  can  thus  swallow  meconium  cannot  be 
disputed,  but,  assuming  that,  in  the  body  of  a  child  which  has  not  lived 
to  breathe,  this  substance  is  found  in  the  air-passages  and  stomach,  how 
is  the  conclusion  affected?  From  a  case  which  occurred  to  Fleisher,  it  is 
probable  that  as  some  portion  of  the  meconium  may  be  discharged  from 
the  bowels  of  a  child  during  labor,  and  as  the  mouth  passes  over  this 
liquid  a  portion  may  be  drawn  into  the  throat  by  aspiration.     When  once 


MECONIUM    IN    THE    STOMACH. 


oGl 


Fig.  54. 


there  the  instinctive  act  of  swallowing-  would  immediately  convey  a  por- 
tion of  it  into  the  stomach.  (See  case  in  Vierteljahrsschr.  liir  Gerichtl. 
Med.,  1863,  Bd.  1,  p.  97  ;  also  for  another  case,  Med.  Times  and  Gaz., 
1S61,  ii.  p.  116.)     The  same  remark  applies  to  the  urine. 

The  presence  of  fluids,  therefore — such  as  hlood,  vxeconium,  or  the 
watery  discharf^es  attending  delivery — in  the  stomach  and  air-passages  of 
a  newborn  child,  does  not  prove  live  birth,  but  merely  indicates  the  exist- 
ence of  some  living  actions  in  the  child  at  or  about  the  time  of  its  birth. 
A  woman  was  suddenly  delivered  of  a  child  while  sitting  over  a  slop-pail 
of  dirty  water.  On  examining  the  body,  it  was  obvious  that  it  had  not 
breathed.  There  was  no  air  in  the  lungs,  but  a  quantity  of  dirty  water 
like  that  in  the  pail  was  found  in  the  stomach.  This  could  have  entered 
the  organ  only  by  the  act  of  swallowing,  and, 
in  Ramsbotham's  opinion,  the  child  had  swal- 
lowed the  liquid  under  some  foetal  attempt  to 
breathe.  The  coroner  who  held  the  inquest 
directed  the  jury  that  the  child  was  born  dead : 
but  most  physiologists  will  consider  that  the 
power  of  swallowing  cannot  be  exerted  by  a 
dead  child;  and  as  its  body  must  have  been 
entirely  delivered  in  order  to  have  fallen  into 
the  liquid,  there  was  proof  that  it  had  been  born 
living,  and  that  in  this  instance  it  had  died  after 
it  was  entirely  born,  by  the  prevention  of  the 
act  of  breathing.  The  facts  connected  with  the 
aspiration  of  liquids  by  newborn  children  have 
been  fully  examined  by  Hofmann.  (Viertel- 
jahrsschr." fur  Gerichtl.  "Med.,  1873,  Bd.  2,  p. 
228.) 

The  meconium  may  be  generally  recognized 
by  its  dirty-green  color  and  general  appearance, 
as  well  as  by  the  absence  of  any  offensive  odor, 
which  it  does  not  acquire  until  after  the  third 
or  fourth  day  from  birth,  when  it  becomes 
mixed  with  feculent  matter.     Its  microscopical 

characters  are  represented  in  the  above  engraving  (Fig.  54).  In  the 
air-passages  it  is  sometimes  associated  with  vernix  caseosa,  and  hairs 
derived  from  the  skin.  (Med.  Times  and  Gaz.,  1861,  i.  p.  591,  and  1861, 
ii.  p.  117  ;  see  also  Ann.  d'Hyg.,  1855,  t.  2,  p.  445.) 

But  little  need  be  said  on  its  chemical  properties  ;  still,  as  the  detection 
of  stains  of  meconium  on  clothing  may  occasionally  form  a  part  of  the 
medical  evidence,  a  few  observations  are  here  required.  The  stains  which 
it  produces  are  of  a  brownish-green  color,  very  difficult  to  remove  by 
washing.  They  stiffen  the  stuff,  and  are  usually  slighth"  raised  above  the 
surface,  without  always  penetrating  below  it.  Meconium  forms  with 
water  a  greenish-colored  liquid,  having  an  acid  reaction,  and  a  boiling  tem- 
perature does  not  affect  the  solution.  Nitric  acid  and  sulphuric  acid  with 
sugar  yield  with  it  the  green  and  red-colored  compounds  which  they  pro- 
duce with  bile.     Cholesterin  may  be  separated  from  it  by  hot  ether. 

Huber  has  subjected  meconium  to  an  elaborate  investigation.  Accord- 
ing to  him,  the  most  important  substance,  medico-legally  considered,  met 
with  in  meconium  is  a  greenish-yellow  body  which  gives  it  its  dark-green 
color.  These  bodies  are  admirabh'  depicted  by  Tardieu.  (Sur  Tlnfanti- 
cide,  plate  2.)  They  are  oblong,  elliptical,  of  oval  or  roundish  contour, 
not  unfrequentlv  flaky  and  with  rounded  angles,  and  are  very  variable  in 
36 


Microscopical  appearances  of 
Jleconium:  «,  crystals  of  cho- 
lesterin; 6,  epithelial  scales;  c, 
masses  of  green  coloring  mat- 
ter of  bile  (biliverdin);  rf,  e, 
granules ;  magnified.  400  diam- 
eters. 


562  DISTINGUISHING    CHARACTER    OF    MECONIUM, 

size,  some  being  excess! velj'  minute,  others  as  large  as  the  epithelial  cells 
depicted  in  Fig.  53,  p.  559.  They  are  homogeneous  in  structure,  and, 
being  enveloped  in  mucus,  it  is  ditKcult  to  ascertain  the  action  of  chemical 
reagents  upon  them  ;  but  the}-  are  unaltered  by  acetic  acid  and  solution 
of  potash,  but  soluble  in  ether.  Huber  held  that  the  discovery  of  these 
bodies  in  stains  is  characteristic  of  the  presence'  of  meconium.  (Fried- 
reich's Blatter  fiir  Grerichtl.  Med.,  1884,  pp.  24,  142.)  Ruber's  memoir 
contains  a  complete  bibliography  of  all  that  relates  to  meconium. 

It  may  be  remarked,  in  reference  to  stains  produced  by  the  feces  of  a 
child  which  has  survived  birth,  that  until  the  fifth  or  sixth  day  they  re- 
tain a  dark-green  or  greenish-yellow  color.  On  the  seventh  day  after 
birth  they  generally  acquire  a  bright-3'ellow  color,  like  that  of  the  yolk  of 
e^jcg  ;  and,  if  the  child  is  in  health,  they  will  retain  this  color  during  all  the 
time  that  it  is  suckled. 

Y.  Ear-test. — Wreden  has  pointed  out  that  the  middle  ear  of  a  newborn 
child  is  filled  with  epithelial  cells  or  metamorphosed  embr^^onal  connective 
tissue ;  and  that  this  becomes  absorbed  or  removed  shortly  after  birth  if 
the  child  be  alive.  The  presence  of  a  distinct  cavity  in  the  middle  ear 
hence  becomes  an  inportant  factor  in  determining  that  a  child  has  survived 
its  birth.  (Lancet,  1817,  ii.  p.  741.)  The  editor  has  found  this  test  useful 
in  several  cases. 

The  slightest  consideration  will  show  that  the  various  indications  of  live 
birth  above  described  are  weak  and  of  purely  accidental  occurrence.  If  a 
child  is  destroyed  either  during  birth,  or  within  a  few  minutes  afterwards, 
there  will  be  no  medical  evidence  to  indicate  the  period  at  which  its  de- 
struction took  place:  the  external  and  internal  appearances  presented  by 
the  body  will  be  the  same  in  the  two  cases.  It  is  most  probable  that,  in 
the  greater  number  of  instances  of  child-murder,  a  child  is  actually 
destroyed  either  during  birth  or  immediately  afterwards ;  and,  therefore, 
the  characters  above  described  can  rarely  be  available  in  practice.  If  any 
exception  is  made,  it  is  with  respect  to  the  nature,  situation,  and  extent 
of  marks  of  violence  ;  but  the  presence  of  these  depends  on  mere  accident. 
Hence,  then,  Ave  come  to  the  conclusion  that,  although  medical  evidence 
can  generally  show,  from  the  state  of  the  lungs,  that  a  child  has  really 
lived,  it  can  rarely  be  in  a  condition  to  prove,  in  a  case  of  infanticide,  that 
its  life  had  certainh^  continued  after  its  entire  birth.  We  could  only  ven- 
ture upon  this  inference  when  the  signs  of  breathing  M'ere  full  and  com- 
plete, or  when  some  article  of  food  was  found  in  the  stomach. 

Conclusions. — The  general  conclusions  which  may  be  drawn  from  the 
facts  contained  in  this  chapter,  on  the  question  whether  a  child  has  or  has 
not  been  horn  olive,  are  as  follows : — 

1.  That  if  the  lungs  are  fully  and  perfectly  distended  with  air  by  the 
act  of  breathing,  this  affords  a  strong  presumption  that  the  child  has  been 
horn  alive,  since  breathing  during  birth  is  in  general  only  partial  and 
imperfect. 

2.  That  the  presence  of  marks  of  severe  violence  on  various  parts  of  the 
body,  if  possessing  vital  characters,  renders  it  probable  that  the  child  had 
been  born  alive  when  the  violence  was  inflicted. 

3  That  certain  changes  in  the  umbilical  vessels,  and  the  separation  (by 
a  vital  process)  and  cicatrization  of  the  navel-string,  as  well  as  a  general 
peelino-  or  scaling-off  of  the  cuticle,  indicate  live  birth. 

4.  That  the  absence  of  meconium  from  the  intestines,  and  of  urine  from 
the  bladder,  are  not  proofs  that  a  child  has  been  born  alive,  since  these 
liquids  may  be  discharged  during  the  act  of  birth. 

5.  That  the  open  or  contracted  state  of  the  foramen  ovale  or  ductus 


CAUSES    OF    DEATJI    IN    NEWBORN    CHILDREN.  o(>3 

arteriosus  furnishes  no  evidence  of  a  child  having  been  born  alive.  These 
parts  may  become  closed  and  contracted  before  birlh,  and  therefore  he 
found  closed  in  a  child  born  dead;  (u-  they  may  remain  open  after  birlh 
in  a  child  born  living,  even  subseciuently  to  the  establishment  of  respiration. 

6.  That  the  presence  of  air  and  of  farinaceous  or  other  food  in  the 
stomach  and  bowels  proves  that  a  child  has  been  entirely  born  alive. 

7.  That  the  presence  in  the  stomach  and  air-passages  of  blood,  meconium, 
vernix  caseosa,  or  the  natural  di.scharges,  does  not  prove  that  a  child  was 
born  alive. 

8.  That  the  presence  of  an  air-cavity  in  the  tympanum,  or  middle  ear, 
affords  additional  evidence  of  live  birth. 

9.  That,  irrespective  of  the  above  conclusions,  there  is  no  certain  mecli- 
cal  sign  which  indicates  that  a  child  that  has  died  at  or  about  the  time  of 
birth — has  been  born  alive. 


CHAPTER     LII. 

CAUSES     OF     DEATH     IX     NEWBORN     CHILDKEX. PROPORTrOJT    OF     CHILDREN      BORN    DEAD. 

NATURAL    CAUSES    OF     DEATH. A    PROTRACTED    DELIVERY. DEBILITY. BLEEDING     FROM 

LACERATION     OF     THE     NAVEL-STRING. COMPRESSION    OF    THE    NAVEL-STRING. MALFOR- 
MATION.  DESTRUCTION    OF     MONSTROUS    BIRTHS. DEATH    FROM    CONGENITAL    DISEASE. 

Causes  of  Death  in  Newborn  Children. — The  next  important  question 
in  a  case  of  infanticide,  and  that-  upjon  which  a  charge  of  murder  essentially 
rests,  is — What  was  the  cause  of  death  ?  1.  It  is  admitted  that  a  child 
may  die  during  birth  or  afterwards.  2.  In  either  of  these  cases  it  may 
die  from  natural  or  violent  causes.  The  violent  causes  may  have  origin- 
ated in  accident  or  in  criminal  design.  The  last  condition  only  involves 
the  C[uestion  of  child-murder.  If  death  has  clearly  proceeded  from  natural 
causes,  it  is  of  no  importance  to  settle  whether  the  cause  operated  during 
or  after  birth.     All  charge  of  criminality  is  henceforth  at  an  end. 

It  is  well  known  that  of  children  born  under  ordinary  circumstances  a 
great  number  die  from  natural  causes  either  during-  birth  or  soon  after- 
wards ;  and  in  every  case  of  child-murder  death  will  be  assumed  to  have 
arisen  frord  some  cause  of  this  kind,  until  the  contrary  appears  from  the 
medical  evidence.  This  throws  the  onus  of  proof  entirely  on  the  prose- 
cution. Many  children  die  before  performing  the  act  of  respiration,  and 
thus  a  large  number  come  into  the  world  dead  or  stillborn.  The  pro- 
portion of  stillborn  among  legitimate  children,  as  it  is  derived  from 
statistical  tables  extending  over  a  series  of  years,  and  embracing  not  fewer 
than  eight  millions  of  births,  varies  from  one  in  eighteen  to  one  in  twentv 
of  all  births.  (Brit,  and  For.  Med.  Rev.,  Xo.  7,  p.  23.5.)  la  immature 
and  illegitimate  children,-  forming  the  greater  number  of  those  which  give 
rise  to  charges  of  child-murder,  the  proportionate  mortality  is  much 
greater — probably  about  one  in  eight  or  ten.  Stillbirths  are  much  more 
frequent  in  first  than  in  after-pregnancies ;  and  children  are  much  more 
frequently  born  dead  among  priniiparous  than  among  pluriparous  women. 
Males  are  more  often  stillborn  than  females.  According  to  Lawrence's 
observations,  the  proportion  of  deaths  is  1  to  1 1  among  the  priniiparous, 
and  1  to  31.2  among  the  pluriparous.  (Edin.  Med.  Jour.,  March,  18P.3,  p. 
811.)     In  most  cases  of  child-murder,  the  woman  is  priniiparous.     These 


564  DEATH  FROM  NATURAL  CAUSES. 

facts  should  be  borne  in  mind  when  we  are  estimating-  the  lorobability  of 
the  cause  of  death  being-  natural. 

Should  breathing  be  established  by  a  protrusion  of  the  child's  head  from 
the  outlet,  or  during  the  birth  of  the  body,  the  chances  of  death  from 
natural  causes  are  considerably  diminished.  jS'evertheless,  as  W.  Hunter 
long  ago  suggested,  a  child  may  breathe  and  die.  Thus,  according  to  this 
author,  "If  the  child  makes  but  one  gasp  and  instantly  dies,  the  lungs 
will  swim  in  water  as  readily  as  if  it  had  breathed  longer  and  had  then 
been  strangled."  In  general,  it  would  require  more  than  one  gasp  to 
cause  the  lungs  to  float  readily  in  water  ;  but,  waiving  this  point,  the  real 
question  is — If  the  child  breathed  either  during  or  after  birth,  what  could 
have  caused  its  death  ?  The  number  of  gasps  Avhich  a  child  may  make, 
or  which  may  be  required  for  the  lungs  to  swim  in  water,  is  of  no  moment ; 
the  point  to  be  considered  is,  whether  its  death  was  due  to  causes  of  an 
accidental  or  criminal  nature.  So  again  observes  Hunter  :  "  We  frequently 
see  children  born,  who,  from  circumstances  in  their  constitution,  or  in  the 
nature  of  the  labor,  are  but  barely  alive,  and  after  breathing  a  minute  or 
two,  or  an  hour  or  two,  die,  in  spite  of  all  our  attention.  And  why  may  not 
this  misfortune  happen  to  a  woman  who  is  brought  to  bed  by  herself?" 
The  substance  of  this  remark  is  that  many  children  may  die  naturally 
after  having  been  born  alive;  and  in  Hunter's  time  these  cases  were  not, 
perhaps,  sufficiently  attended  to.  In  the  present  day,  hoAvever,  the  case 
is  different ;  a  charge  of  child-murder  is  seldom  raised,  except  in  those  in- 
stances where  there  are  the  most  obvious  marks  of  severe  and  mortal 
injuries  on  the  body  of  a  child  ;  and  it  must  be  admitted  that  the  discovery 
of  violence  of  this  "kind  on  the  body  of  a  nev/born  infant  renders  a  full  in- 
quiry into  the  circumstances  necessary.  Among  the  natural  causes  of 
the  death  of  a  child  may  be  enumerated  the  following: — 

1.  A  Protracied  Delivery. — The  death  of  a  child  may  proceed,  in  this 
case,  from  injury  suffered  by  the  head  during  the  violent  contractions  of 
the  womb,  or  from  an  interruption  to  the  circulation  in  the  umbilical  cord 
before  the  act  of  breathing  can  be  performed.  As  it  is  elsewhere  explained 
(poHt,  pp.  565,  5GT),  each  contraction  of  the  womb  affects  the  placental 
circulation,  and  a  succes.«ion  of  these  contractions  in  a  protracted  delivery 
will  have  the  same  effect  on  the  child  as  the  arrest  of  breathing  after  birth, 
i.  e.  non-oxvgenated  blood  will  be  circulated  and  may  cause  the  death  of 
the  child.  For  a  similar  reason,  a  premature  separation  of  the  placenta 
may  lead  to  its  death. 

A  child,  if  feeble  and  delicate,  or  if  prematurely  born,  may  die  from  ex- 
haustion under  these  circumstances  before  respiration  is  established.  This 
cause  of  death  may  be  suspected  when  a  serous  tumor  (or  cojmt  succe- 
da/neum)  is  found  on  the  head  of  a  child  and  the  head  itself  is  deformed 
or  elongated  as  a  result  of  pressure  ;  or  an  effusion  of  blood  {cephalhse- 
motoma)  is  found  beneath  the  pericranium.  These  appearances  will  be 
accompanied  with  a  congested  state  of  the  vessels  of  the  brain.  The  ex- 
istence of  deformity  in  the  pelvis  of  the  woman  might  corroborate  this 
view ;  but  in  primiparous  women  (among  whom  charges  of  child-murder 
chiefly  lie)  with  well-formed  pelves  delivery  is  frequently  protracted.  It 
is  presumed  that  there  are  no  marks  of  violence  on  the  body  of  the  child,  ex- 
ceptins-  those  which  may  have  reasonably  arisen  from  accident  in  attempts 
at  self-delivery. 

2.  Debility. — A  child  may  be  born  either  prematurely  or  at  the  full 
period,  and  not  survive  its  birth,  owing  to  a  natural  fceljleness  of  system. 
This  is  observed  among  immature  children  ;  and  it  is  a  condition  especially 
dwelt  on  by  W.  Hunter.     Such  children  may  continue  in  existence  for 


BLEEDING    FROM    LACERATION    OF    THE    NAVEL-STRING.       5bO 

several  hours,  breathing  feebly,  and  may  then  die  from  mere  weakness. 
These  cases  may  be  recognized  by  the  immature  condition  of  the  body 
and  the  appearance  of  a  general  want  of  development. 

3.  Bleeding  from  Laceration  of  the  Navel-string. — A  child  may  die 
from  loss  of  blood,  owing  to  a  sudden  separation  of  the  placenta,  or  an 
accidental  rupture  of  the  navel-string.  In  the  latter  case,  it  is  said  the 
loss  of  blood  is  not  liliely  to  prove  fatal  if  breathing  has  been  established ; 
but  an  instance  is  reported  in  which  a  child  died  from  bleeding  even  under 
these  circumstances.  (Henke's  Zeitschrift,  1839,  Erg.  H.,  p.  200;  also 
1840,  Bd.  1,  p.  34T,  and  Bd.  2,  p.  105;  Ann.  d'Hyg.,  1831,  t.  2,  p.  128.) 
Bleeding  from  the  cord  has  been  observed  to  take  place  at  various  periods 
after  birth,  and  to  have  led  to  the  death  of  the  child.  (Edin.  Month.  Jour., 
July,  1847,  p.  To.)  Death  from  bleeding  may  be  commonly  recognized 
by  "the  blanched  appearance  of  the  body  and  a  want  of  blood  in  the  in- 
ternal organs ;  But  there  are  several  instances  on  record  in  which  the  cord 
was  ruptured  close  to  the  abdomen  without  causing  the  death  of  the  child. 
Bleeding  from  the  vessels  of  the  navel-string  may  prove  fatal  several  days 
after  birth,  even  when  a  child  has  been  properly  attended  to,  and  the  navel- 
string  has  separated  by  the  natural  process.  A  case  of  this  kind  is 
reported  in  which,  in  spite  of  every  application,  the  child  died  from  loss 
of  blood  six  days  after  the  cord  had  separated.  (Med.  Times  and  Gaz., 
1854,  i.  p.  287.)  The  impossibility  of  arresting  the  bleeding  in  this  case 
appeared  to  depend  upon  a  great  deficiency  of  fibrin  in  the  blood,  and  a 
consequent  want  of  tendency  to  coagulation.  (Wieczorek,  Vierteljahrsschr. 
fiir  Gerichtl.  Med.,  1873,  Bd.  1,  p.  385.)  It  has  been  believed  that  the 
danger  arising  from  bleeding  of  the  cord  was  chiefly  confined  to  those 
cases  in  which  it  was  divided  near  to  the  abdomen,  and  where  a  cutting 
instrument  had  been  used  ;  and  this  is  no  doubt  generally  true.  Page 
performed  some  experiments  on  this  subject,  which  showed  that  hemor- 
rhage might  take  place  from  the  divided  navel-string,  even  when  torn 
through  at  a  length  of  eighteen  inches  from  the  body  and  to  such  an  extent 
as  to  endanger  the  life  of  a  child.  He  also  found  that  hemorrhage  from 
the  cord  might  take  place  without  any  interference  with  the  respiration ; 
but  the  arrest  of  this  may  lead  to  hemorrhage  which  might  not  otherwise 
have  occurred. 

If  there  are  severe  wounds  on  the  body  from  which  blood  has  issued,  it 
would  be  obviously  wrong  to  refer  a  blanched  condition  of  the  body  to  acci- 
dental bleeding  from  the  cord.  The  fatal  bleeding  may  really  have  arisen 
from  the  wounds. 

Before  a  medical  expert  refers  death  to  this  cause,  he  should  be  well 
assured  that  the  cord  was  really  torn  through  or  severed  about  the  time 
of  birth  and  not  from  any  accident  subsequently.  A  case  is  reported 
which  shows  the  necessity  for  this  ciiution.  The  body  of  a  newborn  child 
was  taken  from  a  river  in-which  it  had  probably  been  floating  for  nearly 
a  fortnight.  The  placenta  and  cord  were  attached  to  the  body,  but  in 
removing  it  from  the  water  the  cord  was  torn  through  and  the  placenta 
carried  away  by  the  stream.  A  medical  man  examined  the  body,  and, 
seeing  the  cord  ruptured  and  observing  no  marks  of  violence,  he  came  to 
the  conclusion  that  the  cord  had  been  torn  through  by  the  woman  at  birth 
and  that  the  child  had  died  from  hemorrhage.  (Ann.  d'Hyg.,  1873,  t.  2, 
p.  443.)  The  medical  opinion,  however,  was  disproved  by  the  evidence 
of  witnesses. 

4.  Compression  of  the  Ravel-string. — When  a  child  is  born  by  the  feet 
or  buttocks  the  cord  may  be  so  compressed  under  strong  uterine  contrac- 
tion that  the  circulation  between  the  mother  and  child  will  be  arrested, 


566  MALFORMATION MONSTROSITY. 

and  the  latter  will  die.  The  same  fatal  compression  may  follow  when, 
during-  delivery,  the  cord  becomes  twisted  round  the  neck.  A  child  has 
been  known  to  die  under  these  circumstances  before  parturition,  the  cord 
haviusj:  become  twisted  round  its  neck  in  the  uterus.  (Lond.  Med.  Gaz., 
Oct.  1840,  p  122;  also  vol.  Ixxix.  pp.  232,  233.)  Davis  reported  a  case  where 
it  is  probable  that  the  child,  which  was  heard  by  the  mother  to  cry  for  some 
time,  was  strangled  by  the  mother  having  moved  her  body  away  from  the 
infant  after  delivery,  and  thus  tightened  the  navel-string.  (Brit.  Med. 
Jour.,  1882,  ii.  p.  1069.)  On  these  occasions  the  child  is  sometimes  de- 
scribed to  have  died  from  strangulation,  but  it  is  evident  that,  before  the 
establishment  of  respiration,  such  a  mode  of  expression  is  improper. 
There  are  few  or  no  apyjearances  indicative  of  the  cause  of  death.  There 
may  be  lividity  about  the  head  and  lace,  with  a  mark  or  furrow  on  the 
neck,  and  congestion  of  the  brain  internally  ;  it  is,  however,  necessary  to 
remember  that  vessels  of  the  brain  of  a  child  are  alwa/te  more  apparent 
than  those  of  an  adult.  Hofmann  considers  that  asphyxia  is  really  the 
cause  of  death  in  children  which  have  not  breathed.  He  looks  upon  the 
placental  circulation  as  vicarious  to  that  of  the  lungs  after  birth,  the 
arterial  blood  from  the  woman  supplying  the  oxygen  (derived  from  respir- 
ation) necessary  to  support  the  life  of  the  unborn  child.  The  amount  of 
oxygen  required  for  this  purpose  is  exceedingly  small,  and,  according  to 
Schwartz  and  Pfliiger,  it  is  not  sufficient  to  produce  any  difference  of  color 
in  the  blood  of  the  umbilical  vessels.  (Yierteljahrsschr.  fiir  Gerichtl. 
Med.,  18T3.  Bd.  2,  pp.  219,  224.)  Although,  under  compression  of  the 
cord,  a  child  may  die  before  breathing,  from  the  want  of  a  proper  supply 
of  oxygen  through  the  blood,  yet  the  appearances  presented  by  the  lungs 
would  differ  from  those  which  are  found  in  these  organs  after  breathing- 
has  Ijeen  once  established. 

5.  Hal  formation ,  Monstrosity. — There  may  be  a  deficiency  or  defect  of 
some  vital  organ  which  would  at  once  account  for  a  child  dying  either 
during  delivery  or  soon  after  its  birth.  Two  cases  are  reported,  in  one  of 
which  the  child  died  from  an  absolute  deficiency  of  the  gullet,  the  pharynx 
terminating  in  a  cul-de-sac ;  in  the  other  the  duodenum  was  obliterated 
for  more  than  an  inch,  and  this  malformation  had  occasioned  the  child's 
death.  (Lond.  Med.  Gaz.,  vol.  xxvi.  p.  542.)  In  a  third,  a  child  was 
suffocated  by  the  retraction  of  the  base  of  the  tongue,  owing  to  defect 
of  the  frsenum.  (North.  Jour.  Med.,  1849,  p.  278.)  The  non-establish- 
ment of  respiration  sometimes  arises  from  the  mouth  and  fauces  of  the 
child  being  filled  with  mucus.  An  enlargement  of  the  thyroid  gland 
has  occasionally  led  to  the  death  of  a  newborn  child  by  suffocation. 
(Edin.  Month.  Jour.,  July,  184T,  p.  64.)  The  epiglottis  is  sometimes 
fixed  over  the  glottis  so  as  to  prevent  the  entrance  of  air.  In  a  case  of 
this  kind  which  occurred  to  Hicks,  a  child  was  saved  by  the  introduction 
of  a  finger  :  the  air  suddenly  rushed  in,  and  the  child  was  then  enabled  to 
Ijreathe.  But  a  child  may  be  born  in  this  state  when  no  person  is  at 
hand  to  assist  the  woman  :  in  this  case  it  will  die  ;  and  the  lungs  being 
found  in  the  foetal  or  unexpanded  condition  it  will  be  pronounced  still- 
Ijorn.  Obstruction  of  the  air-passages  is  a  frequent  cause  of  death  among 
newborn  children. 

The  varieties  of  malformation  are  very  numerous,  but  there  can  be  no 
difficulty  in  determining  whether  they  are  such  as  to  account  for  death. 
Persons  are  not  allowed  to  destroy  monstrous  births ;  and  the  presence  of 
any  marks  of  violence  in  such  cases  should  be  regarded  with  suspicion. 
It  is  the  more  necessary  to  make  this  statement,  as  there  is  an  idea 
among  the  vulgar  that  it  is  not  illegal  to  destroy  a  monstrous  birth.     A 


SPASMS    OF    THE    LARYNX — CONGENITAL    LISEASES.  5b7 

lady  was  delivered  of  a  hideous  two-headed  monster.  At  tlie  earnest 
solicitations  of  the  friends  the  nurse  destroyed  it.  The  question  was — 
Was  this  woman  guilty  of  murder?  The  only  case  in  reference  to  this 
poiat,  which  is  recorded  by  medico-legal  writers,  is  that  of  two  women 
who  were  tried  at  the  York  Assizes  in  1812  for  drowning  a  child  which 
was  bora  with  some  malformation  of  the  head,  in  consequence  of  which  it 
was  not  likely  that  it  could  survive  many  hours.  It  did  not  appear  that 
there  had  been  any  malice  or  concealment  on  the  part  of  the  prisoners, 
who  were  not  aware  of  the  illegality  of  the  act.  (Paris  and  Fonblanque, 
Med.  Jar.,  vol.  i.  p.  228.)  The  absence  of  malicious  intention  would 
probably  lead  to  an  acquittal  on  the  charge  of  murder ;  but  such  an  act 
would  doubtless  amount  to  manslaughter,  as  the  degree  of  monstrosity  or 
the  viability  of  the  offsprinj,-  cannot  be  received  as  an  extenuating  circum-' 
stance.  As  to  the  first,  if  a  liberty  of  judging  of  what  was  monstrous  and 
what  not  were  conceded  to  any  ignorant  nurse  children  simply  deformed 
might  be  put  to  death  on  this  pretence  ;  as  to  the  second,  it  is  held  in  law 
that  whoever  accelerates  death  causes  it ;  hence  the  fact  that  a  child  is  not 
likely  to  live  more  than  a  few  hours  does  not  justify  the  act  of  one  who 
prematurely  destroys  it. 

6.  Spasms  of  the  Larynx. — Some  children  are  born  alive,  and  on  com- 
ing into  the  world  make  attempts  to  breathe,  but,  owing  to  spasms  of  the 
larynx  and  retraction  of  the  tongue,  the  air  is  unable  to  enter  ;  the  ch-ild 
dies  soon  after  birth,  and  on  inspection  no  air  being  found  in  the  lungs, 
the  child  is  wrongly  pronounced  to  have  been  born  dead.  (Guy's  Hosp. 
R3p.,  1866,  p.  476.)  A  careful  examination  of  the  fauces  may  show  the 
presence  of  mucus  or  meconium,  or  a  condition  of  the  epiglottis  which 
may  account  for  the  obstruction  to  respiration.  Hicks  has  on  more  than 
one  occasion  seen  the  newborn  child  make  these  inspiratory  efforts,  and 
by  lifting  the  epiglottis  has  given  free  passage  to  the  air,  and  the  child 
has  been  saved. 

7.  Atelectasis. — Atelectasis,  as  it  has  been  elsewhere  explained  {ante, 
p.  544),  implies  simply  an  unexpanded  state  of  the  lungs.  In  some  cases 
it  is  complete,  in  others  partial.  It  can  scarcely  be  regarded  as  a  diseased 
condition,  as  the  body  of  a  child  may  be  otherwise  healthy  ;  the  lungs 
themselves  are  in  a  normal  state,  and  they  can  be  easily  expanded  by  the 
artificial  introduction  of  air,  or  by  other  remedial  measures,  when  assist- 
ance is  at  hand.  This  imperfect  expansion  of  the  lungs  is  generally  due 
to  debility  in  the  child,  and  it  is  especially  a  cause  of  death  in  weakly  or 
immature  children.  But  strong  and  healthy  children  may  die  from  simple 
non-inflation  of  the  lungs. 

Assuming  that  in  utero  the  child  lives  by  Avhat  has  been  called  "pla- 
cental respiration,"  z.  e.  a  continuous  supply  of  sufficiently  oxygenated 
blood  from  the  woman,  another  explanation  may  be  offered.  If  anything 
should  arrest  th3  placental  circulation  during  labor  by  interrupting  the 
flow  of  blood  to  the  child  through  the  umbilical  cord,  this  may  cause  its 
death  before  pulmonary  inspiration  can  be  established.  The  child  is  born 
asphyxiated,  and  this  may  explain  the  state  of  atelectasis.  Every  con- 
traction of  the  womb  more  or  less  interrupts  placental  respiration  as  it  is 
above  defined.  The  child  lives  inside  the  womb  by  the  placenta,  and  out- 
side by  the  lungs.  If  the  action  of  the  placenta  is  destroyed  before  that 
of  the  lungs  can  be  set  up,  this  would  explain  the  condition  known  under 
the  name  of  atelectasis.  (See  a  paper  by  Hofmann,  A^'ierteljahrsschr.  fiir 
Gerichtl.  Med.,  1873,  2,  p.  219.) 

8.  Congenital  Diseases. — It  has  been  elsewhere  stated  (p.  544,  ante) 
that  a  child  may  be  born  laboring  under  such  a  degree  of  congenital  dis- 


668  CONGENITAL    DISEASES. 

ease  as  to  render  it  incapable  of  living.  The  discovery  of  any  of  the  foetal 
organs  merely  in  a  morbid  condition  amounts  to  nothing  unless  the  dis- 
ease has  advanced  to  a  degree  which  would  be  sufficient  to  account  for 
death.  There  are,  doubtless,  many  obscure  affections,  particularly  of  the 
brain,  which  are  liable  to  destroy  the  life  of  a  child  without  leaving  any 
well-marked  changes  in  the  dead  body.  According  to  Burgess,  apoplexy 
and  asphyxia  are  common  causes  of  death  among  newborn  children. 
(Lond.  Med.  Gaz.,  vol.  xxvi.  p.  492;  Henke's  Zeitschrift  der  S.  A.,  1843, 
p.  67.)  Probably  diseases  of  the  lungs  are  of  the  greatest  importance  in 
a  medico-legal  point  of  view  ;  because,  by  directly  affecting  the  lungs, 
they  render  it  impossible  for  a  child  to  live,  or  to  survive  its  birth  for  a 
long  period.  These  diseases  in  the  fostal  state  are  principally  congestion, 
hepatization,  tubercle,  scirrhus,  oedema,  the  existence  of  any  of  which  it  is 
not  difficult  to  discover.  They  render  the  structure  of  the  lungs  heavier 
than  water,  and  thus  prevent  the  organs  from  acquiring  that  buo3'ancy 
which  in  their  healthier  state  they  are  known  to  possess.  It  is  not  com- 
mon to  find  the  lungs  diseased  throughout — a  portion  may  be  sufficiently 
healthy  to  allow  of  a  partial  performance  of  respiration. 

Conclusions. — The  following  conclusions  may  be  drawn  from  the  pre- 
ceding remarks : 

1.  That  a  large  number  of  illegitimate  children,  especially  when  im- 
raature,  are  born  dead  from  natural  causes. 

2.  That  a  child  may  die  from  exhaustion  as  the  result  of  a  protracted 
labor. 

3.  That  if  a  child  be  prematurely  born,  or  if  it  be  small  and  weak  even 
at  the  natural  period,  it  may  die  from  mere  debility  or  want  of  power 
either  to  commence  or  to  continue  the  act  of  breathing. 

4.  A  child  may  die  from  loss  of  blood,  owing  to  accidental  rupture  of 
the  cord  during  delivery  ;  and  may  even  die  from  this  cause  after  it  has 
breathed. 

5.  That  fatal  bleeding  is  more  likely  to  occur  when  the  cord  has  been 
cut  close  to  the  abdomen  than  when  it  has  been  lacerated  or  cut  at  a  dis- 
tance from  the  navel. 

6.  That  the  division  of  the  cord,  whether  by  rupture  or  incision,  with- 
out ligature,  is  by  no  means  necessarily  fatal  to  a  healthy  mature  child. 

7.  That  a  child  may  die  from  accidental  compression  of  the  cord  during 
delivery,  the  circulation  between  the  mother  and  the  child  being  thereby 
arrested  before  respiration  has  commenced. 

8.  That  death  may  speedily  follow  birth  from  some  malformation  or 
defect,  or  from  a  defective  condition  of  organs  important  to  life. 

9.  That  a  child  may  die  from  congenital  disease  affecting  the  organs  of 
respiration  or  the  air-passages. 


VIOLENT    CAUSES    OF    DEATH.  669 


CHAPTER    LIII. 

VIOLENT     CAUSES    OF     DEATH. — SUFFOCATION. DROWNING. — DEATH     OP     THE     CHILD     FROM 

COLD     AND     EXPOSURE  STARVATION. DEATH     FROM     IMMATURITY. WOUNDS     IN     NEW- 
BORN   CUILDREN. FRACTURES    OP    THE    SKULL,     ACCIDENTAL     AND     CRIMINAL. TWISTING 

OP    THE    NECK. VIOLENCE    IN    SELF-DELIVERY. POWER    OF     LOCOMOTION     AND     EXERTION 

IN    FEMALES    AFTEIJ    DELIVERY. 

Violent  Causes  of  Death. — In  this  chapter  we  have  to  consider  those 
modes  of  death  which  are  totally  independent  of  the  existence  of  congen- 
ital disease  or  other  natural  causes.  In  most  cases  of  alleged  child-murder 
the  body  of  the  child  bears  about  it  the  marks  of  physical  injury,  such  as 
those  which  are  indicative  of  strangulation,  wounds,  burns,  and  fractures. 
The  marks  of  violence  may  be  such  as  to  leave  no  doubt  that  they  were 
wilfully  inflicted.  In  order  to  render  either  the  woman  or  a  confederate 
criminally  responsible,  it  must  be  distinctly  proved  that  the  injuries  were 
unlawfully  inflicted  on  a  legally  living  child,  and  that  they  were  the  cause 
of  death.  If  the  child  has  died  after  birth  from  violence  carelessly  or 
ignorantly  inflicted  during  birth  or  afterwards,  or  from  culpable  negligence, 
this  will  constitute  a  case  of  manslaughter  A  question  of  medical  re- 
sponsibility may  be  raised  under  these  circumstances,  as  where  a  medical 
man  is  charged  with  having  caused  the  death  of  a  child  by  gross  igno- 
rance and  carelessness  in  tlie  delivery  of  a  woman.  The  following  in- 
stance is  reported.  (Chitty's  Med.  Jur.,  p.  416  ;  also  Archbold,  p.  345.) 
A  mann  amed  Senior,  an  unlicensed  medical  practitioner,  was  tried  for  the 
manslaughter  of  an  infant  by  injuries  inflicted  on  it  at  its  birth.  The 
prisoner  practised  midwifery,  and  was  called  to  attend  the  prosecutrix, 
who  was  taken  in  labor.  The  evidence  showed  that  when  the  head  of  the 
child  presented,  the  prisoner,  by  some  mismanagement,  fractured  and 
otherwise  so  injured  the  cranium  that  the  child  died  immediately  after  it 
was  born.  It  was  argued,  in  defence,  that  as  the  child  was  not  born,  but 
in  ventre  sa  mere  at  the  time  the  wounds  and  injuries  were  inflicted,  the 
prisoner  could  not  be  guilty  of  manslaughter.  The  judge,  however,  held, 
that  as  the  child  was  born  alive  and  had  subsequently  died  from  the  vio- 
lence, the  case  might  be  one  of  manslaughter.  This  opinion  was  after- 
wards confirmed  by  the  other  judges,  and  the  prisoner  was  convicted  and 
sentenced  to  imprisonment.  Prom  the  decision  in  this  case  it  will  be  seen 
that,  if  the  prisoner  had  effectually  destroyed  the  child  before  it  was  en- 
tirely born,  he  would  not  have  been  guilty  of  any  crime. 

Some  of  the  causes  of  death  in  newborn  children  are  unavoidable,  others 
may  be  avoided  by  care  and  ordinary  precautions.  In  some  cases  where 
the  death  of  the  child  after  its  birth  had  been  traced  to  culpable  negligence 
on  the  part  of  the  woman,  judges  have  directed  a  verdict  of  manslaughter, 
and  have  inflicted  a  severe  punishment — ten  years'  penal  service.  (Reg. 
V.  Maynard,  Devon  Aut.  Ass.,  1871 ;  Reg.  v.  Libbey,  Cornwall.  Aut.  Ass,, 
1871,  and  Reg.  v.  Sell,  Hereford  Lent  Ass.,  187-3.)  In  no  case,  however, 
have  they  dispensed  with  the  |)roof  that  the  child  was  born  alive,  either 
from  medical  or  other  evidence,  or  from  the  confession  of  the  woman. 

Some  general  observations  have  been  elsewhere  made  on  the  mode  in 
which  the  dead  body  of  a  child  in  an  alleged  case  of  child-murder  should 
be  examined  (ante,  p.  535).     A  note  of  all  marks  of  physical  injury,  how- 


570  SUFFOCATION. 

ever  slight  in  appearance,  may  be  of  importance  in  the  case.  There  are 
some  forms  of  child-murder  which  are  not  necessarih-  attended  with  marks 
of  violence ;  thus  a  child  may  be  crimiually  destroj'ed  by  suffocation, 
drowning,  exposure  to  cold,  or  privation  of  food.  It  may  die  under  these 
circumstances,  and  its  body  may  present  no  unusual  appearance.  These 
modes  of  destroying  life  will  therefore  first  require  consideration. 

1.  Suffocation. — This  is  a  common  cause  of  death  in  newborn  children, 
A  wet  cloth  may  be  placed  over  the  child's  mouth  or  thrust  into  the 
cavity,  either  during  birth  or  afterwards  and  before  or  after  the  perform- 
ance of  respiration.  To  the  latter  case  only  could  the  term  "  suffocation" 
be  strictly  applied.  In  Reg.  v.  Eley  (C.  C.  C,  Auff.  1878),  a  case  of 
alleged  manslaughter,  the  child  was  found  dead  with  a  pocket-handker- 
chief forcibly  stuffed  into  its  mouth.  The  state  of  the  lungs  showed  that 
it  had  breathed,  but  it  had  not  been  heard  to  cry.  According  to  the 
medical  evidence,  the  child  had  died  from  suffocation.  The  defence  was 
that  there  was  no  proof  that  it  had  been  born  alive.  IS'ot withstanding 
the  plain  evidence  as  to  the  mode  of  death  the  jury  acquitted  the  prisoner. 
A  child  may  be  destroyed  by  being  allowed  to  remain  closely  oompressed 
under  the  bed-clothes  after  delivery,  or  by  its  head  being  thrust  into  straw, 
feathers,  ashes,  and  similar  substances.  Under  these  circumstances,  the 
child  is  not  suffocated,  but  dies  from  the  prevention  of  breathing.  The  ap- 
pearances in  the  body  in  such  cases  are  seldom  sufficient  to  excite  a  suspicion 
of  the  cause  of  death,  unless  undue  violence  has  been  employed.  ■  There 
is  commonly  merely  lividity  about  the  head  and  face,  with  slight  conges- 
tion of  the  lungs.  A  careful  examination  of  the  mouth  and  throat  should 
be  made,  as  foreign  substances  are  sometimes  found  in  this  situation, 
affording  circumstantial  evidence  of  the  mode- in  which  the  suffocation  has 
taken  place.  Thus  wood,  straw,  feathers,  ashes,  tow,  or  a  hard  plug  of 
linen  have  been  found  blocking  up  the  mouth  and  throat,  drawn  into  these 
partsby  aspiration  when  the  mouth  of  a  child  has  been  covered  with  such 
substances.  "When  a  child  is  found  dead  under  these  circumstances,  a 
question  will  arise  whether  the  ashes,  dust,  or  other  substances  found  in 
the  air-passages  have  either  been  wilfully  thrust  into  the  mouth  and  throat 
or  accidentally  drawn  in  by  aspiration.  Whether  an  accused  person  has 
placed  the  ashes  in  the  mouth  or  buried  the  face  of  a  child  in  them  so  that 
Jhey  might  be  thus  drawn  in,  can  make  no  difference  in  the  nature  of  the 
orime.  If  the  a?hes  are  in  large  quantity,  of  large  size,  firmly  impacted, 
and  the  lining  membrane  of  the  mouth  presents  signs  of  laceration  or 
bruising,  there  can  be  no  doubt  that  violence  has  been  used.  Aspfration 
would  not  explain  facts  of  this  kind.  Again,  the  cinders  and  other  sub- 
stances may  be  found  in  the  windpipe  and  bronchi,  into  which  parts  they 
could  not  have  been  forced  by  manual  violence.  In  all  these  cases  the 
mouth  and  fauces  require  careful  examination. 

If  a  child  has  lived  sufficiently  long  to  be  fed,  it  may  be  accidentally 
suffocated  by  the  entrance  of  portions  of  solid  food,  such  as  the  curd  of 
milk  into  the  windpipe  and  air-passages.  A  newborn  child  may  be  suffo- 
cated by  having  its  head  held  over  noxious  vapors,  such  as  the  exhalations 
of  a  privy  or  of  burning  sulphur;  audit  is  here  necessary  to  remind  a 
medical  jurist  that  other  highly  poisonous  vapors,  e.g.  chloroform  or  coal- 
gas  (the  agent  u.sed  for  the  destruction  of  stray  dogs  in  Paris),  may  be 
used' by  a  criminal  without  leaving  any  indication  in  the  body — except 
possibly  for  a  short  time  that  which  may  depend  upon  their  peculiar  odor. 
There  are  few  of  these  cases  of  suffocation  in  which  a  positive  medical 
opinion  of  the  cause  of  death  could  be  given  unless  some  circumstantial 
evidence  were  produced  and  the  witness  were  allowed  to  say  whether  the 


ACCIDENTAL    CAUSES    OF    SUFFOCATION.  571 

allec-ed   facts  were   or  were  not   sufficient  to   account  for   death.     (Ann. 
d'H3^g-.,  1832,  t  1,  p.  G91.) 

On  the  other  hand,  if  it  be  even  clearly  proved  that  death  has  been 
caused  by  suffocation  it  must  be  remembered  that  a  child  may  be  acci- 
dentally suffocated  and  the  crime  of  murder  falsely  imputed.  Duncan, 
quoting-  the  observations  of  Buhl,  states  that  obstruction  of  the  air-pass- 
ages by  mucus  and"  other  matters  is  a  frequent  cause  of  death  in  newborn 
children.  Among-  twenty-seven  children  dying  during  birth  or  shortly 
after,  eleven  died  from  obstruction  of  the  air-passages  with  foreign  matters. 
Eight  were  born  dead,  and  of  those  which  were  alive  at  birth  not  one 
survived  the  first  day.  In  ten  of  the  cases  the  obstruction  was  produced 
by  a  greenish  or  greenish-brown  or  slimy  mass  (meconium  and  mucus) 
filling  the  larynx  and  windpipe.  In  two  of  the  cases  in  which  the  child 
died  during- delivery  air  was  found  in  the  lungs,  and  in  only  one  of  these 
the  air  had  been  derived  from  the  act  of  breathing  during  birth.  (Edin. 
Month.  Med.  Jour.,  April,  1863,  p.  924;  also  Med.  Times  and  Gaz.,  1861, 
ii.  p.  117.)  In  Hicks's  case  (p.  566,  ante),  the  base  of  the  tongue  in  a 
newborn  child  was  so  drawn  down  by  spasmodic  action  as  to  close  the 
glottis  by  pressing  backwards  the  epiglottis.  The  child  w^as  saved  by 
simply  raising  the  epiglottis,  when  air  rushed  in  and  breathing  was  estab- 
lished ;  but  many  children  may  be  born  under  similar  conditions  when  no 
assistance  is  at  hand.  Cases  of  this  kind,  however,  rarely  give  rise  to 
charges  of  child-murder,  as  no  air  is  found  in  the  lungs.  A  child  might 
be  killed  during  delivery  by  pressure  applied  to  the  chest;  this  might 
be  such  as  not  to  produce  any  mark  of  violence.  If  the  child  had  not 
breathed  there  would  be  nothing  to  indicate  the  mode  of  death;  if  air 
had  entered  the  lungs  then  the  usual  appearances  will  be  found  in  these 
organs  (p.  539).  In  dealing  with  a  case  of  this  kind  it  should  be  remem- 
bered that  a  child  with  its  head  born  but  detained  in  the  outlet  by  the 
size  of  its  shoulders  might  die  from  pressure  exerted  on  the  chest  by  the 
vagina.  It  might  hav3  breathed  but  be  born  dead,  with  the  marks  of 
suffocation  about  it. 

There  is  another  accidental  cause  of  the  death  of  a  newborn  child  during 
delivery.  The  membranes  or  caul  may  be  carried  forward  over  the  head 
and  face,  and  the  act  of  breathing  thus  mechanically  prevented.  If  no 
assistance  is  at  hand,  the  child,  though  born  living,  will  die  soon  after  birth 
in  consequence  of  the  prevention  of  respiration.  If,  when  the  dead  body  is 
found,  the  membranes  are  no  longer  there,  the  cause  of  the  prevention  of 
respiration  would  not  be  apparent.  The  child,  although  born  living,  would 
probably  be  pronounced  to  have  been  born  dead.  (Med.  Times  and  Gaz., 
1863,  i.  p.  126.)  The  delivery  of  a  child  with  a  mask  or  caul  around'its 
head  is  not  an  unfrequent  occurrence.  In  1862,  Blenkinsop  communicated 
to  the  author  a  case  in  which  a  mature  and  healthy  child  so  born  was 
allowed  to  perish  by  those  who  had  access  to  it.  The  caul  was  simply  not 
removed,  so  that  breathing  could  not  be  set  up.  The  lungs  contained  no 
air.  There  was  congestion  of  the  brain  and  lividity  of  the  bod}^  but  no 
mark  of  violence.  There  was  some  evidence  that  the  child  had  been  born 
living-,  and  that  the  cause  of  death  was  the  prevention  of  respiration  by 
omission  to  do  that  which  was  necessary  ;  but  as  the  medical  evidence 
showed  that  the  child  had  not  breathed,  the  coroner  held  that  it  had  never 
had  any  (legal)  existence,  and  that  there  was  no  ground  for  further  inves- 
tigation. W.  Hunter,  who  was  well  aware  of  the  risk  to  which  a  woman 
might  be  thus  exposed,  observes  in  relation  to  this  state  of  things :  "  When 
a  woman  is  delivered  by  herself,  a  strong  child  may  be  born  perfectly 
alive,  and  die  in  a  very  few  minutes  for  want  of  breath,  either  by  being 


672  INFANTICIDE — SUFFOCATION. 

on  its  face  in  a  pool  formed  by  the  natural  discharges,  or  upon  wet 
clothes ;  or  by  the  wet  things  over  it  collapsing  and  excluding  air,  or 
being  drawn  close  to  its  mouth  and  nose  by  the  suction  of  breathing.  An 
unhappy  woman  delivered  by  herself,  distracted  in  her  mind  and  ex- 
hausted in  her  body,  will  not  have  strength  or  recollection  enough  to  fly 
instantly  to  the  relief  of  her  child."  It  may  be  added  that  a  primiparous 
woman  may  faint  or  be  wholly  unconscious  of  her  situation;  or,  if  con- 
scious, she  may  be  ignorant  of  the  necessity  of  removing  the  child,  and 
thus  it  may  be  suffocated  without  her  having  been  intentionally  accessory 
to  its  death.  In  such  cases,  however,  there  should  be  no  marks  of  vio- 
lence on  the  body,  or,  if  present,  they  should  be  of  such  a  nature  and  in 
such  a  situation  as  to  be  readily  explicable  on  the  supposition  of  an  acci- 
dental origin.  (See  Yierteljahrsschr.  fiir  Gerichtl.  Med.,  1874,  2,  p.  123.) 
An  infant  is  easily  destroyed  by  suffocation.  It  is  a  frequent  form  of 
infanticide.  Tardieu  stated  that  he  had  had  the  cases  of  132  newborn 
children  to  examine,  and  in  72  of  them  he  detected  clear  evidence  of  death 
by  suffocation.  (Ann.  d'Hyg.,  1855,  t.  2,  p.  372.)  If  the  mouth  and 
nostrils  of  a  child  are  kept  covered  for  a  few  minutes,  by  the  face  being 
closely  wrapped  in  clothes,  asphyxia  may  come  on  without  this  being 
indicated  by  convulsions  or  any  other  marked  symptoms  (see  p.  435, 
ante).  A  suspicion  of  murder  may  arise  in  such  cases;  but  the  absence 
of  marks  of  violence,  with  an  explanation  of  the  circumstances,  will  rarely 
allow  the  case  to  be  carried  beyond  an  inquest.  Sometimes  the  bod}/  is 
found  maltreated,  with  severe  fractures  or  contusions  on  the  skull,  and 
marks  of  strangulation  on  the  neck  ;  concealed  in  a  feather-bed  or  privy  ; 
or  cut  up  and  burnt.  This  kind  of  violence  may  properly  excite  a  suspi- 
cion of  murder,  and  lead  to  the  belief  that  the  allegation  of  death  from 
accidental  suffocation  is  a  mere  pretence.  This,  however,  is  purely  a  ques- 
tion for  a  jury,  and  not  for  a  medical  witness.  Unless  the  case  is  of  a 
glaring  nature,  the  violence  is  considered  to  have  been  employed  for  the 
purpose  rather  of  concealing  the  birth  of  a  child  than  of  destroying  it.  In 
the  present  day,  these  cases  of  death  from  accidental  sufTocation,  when 
properly  investigated,  can  never  involve  an  innocent  woman  in  a  charge 
of  murder,  although  the  facts  may  show  in  many  instances  that  the  death 
of  the  child  was  really  due  to  great  imprudence,  gross  neglect,  or  culpable 
indifference  on  her  part.  When  culpable  neglect  or  reckless  indifference 
to  the  life  of  a  newborn  child  has  been  proved  against  a  woman  charged 
with  murder,  a  verdict  of  manslaughter  is  usually  returned. 

The  appearances  in  the  body  in  cases  of  death  from  suffocation  have 
been  elsewhere  described,  in  reference  to  adults  (p.  428) ;  they  are  similar 
in  newborn  children,  provided  respiration  has  been  fully  performed.  Tar- 
dieu attaches  great  importance  to  the  discovery  of  subpleural  ecchymoses 
in  the  lungs  of  children  ;  he  has  also  noticed  small  effusions  of  blood  on 
the  surface  and  in  the  substance  of  the  thymus  gland.  (Ann.  d'Hyg., 
1855,  t.  2,  p.  379.)  If  the  lungs  float  on  water,  as  the  result  of  breathing, 
then  the  appearances  described  will  be  met  with ;  but  it  is  worthy  of  re- 
mark that  in  three  instances  Tardieu  met  with  similar  appearances  in 
children  whose  lungs  had  not  received  air,  and  sank  when  placed  on  water. 
There  is  no  doubt  that  these  ecchymoses  are  very  valuable  signs  of  suffo- 
cation. Donillard  and  Gallard  have,  however,  met  with  them  in  death 
from  natural  causes.  (Ann.  d'Hyg.,  1872,  t.  1,  p.  201.)  They  were 
children  prematurely  born,  and  under  conditions  which  prevented  full  vital 
development.  One"  uttered  several  cries,  but  in  spite  of  this  the  lungs 
contained  no  air.  The  subpleural  ecchymoses  met  with  in  children  under 
these  circumstances  are  ascribed  by  Tardieu  to  the  efibrts  made  to  breathe 


DEATH    FROM    DROWXI^'G.  573 

after  birth.  Partial  emphysema  of  the  lungs  is  occasionally  observed. 
Ssabinski  is  of  opinion  that  a  bloodless  condition  of  the  spleen  is  a  more 
serviceable  sign  of  suffocation.  (Vierteljahrsschr.  fiir  Gerichtl.  Med., 
18G7,  Bd.  2,  p.  146.) 

Some  remarks  have  been  elsewhere  made  on  the  evidence  derivable  from 
the  presence  of  subpleural  ecchyraoses  (p.  430).  In  death  from  suffocation 
they  are  not  always  found,  and  in  other  forms  of  asphyxia  they  have  been 
occasionally  seen,  so  that  they  cannot  be  considered  as  characteristic  of 
any  farm.  In  18T2,  a  servant  girl  had  given  birth  to  a  healthy  child. 
The  child  was  found  alive,  about  a  quarter  of  an  hour  afterwards,  in  a 
prir-y,  and  it  lived  a  few  minutes  after  the  discovery.  Its  jaw  was  broken, ' 
its  cheek  torn,  and  the  mouth  contained  ashes,  some  of  which  were  found 
in  the  back  part  of  the  throat.  The  body  was  blanched,  and  there  had 
evidently  been  a  great  loss  of  blood  from  the  wounds  and  the  torn  navel- 
string.  There  was  no  engor^'ement  of  the  lungs,  nor  were  there  any  sub- 
pleural ecchyraoses.  The  lining  membrane  of  the  windpipe  was  stained 
with  ashes,  and  a  small  cinder  was  found  in  the  left  bronchus.  In  this 
case  there  was  no  question  respecting  live  birth,  as  the  child  was  living 
when  found.  But  what  was  the  cause  of  death  ?  and  was  this  accidental 
or  the  result  of  violence  wilfully  applied  after  birth?  In  the  opinion  of 
Moore,  the  mouth  of  the  child  had  been  forcibly  torn  open  and  filled  with 
ashes  in  order  to  suffocate  it;  these  ashes  mig-ht  have  been  then  drawn  by 
aspiration  into  the  air-passages,  and  death  caused  partly  by  suffocation 
and  partly  by  hemorrhaare  from  the  wounds,  the  child's  body  being  blood- 
less. The  condition  of  the  luna's  was  not  inconsistent  with  death  from 
suffocation.  (For  some  remarks  on  death  from  suffocation  in  child-murder, 
with  reports  of  cases,  see  a  paper  bv  Severin  Causse,  Ann.  d'Hys-.,  1869, 
t.  2,  pp.  122,  443.) 

2.  Drowning. — The  fact  of  drowning  cannot  be  verified  by  any  appear- 
ances on  the  body  of  a  child  which  has  not  breathed.  Thus,  if  a  woman 
caused  herself  to  be  delivered  in  a  bath,  and  the  child  was  forcibly  re- 
tained under  water  (a  case  which  is  said  to  have  occurred),  it  would.,  of 
course,  die  ;  but  no  evidence  of  the  mode  of  death  would  be  found  in  the 
body.  After  respiration  the  signs  of  drowning  will  be  the  same  as  those 
met  within  the  aidult  (see  p.  3T8,'  ante).  The  main  question  for  a  witness 
to  decide  will  be  whether  the  child  was  put  into  the  water  living  or  dead. 
Infanticide  by  drov,^ning  is  by  no  means  common;  the  child  is  generally 
suffocated,  strangled,  or  destroyed  in  other  ways,  and  its  body  is  then 
thrown  into  water  in  order  to  conceal  the  real  manner  of  its  death.  The 
fact  of  the  dead  body  of  an  infant  being  found  in  water  must  not  allow  a 
witness  to  be  thrown  off  his  guard;  although  a  verdict  of  "  found  drowned  " 
is  commonly  returned  in  these  cases,  the  body  should  be  carefully  inspected 
in  order  to  determine  what  was  really  the  cause  of  death.  All  marks  of 
violence  on  the  bodies  of  children  that  have  died  by  drowning  should  be 
such  as  to  have  resulted  from  accidental  causes.  The  throat  and  air- 
passages  should  be  particularly  examined.  It  is  not  necessary  that  the 
u-JwIe  of  the  body  of  a  child  should  be  submerged  in  order  that  it  may  be 
destroyed  by  drowning;  the  mere  immersion  of  the  head  in  water  or  the 
covering  of  the  raouth  by  liquid  will  suffice  to  produce  the  usual  effects  of 
asphyxia. 

The  outlets  of  the  ears  and  the  air-passages  should  be  examined  for 
foreign  substances  which  may  be  deposited  in  them.  Xewborn  children 
may  be  drowned  or  suffocated  by  being  thrown  into  mud  or  into  the  soil 
of  a  privy.  Sometimes  the  child  is  destroyed  by  other  means,  and  its 
body  is  thus  disposed  of  for  the  purpose  of  concealment.     Should  there  be 


574  HOMICIDAL    AND    ACCIDENTAL    DROWNING. 

a  lar.ffe  quantity  of  liquid  pre!?ent,  the  phenomena  are  those  of  drowning. 
The  liquid  portion  of  the  soil  abounding  in  sulphide  of  ammonium  may 
be  found,  if  the  child  was  thrown  in  living,  in  the  air-passages,  gullet,  or 
stomach.  The  mere  discovery  of  soil  in  the  mouth  would  not  suffice  to 
show  that  the  child  was  living  when  immersed;  but  the  presence  of  for- 
eign substances,  such  as  dirt,  straw,  or  Sshes,  in  the  air-passages,  gullet, 
and  stomach,  has  usually  been  taken  as  a  medical  proof  that  the  child  was 
living  when  immersed,  and  that  the  solid  substances  had  been  drawn  into 
the  passages  by  aspiration  or  by  the  act  of  swallowing. 

On  these  occasions  the  defence  may  be:  1.  That  the  child  was  born 
dead  and  that  the  body  was  thrown  in  for  concealment;  but  the  medical 
evidence  may  show  that  it  had  bi'eathed  and  had  probably  been  born 
living.  2.  It  may  be  alleged  that  the  child  breathed  for  a  few  moments 
after  birth,  had  then  died,  and  that  the  woman  had  attempted  to  conceal 
the  dead  body.  A  medical  witness  may  be  here  asked  whether  a  woman 
could  have  had  power  to  convey  the  body  to  the  place — a  point  which 
must,  as  a  general  rule,  be  conceded.  3  It  is  commonly  urged  that  the 
woman,  being  compelled  to  go  to  the  privy,  was  there  delivered  vncon- 
sciousli/  or  unexpectedly  ;  that  her  waters  had  broken,  and  that  she  had 
no  idea  of  anything  more  having  happened  ;  or  that  the  child  had  dropped 
from  her,  and  was  either  suffocated  or  prevented  from  breathing.  (Med. 
Times  and  Gaz.,  18G1,  ii.  p.  646.)  All  these  circumstances  may  readily 
occur;  but,  on  the  other  hand,  such  statements  may  be  inconsistent  with 
some  of  the  medical  facts.  (See  a  case,  Ann.  d'Hyg.,  1855,  t.  2.  p.  453  ; 
also  Casper's  Klin.  Novel.,  1863,  p.  585.)  Thus  the  head  or  the  limbs  of 
a  child  may  be  found  to  have  been  separated  or  divided  by  some  cutting 
instrument,  or  a  cord  or  other  ligature  may  be  found  tightly  bound  around 
its  neck,  or  there  may  be  a  tightl3^-fitting  plug  in  the  throat.  Then,  again, 
the  body  may  be  entire,  but  the  navel-string  may  be  cleanly  cut.  This 
would  tend  to  set  aside  the  explanation  of  the  child  having  accidentally 
dropped  from  the  female;  because  in  such  an  accident  the  cord  should 
alwavs  be  found  rwjitured.  The  practitioner  should  make  a  careful  ex- 
amination of  the  divided  ends  of  the  cord  by  the  aid  of  a  lens,  or  a  rupture 
may  be  mistaken  for  a  section  with  a  sharp  instrument.  Higginson  pub- 
lished a  case  of  some  interest  in  this  point  of  view.  The  child  fell  from 
the  mother,  and  the  cord  broke  spontaneously.  "The  torn  ends  were," 
he  states,  "nearly  as  sharp-edged  and  flat  as  if  cut."  (Ijond.  Med.  Gaz., 
vol.  xlviii.  p.  985.)  This  case  goes  to  prove  that  a  careless  or  hasty  ex- 
amination of  the  ends  of  a  cord  may  lead  to  a  serious  mistake.  When  the 
cord  is  lacerated,  this  will  be,  cdsferis  paribus,  in  favor  of  the  woman's 
statement  as  to  the  mode  in  which  her  delivery  occurred. 

Drowning  rna}''  be  the  result  of  accident  from  sudden  delivery.  A 
woman  in  an  advanced  state  of  pregnancy  while  sitting  on  a  chamber- 
vessel  was  suddenly  delivered.  The  child  fell  into  the  fluids  in  the  vessel 
and  before  assistance  could  be  rendered  it  was  dead.  Whether  in  any  in- 
stance the  drowning  of  a  child  was  accidental  or  criminal  must  be  a  ques- 
tion for  a  jury  to  determine  from  all  the  facts  laid  before  them.  The  situa- 
tion in  which  the  body  of  an  infant  is  found  may  be  consistent  with  the 
supposition  of  accident.  Thus  a  child  may  be  accidentally  drowned  by  its 
mouth  falling  into  a  pool  of  the  discharires  during  delivery,  although  this 
would  be  rather  a  case  of  suffocation.  The  throat,  windpipe,  and  stomach 
of  the  child  should  always  be  examined  on  these  occasions,  as  mud,  sticks, 
straw,  weeds,  or  other  substances  may  be  found  in  these  parts,  indicating, 
according  to  circumstances,  that  the  child  had  been  put  into  the  water 
living  and  that  it  had  been  drowned  in  a  particular  pond  or  vessel. 


IMMATURITY    IN    CASES    OF    ABORTION.  575 

3.  Cold  and  Exposure. — A  newborn  child  may  be  easily  destroyed  by 
simply  expu.sing-  it  uncovered  or  but  sliyhtly  covered  to  a  cold  atmosphere, 
la  a  case  of  this  kind  there  may  be  no  marks  of  violence  on  the  body  or 
these  may  be  slii^'ht  and  evidently  of  accidental  origin.  In  death  from 
cold  the  only  appearance  occasionally  met  with  has  been  congestion  of  the 
brain  with  or  without  serous  effusions  in  the  ventricles.  (See  Cold  p.  476, 
ante.)  The  evidence  in  these  cases  must  be  purely  circumstantial.  The 
medical  witness  may  have  to  consider  how  far  the  situation  in  which  the 
body  was  found,  the  kind  of  exposure,  and  the  temperature  of  the  air 
would  suffice  to  account  for  death  from  the  alleged  cause.  There  is  no 
doubt  that  a  newborn  child  may  soon  perish  from  t  xposure  to  a  low  tem- 
perature, and  that  warm  clothing  is  required  for  the  preservation  of  its 
life.  An  inspection  of  the  body  should  never  be  omitted  on  these  occa- 
sions,  because  it  might  turn  out  that  there  was  some  latent  cause  of 
natural  death  which  would  at  once  do  awav  with  the  charge  of  murder. 
Admitting  that  the  child  had  died  from  cold,  it  becomes  necessary  to  in- 
quire whether  it  was  exposed  with  a  malicious  intention  that  it  should 
thus  perish.  Unless  wilful  malice  be  made  out,  the  accused  cannot  be  con- 
victed of  murder,  and  unless  culpable  neglect  is  proved  she  cannot  be  con- 
victed of  manslaughter.  In  general,  women  do  not  expose  their  children 
for  the  purpose  of  destroying  them,  but  for  the  purpose  of  abandoning 
them  ;  hence  it  is  rare  to  hear  of  convictiou  for  child-murder  where  cold 
was  the  cause  of  death,  although  some  medical  jurists  have  called  this 
infanticide  by  omission. 

i.  Starvation. — A  newborn  child  kept  long  without  food  will  die,  and 
no  evidence  of  the  fact  may  be  derivable  from  an  examination  of  the 
body.  There  may  be  no  marks  of  violence  externally  nor  any  patho- 
logical changes  internally  to  account  for  death.  This  is  a  rare  form  of 
murder,  except  as  it  may  be  accidentally  combined  with  exposu>-e  to  cold. 
In  order  to  convict  the  mother  it  is  necessary  to  show  that  the  child  was 
wilfully  kept  without  food  with  the  criminal  design  of  destroying  it. 
Mere  neglect  or  imprudence  will  not  make  the  case  infanticide.  The 
only  appearance  likely  to  be  found  on  an  examination  of  the  body  would 
be  complete  emptiness  of  the  alimentary  canal.  Without  corroborative 
circumstantial  evidence  this  would  not  suffice  to  establish  the  cause  of 
death,  and  a  medical  witness  could  only  form  a  probable  conjecture  on 
the  point.  In  a  suspected  case  of  this  kind  the  contents  of  the  stomach 
should  1)0  tested  for  farinaceous  and  other  kinds  of  food. 

5.  Immaturity  in  Gases  of  Abortion. — From  the  case  of  Reg.  "y.West 
(Nottingham  Lent  Ass.,  18J8)  it  would  appear  that  if  by  the  perpetration 
of  abortion  or  the  criminal  induction  of  premature  labor  a  child  be  born 
living  at  so  early  a  period  of  uterine  life  that  it  dies  merely  from  imma- 
turiti/,  the  person  causing  the  abortion  or  leading  to  the  premature  birth 
may  be  tried  on  a  charge  of  murder.  A  midwife  was  alleged  to  have 
perpetrated  abortion  on  a  female  who  was  between  the  fifth  and  sixth 
months  of  pregnancy.  The  child  was  born  living  but  died  five  hours 
after  its  birth.  There  was  no  violence  offered  to  it,  and  its  death  ap- 
peared to  be  due  entirely  to  its  immaturity.  The  prisoner  was  acquitted 
apparently  on  the  ground  that  abortion  might  have  arisen  from  other 
causes.  In  a  case  of  this  kind  it  must  be  clearly  proved  that  the  child 
survived  its  birth. 

Among  those  causes  of  violent  death  which  leave  on  the  body  of  the 
child  marks  or  appearances  indicative  of  the  cause  may  be  mentioned 
wounds,  strangulation,  and  poisoning. 


576  INJURIES    TO    THE    HEAD. 

6.  Wounds. — This  is  a  frequent  cause  of  death  in  cases  of  child-murder. 
Wounds  may,  however,  be  found  on  the  body  of  a  child  which  has  died 
from  some  other  cause.  The  principal  questions  which  a  medical  witness 
has  to  answer  are  (1)  whether  the  wounds  were  inflicted  on  the  body  of 
the  child  before  or  after  death  ;  (2)  whether  they  were  sufficient  to  account 
for  death  ;  and  (3)  whether  they  resulted  from  accident  or  criminal  design. 
The  child  may  have  been  destroyed  by  burning,  and  evidence  must  then 
be  sought  for  by  an  examination  of  the  state  of  the  skin.  All  these 
questions  have  been  fully  considered  in  treating  the  subject  of  Wounds 
and  Burns,  and  they  therefore  do  not  require  any  special  notice  in  this 
place.  Incised  wounds  found  on  the  bodies  of  newborn  children  may  be 
referred  to  the  use  of  a  knife  or  scissors  by  the  prisoner  in  attempting  to 
sever  the  navel-string,  and  they  may,  therefore,  be  due  to  accident.  This 
point  should  not  be  forgotten,  for  a  wound  even  of  a  severe  kind  might 
be  thus  accidentally  inflicted.  In  such  cases  we  should  always  expect  to 
find  the  navel-string  cut  and  not  lacerated.  The  end  of  it  may,  for  the 
purpose  of  examination,  be  stretched  out  on  a  white  card.  This  will  in 
general  suffice  to  show  whether  it  has  been  cut  or  torn.  Wounds,  how- 
ever slight,  should  not  be  overlooked ;  minute  punctures  or  incisions  ex- 
ternally may  correspond  to  deep-seated  injury  of  vital  organs.  The  spinal 
marrow  is  said  to  have  been  wounded  by  needles  or  stilettoes  introduced 
between  the  vertebraj,  the  skin  having  been  drawn  down  before  the  wound 
was  inflicted  in  order  to  give  to  it  a  valvular  character,  and  to  render  it 
apparently  superficial.  The  brain  is  also  said  to  have  been  wounded  by 
similar  weapons  either  through  the  nose  or  the  thinner  parts  of  the  skull 
(the  fontanelles).  Hence  in  examining  the  head  of  a  newborn  child  to 
determine  the  cause  of  death  it  is  always  necessary  to  observe  the  state 
of  the  fontanelles.  Children  have  been  destroyed  by  small  punctures 
made  through  these  membranous  coverings.  Fatal  wounds  of  the  brain 
have  been  thereby  produced.     (Ann.  d'Hyg.,  1878,  t.  2,  p.  498.) 

In  some  instances  the  body  of  a  child  is  found  cut  to  pieces,  and  the 
allegation  in  defence  may  be  that  the  child  was  stillborn,  and  the  body 
thus  treated  merely  for  the  purpose  of  concealment.  Toulmouche  has  re- 
ported a  case  of  this  kind,  which  was  the  subject  of  a  trial.  As  the  woman 
had  not  destroyed  the  lungs,  experiments  on  these  organs  gave  satisfactory 
results  of  complete  respiration.  The  cavities  of  the  hean  and  great  vessels 
were  empty ;  the  body  was  generally  drained  of  blood,  and  the  skin 
throughout  very  pale.  This  led  to  the  inference  that  the  mutilations  must 
have  been  inflicted  while  the  child  was  living ;  and  as  all  the  parts  were 
healthy,  and  no  natural  cause  of  death  was  apparent,  Toulmouche  ascribed 
the  death  of  the  child  to  the  wounds.  The  woman  was  convicted.  (Ann. 
d'Hyg.,  1853,  t.  2,  p.  200.)  In  this  country  she  would  probably  have 
escaped  under  a  verdict  of  "  concealment  of  birth." 

Injuries  to  the  Head. — It  has  been  elsewhere  stated  that,  during  a  pro- 
tracted delivery,  there  is  formed  on  the  head  of  a  child  a  tumor  containing 
either  serum,  blood,  or  a  mixture  of  the  two.  If  a  woman  has  been  secretly 
delivered,  non-professional  persons  may  ascribe  a  tumor  of  this  kind  to 
violence,  whereas  it  may  really  have  been  produced  by  natural  causes. 
The  tumor  is  generally  situated  on  one  of  the  parietal  bones,  its  situation 
depending  on  that  part  of  the  head  which  presents  during  delivery.  After 
the  discharge  of  the  v.-aters,  the  scalp  is  firmly  compressed  by  the  mouth 
of  the  womb,  and  subsequently  by  the  os  externum.  This  pressure  inter- 
feres with  the  circulation  through  the  skin,  and  causes  the  compressed 
portion  of  the  scalp  to  swell.  In  the  simplest  form  of  this  tumor,  serum 
only  is  found  in  the  swollen  part,  outside  the  pericranium  or  membrane 


FRACTURES  OF  THE  SKULL.  577 

covering-  the  bone,  and  is  tei-med  Caput  succedaneum :  occasionally  this  is 
mixed  with  blood,  and  there  are  small  ecchymoses  of  the  scalp,  as  well  as 
of  the  pericranium  and  skull,  hut  there  is  generally  no  injury  to  the  bones, 
nor  is  there  any  laceration  of  the  skin  externally.  In  other  cases  blood  is 
found  effused  in  the  tumor  under  the  membrane  covering  the  skull.  The 
term  Gephalsematoma  is  applied  to  a  tumor  which  has  this  natural  origin 
(p.  564,  ante).  The  sanguineous  is  more  likely  to  be  confounded  with  the 
effects  of  violence  than  the  serous  tumor ;  but  it  may  be  identified  by  the 
scalp  being  always  uninjured,  although  it  may  present  redness  and  lividity. 
Violence  from  blows  or  falls  which  would  produce  effusions  of  blood  be- 
neath the  scalp,  or  within  the  skull,  would  in  general  be  indicated  by 
injury  to  the  skin  or  by  fracture  of  the  bones. 

The  only  injuries  to  the  head  which  require  to  be  specially  considered 
in  relation  to  infanticide  a,ve  fractures  of  the  skull :  and  here  the  question 
to  which  we  may  chiefly  confine  our  attention  is  whether  the  fracture  arose 
from  accident  or  criminal  violence.  The  rules  for  determining  v/hether 
these  injuries  were  inflicted  during  life  or  after  death  have  been  elsewhere 
considered.  (See  Wounds,  pp.  241,  354.)  Although  it  has  been  a  matter 
of  frequent  observation  that  great  violence  may  be  done  to  the  head  of  a 
child  during  parturition  without  necessarily  giving  rise  to  fracture,  yet  it 
is  placed  beyond  all  doubt  that  such  an  injury  may  occur  by  the  expulsive 
efforts  of  the  womb  in  forcing  the  head  of  a  child  against  the  bones  of  the 
pelvis.  Even  the  violent  compression  which  the  head  sometimes  experi- 
ences in  passing  the  mouth  of  the  womb  may  suffice  for  the  production  of 
fracture,     (See  Edin.  Med.  and  Surg.  Jour.,  vol.  xxvi.  p.  75.) 

It  was  formerly  supposed  that  fractures  of  the  skull  in  newborn  children 
were  always  indicative  of  criminal  violence  ;  but  cases  which  have  occurred 
in  obstetric  practice  have  established  the  certainty  of  their  accidental 
occurrence.  These  accidental  fractures,  it  is  to  be  observed,  are  generallv 
slight;  they  commonly  amount  merely  to  fissures  in  the  bones,  beginning 
at  the  sutures  and  extending  downwards  for  about  an  inch  or  less  into  the 
body  of  the  bone.  According  to  Weber,  the  frontal  and  parietal  bones 
are  the  only  bones  liable  to  be  fissured  or  fractured  by  the  action  of  the 
w^omb  during  delivery ;  and  in  the  greater  number  of  cases  reported,  the 
parietal  bones  only  have  presented  marks  of  fracture.  The  possible 
occurrence  of  an  injury  of  this  kind  as  the  result  of  uterine  action  has  been 
strained,  in  several  cases  of  child-murder,  to  explain  the  origin  of  fractures 
which  could  not  fairly  or  reasonably  be  assigned  to  such  an  accident.  A 
case  was  tried  at  Glasgow,  in  April,  1852  (case  of  Ann  Irvin),  in  which 
there  was  no  doubt,  from  the  state  of  the  lungs,  that  the  child  had  fully 
breathed,  and  there  was  violence  to  the  head  which  satisfactorily  accounted 
for  its  death.  The  whole  of  the  right  side  of  the  head  was  deeply  ecchy- 
mosed,  and  there  was  a  large  quantity  of  coagulated  blood  lying  beneath 
the  scalp.  In  the  centre  of  the  right  parietal  bone  there  was  a  fracture  ex- 
tending across  the  vertex  for  fully  four  inches,  and  involving  a  part  of  the 
parietal  bone  on  the  opposite  side  ;  it  was  in  a  continuous,  even  line,  not 
radiated  and  not  depressed.  The  pericranium,  bones,  and  soft  parts  in  the 
track  of  the  fracture  were  deeply  ecchymosed,  while  on  the  surface  of  the 
brain,  particularly  on  the  right  side,  there  was  a  copious  eifusion  of  clotted 
blood.  It  was  impossible  to  refer  severe  injuries  of  this  kind  to  the  action 
of  the  womb  in  delivery,  or  to  violence  applied  after  death.  The  prisoner 
alleged  that  the  child  was  stillborn. 

Accidental  fractures  and  effusions  of  blood  which  are  caused  by  uterine 
action  may  be  in  general   recognized  by  their  slight  extent.     In  cases  of 
murder  by  violence  to  the  head  the  injuries  are  commonly  much  more 
37 


578  ACCIDENTAL    FRACTURES. 

severe:  the  bones  are  driven  in,  the  brain. protrudes,  and  the  scalp  is  ex- 
tensively lacerated.  Such  severe  injuries  as  these  cannot  be  ascribed  to 
the  action  of  the  womb  in  parturition.  Here,  however,  it  may  be  fairly 
urged  that  the  woman  was  unexpectedly  seized  with  labor,  that  the  child 
was  expelled  suddenly  by  the  violent  efforts  of  the  womb,  and  that  the 
injuries  might  have  arisen  from  its  bead  coming  in  contact  with  some 
hard  surface — as  a  floor  or  pavement.  It  must  be  admitted  that  a  woman 
may  be  thus  suddenly  and  unexpectedly  delivered  while  in  the  erect  pos- 
ture, although  this  is  not  common  among  primiparous  women  ;  and  that 
injuries  may  be  thus  accidentally  produced  on  the  head  of  a  child. 

A  woman  is  often  unable  to  distinguish  the  sense  of  fulness  produced 
by  the  descent  of  a  child  from  the  feeling  which  leads  her  to  suppose  that 
she  is  about  to  have  a  stool ;  and  thus  it  is  dangerous,  when  a  labor  has 
advanced,  to  allow  a  woman  to  yield  to  this  feeling,  for  there  is  nothing 
more  probable  than  that  the  child  will  be  suddenly  born.  Rankin  reported 
two  cases  of  this  description  where  there  could  not  be  the  slightest  suspi- 
cion of  criminality.  In  one,  a  primipara,  the  child  was  actually  born  under 
these  circumstances,  but  its  life  was  fortunately  saved  :  had  there  been  no 
other  convenience  but  a  privy  it  must  have  been  inevitably  lost.  In  the 
second,  although  a  case  of  third  pregnancy,  the  female  was  equally  deceived 
by  her  sensations.  (Edin.  Month.  Jour.,  Jan.  1843,  p.  ]1.)  It  is  true  that 
this  alleged  mistaken  sensation  forms  a  frequent  and  specious  defence  on 
charges  of  child-murder ;  but  still  a  medical  jurist  is  bound  to  admit  that 
this  accident  may  occur  to  women  without  necessarily  implying  guilt. 

The  following  case  shows  that  a  fracture  of  the  skull  of  a  child  may 
occur  when  a  woman  is  delivered  in  the  erect  posture.  In  this  instance 
there  was  merely  the  appearance  of  a  bruise  on  the  head,  and  the  navel- 
string  was  ruptured  (not  cut)  three  inches  from  the  navel.  The  child  did 
not  suffer  from  the  fall,  and  continued  well  until  six  days  after  its  birth, 
when  it  was  seized  with  convulsions  and  died.  A  fissure  of  about  an  inch 
and  a  half  in  length  was  found  in  the  upper  part  of  the  left  parietal  bone. 
A  clot  of  blood  was  found  in  this  situation  between  the  dura  mater  and 
bone,  and  there  was  congestion  of  the  vessels  of  the  membranes  ;  but 
with  this  exception  there  was  no  morbid  appearance  in  the  body.  (Assoc. 
Jour.,  Oct.  1853,  p.  901.)  Porter  Smith  communicated  to  the  author  a 
case  in  which  the  facts  were  similar  to  those  above  related.  In  conse- 
quence of  the  concealment  of  the  body,  however,  the  mother  w-as  charged 
with  murder.  The  right  parietal  bone  was  fractured,  and  there  was  effu- 
sion of  blood  internally,  but  there  was  no  mark  of  external  violence.  The 
cord  had  been  ruptured  at  a  distance  of  two  inches  and  a  half  from  the 
navel.  The  stomach  of  the  child  contained  the  usual  albuminous  and 
mucous  matters  of  the  fcetal  state,  without  any  appearance  of  food.  The 
lungs  contained  air,  and  were  highly  crepitant ;  the  foramen  ovale  and 
the  ductus  arteriosus  were  in  their  foetal  condition.  The  child  had  prob- 
ably been  drowned  in  the  discharges  from  want  of  assistance  at  the  time 
of  birth.  The  woman,  who  admitted  that  the  child  had  fallen  from  her 
suddenly,  was  acquitted.  Olshausen  published  four  cases  of  sudden  de- 
livery, in  each  of  which  the  child  dropped  from  the  woman,  and  in  two  of 
them  there  were  fissures  in  the  parietal  bones.  The  children  recovered 
from  the  effects  of  the  accidents.  (Med.  Times  and  Gaz.,  18fi0,  ii.  p.  219; 
Amer.  Jour.  Med.  Sci.,  1861,  p.  279.)  Other  cases  of  rapid  delivery  in 
the  erect  posture  are  reported  in  the  Lancet  (1861,  i.  p.  13).  In  these 
there  was  no  injury  to  the  child,  although  in  one  case  the  delivery  took 
place  on  the  deck  of  a  vessel. 

A  medical  witness  would  find  no  difficulty  in  determining  the  proba- 


POWER    OF    EXERTION    AFTER    DELIVERY.  579 

bility  of  this  explanation  of  the  accidental  origin  of  such  fractures,  if  he 
were  made  acquainted  with  all  the  facts  connected  with  the  delivery.  But 
the  acquisitiou  of  this  knowledi,re  must  be  accidental ;  and  it  will  in  gen- 
eral be  out  of  his  power  to  obtain  it.  When  the  fractures  are  accom- 
panied by  cuts,  punctures,  or  lacerations  of  the  scalp  or  face,  although 
their  production  might  be  accounted  for  by  an  alleged  fall  during  parturi- 
tion, the  cause  of  these  wounds  would  still  remain  to  be  explained.  In 
fractures  of  the  bones  of  the  head  in  newborn  children  the  presence  of 
effusions  of  blood  on  the  outside  of  the  skull,  or  on  the  membranes  within, 
is  one  of  the  most  common  appearances.  Effusions  of  blood  beneath  the 
skin  of  the  scalp  are  by  no  means  uncommon  in  newborn  children,  and  are 
not  necessarily  indicative  of  criminal  violence.  Each  case,  however,  must 
be  decided  by  the  circumstances  attending  it.  Effusions  on  the  membranes 
and  in  the  substance  of  the  brain  are  generally  the  result  of  great  violence 
to  the  head.     (See  Tardieu,  L'Enfanticide,  p.  133.) 

Ttuisting  of  the  Neck. — Children  are  sometimes  destroyed  in  the  act  of 
birth  by  the  neck  being  forcibly  twisted,  whereby  a  displacement  of  ths 
vertebrae  of  the  neck,  with  injury  to  the  spinal  marrow,  may  occur  and 
destroy  life.  Such  injuries  are  immediately  discovered  by  an  examination 
of  the  bod}^.  It  should  be  remembered  that  the  neck  of  a  child  is  very 
short,  and  that  it  always  possesses  considerable  mobility. 

Destruction  by  Fire. — Newborn  children  are  sometimes  destroyed  by 
placing  tbeir  bodies  in  a  fierce  fire.  The  result  of  this  is  that  only  charred 
flesh  with  white  fragments  of  burnt  bones  may  be  found.  In  one  case  the 
body  of  a  child  was  found  in  a  saucepan,  boiled.  It  was  here  a  question 
whether  it  had  been  put  in  living  or  dead  (see  p.  368.) 

Violence  in  Self-delivery . — When  the  marks  of  violence  found  on  the 
head,  neck,  or  body  of  a  child  cannot  be  easily  referred  to  uterine  action 
or  to  an  accidental  fall,  it  is  common  to  ascribe  them  to  the  efforts  made 
by  a  woman  in  her  attempts  to  deliver  herself — the  destruction  of  the 
child  being  an  accidental  result  of  these  efforts.  A  medical  opinion  in 
such  cases  must  depend  upon  the  nature,  situation,  and  extent  of  the  in- 
juries; and  each  case  must  be  therefore  decided  by  the  circumstances  at- 
tending it.  A  medical  witness,  however,  should  always  be  prepared  to 
allow  that  a  woman  at  the  time  of  her  delivery,  owing  to  pain  and 
anxiety,  may  be  deprived  of  judgment,  and  may  destroy  her  offspring 
without  being  conscious  of  w^hat  she  is  doing.  It  is,  therefore,  a  sound 
principle  of  law  that  mere  appearances  of  violence  on  a  child's  body  are 
not  per  se  sufficient,  unless  there  is  some  evidence  to  show  that  the  yio- 
lence  was  knowingly  and  intentionally  inflicted,  or  the  appearances  are  of 
such  a  kind  as  of  themselves  to  indicate  intentional  homicide. 

Power  of  Exertion  in  recently  delivered  Women. — On  these  occasions, 
a  witness  will  often  find  himself  questioned  respecting  the  strength  or 
capability  for  exertion  evinced  by  the  lower  class  of  women  shortly  after 
childbirth.  Alison  remarks  that  many  respectable  medical  practitioners, 
judging  only  from  what  they  have  observed  among  the  higher  ranks,  are 
liable  to  be  led  into  an  erroneous  opinion,  which  may  affect  their  evidence. 
He  mentions  a  case  in  which  a  woman  accused  of  child-murder  walked  a 
distance  of  twenty-eight  miles  in  a  single  day,  with  her  child  on  her  back, 
two  or  three  days  after  her  delivery.  (Case  of  Anderson,  Aberdeen 
Spring  Circ,  1829.)  Instances  have  even  occurred  in  which  women 
have  walked  six  and  eight  miles,  on  the  very  day  of  their  delivery,  with- 
out sensible  inconvenience.  In  one  case  (Sn)ith,  Ayr  Spring  Circ,  1824), 
the  woman  was  engaged  in  reaping;  she  retired  to  a  little  distance, 
effected  her  delivery  by  herself,  and  went  on  with  her  work  for  the  re- 


580  POWER    OF    EXERTION    AFTER    DELIVERY. 

mainder  of  the  day,  appearing-  only  a  little  thinner  and  paler  than  usual. 
In  Keg.  V.  Stowler  (Wells  Aut.  Ass.,  1865),  two  witnesses  proved  that 
the  prisoner,  who  was  tried  for  the  murder  of  her  child,  was  at  work  with 
them  in  a  field  al)Out  800  yards  from  a  pond  in  which  the  body  was  after- 
wards found.  They  lelt  the  prisoner  weeding,  returned  in  about  an  hour, 
and  she  was  not  then  in  the  field.  After  a  time  she  returned,  sat  on  a 
bank,  and  then  resumed  her  work.  The  witnesses  noticed  that,  on  her 
return,  there  was  a  great  difference  in  her  appearance.  In  this  short  in- 
terval she  had  been  delivered,  had  disposed  of  the  body  of  the  child,  and 
resumed  her  work,  as  if  nothing  had  happened.  A  firm  resolution,  with  a 
desire  to  conceal  her  shame,  may  enable  a  woman,  immediately  after  her 
delivery,  to  perform  acts  connected  with  the  disposal  of  the  bod}^  of  her 
child  which,  from  ordinary  experience,  might  appear  to  be  far  beyond  her 
strength. 

In  Reg.  V.  May  (Exch.  Ct.,  May,  185T),  for  concealment  of  birth,  it 
was  proved  that  the  prisoner,  a  domestic  servant,  had  been  sent  to  market 
with  some  poultry.  On  her  return,  she  asked  the  boy  who  drove  the  cart 
to  stop.  He  did  so  ;  she  got  out,  went  to  a  recess  in  the  hedge  by  the 
side  of  the  road,  in  five  minutes  was  observed  following  the  cart,  and 
walked  home,  a  distance  of  a  mile  and  a  half.  She  went  about  her  usual 
work  on  that  and  the  following  day.  The  woman  had  been  delivered  of 
a  child  in  the  recess,  and  it  was  subsequently  found  there.  One  witness 
heard  it  cry,  but  it  soon  died. 

Conclusioris. — The  conclusions  to  be  derived  from  the  contents  of  this 
chapter  are — 

1.  That  a  newborn  child  may  die  from  violent  causes  of  an  accidental 
nature. 

2.  That  some  forms  of  violent  death  are  not  necessarily  attended  with 
external  signs  indicative  of  violence. 

8.  That  a  child  may  be  accidentally  suffocated  during  delivery. 

4.  That  the  usual  maiks  of  death  from  suffocation  or  drowning  are  not 
apparent,  except  in  the  bodies  of  children  which  have  breathed. 

5.  That  the  state  of  the  navel-string  may  often  furnish  important 
evidence. 

6.  That  a  newborn  child  may  speedily  die  from  exposure  to  cold  or  from 
want  of  food. 

T,  That  slight  fractures  of  the  bones  of  the  cranium  may  arise  from  the 
action  of  the  womb  on  the  head  of  the  child  during  delivery. 

8.  That  women  may  be  unexpectedly  delivered  while  in  an  erect  posture ; 
the  cord  is  under  these  circumstances  sometimes  ruptured,  and  the  child 
may  sustain  injury  by  the  fall. 

0.  That  the  violence  found  on  the  body  of  a  child  may  be  sometimes 
referred  to  attempts  innocently  made  by  a  woman  to  aid  her  delivery. 

10.  That  some  women  recently  delivered  may  have  sufficient  strength 
to  exert  themselves  and  walk  great  distances. 


iMFA:NTicii)E — :>tka:sgulation.     .  651 


CHAPTER   LIV. 

DUATH  OF  THE  CHILD   FROM    STRAXOrLATION. STRANGULATION  BY    THE  NAVEL-STRING. AC- 
CIDENTAL   MARKS    RESEMBJ.ING    THOSE    OF    STRANGULATION. CONSTRICTION     BEFORE    AND 

AFTER    DEATH. BEFORE    AND    AFTER    BREATHING. BEFORE  AND    AFTER    THE    SEVERANCE 

OF  THE  NAVEL-STRING. EXAMINATION  OF  WOMEN. MEDICAL  RESPONSIBILITY. 

Among  the  forms  of  violent  death  which  are  generally  attended  with 
appearances  indicative  of  criminal  design,  are  the  following: — 

T.  Strangulation. — The  destruction  of  a  newborn  child  by  strangula- 
tion is  not  an  unfrequent  form  of  child-murder;  and  here  a  medical  jurist 
has  to  encounter  the  difficulty  that  the  strangulation  may  have  been  acci- 
dentally produced  during  delivery,  by  a  twisting  of  the  navel-string  round 
the  neck.  We  must  not  hastily  conclude,  from  the  red  and  swollen  appear- 
ance of  the  head  and  face  of  a  child  when  found  dead,  that  it  has  been 
destroyed  by  strangulation.  There  is  no  doubt  that  errors  were  formerly 
made  with  respect  to  this  appearance  ;  for  W.  Hunter  observed,  "  When 
a  child's  head  or  face  looks  swollen,  and  is  very  red  or  black,  the  vulgar, 
because  hanged  people  look  so,  are  apt  to  conclude  that  it  must  have  been 
strangled.  But  those  who  are  in  the  practice  of  midwifery  know  that 
there  is  nothing  more  common  in  natural  births,  and  that  the  swelling  and 
deep  color  go  gradually  off  if  the  child  live  but  a  few  days.  This  appear- 
ance is  particularly  observable  in  those  cases  in  which  the  navel-string 
happens  to  gird  the  child's  neck,  and  where  its  head  happens  to  be  born 
some  time  before  its  body." 

Strangulation  by  the  navel-string  can,  of  course,  refer  to  those  cases 
only  in  which  it  becomes  firmly  twisted  round  the  neck  after  the  child 
has  breathed.  This  is  rather  a  rare  occurrence,  because  under  these  cir- 
cumstances death  more  commonly  takes  place  by  compression  of  the  cord, 
and  by  the  con.sequent  arrest  of  circulation,  before  the  act  of  breathing  is 
performed.  The  only  internal  appearance  met  with  in  death  from  this 
cause  is  a  congested  state  of  the  cerebral  vessels,  and  ecchymoses.  The 
presence  of  ecchymosis  on  the  scalp,  as  well  as  of  lividity  of  the  face,  is 
very  conimoa  in  newborn  children  when  the  labor  has  been  tedious  and 
difficult ;  a:id,  therefore,  unless  there  were  some  distinct  marks  of  pressure 
about  the  neck,  with  a  protrusion  of  the  tonsrue,  such  appearances  would 
not  justify  a  suspicion  of  death  from  strangulation. 

It  has  been  supposed  that  the  strangulation  produced  by  the  wilful 
application  of  any  extraneous  constricting  force  to  the  neck  would  be 
known  from  the  accidental  strangulation  caused  by  the  cord,  by  the  fact 
that,  in  the  former  case,  there  would  be  a  livid  or  ecchymosed  mark  or 
depression  on  the  neck,  while  in  the  latter  there  would  not.  Severe 
violence  to  the  neck  of  a  newborn  child  may  produce  in  the  seat  of  con- 
striction not  only  ecchymosis,  but  a  laceration  of  the  skin,  muscles,  and 
windpipe  ;  but  these  appearances  are  not  always  present  even  in  homicidal 
strangulation.  Evans  communicated  to  the  author  the  particulars  of  the 
case  of  a  newborn  child  which  had  been  destroyed  by  strangulation.  Great 
violence  had  been  used,  but  there  was  no  trace  of  discoloration  in  the 
course  of  the  ligature,  or  of  ecchymosis  in  the  tissues  beneath.  The 
muscles   compressed  were  very  dark  in  color.     In    most  cases,  when   a 


582  STRA:SGULATI0N    by    the    NAVEL-STRINa. 

ligature  is  applied  to  the  neck  during  life,  the  skin  above  and  below  it  be- 
comes much  swollen  and  presents  an  cedematous  character.  This  indicates 
an  application  of  violence  when  there  is  still  some  vital  power  in  the  body 
of  tlie  child. 

The  navel-string  itself  may  be  the  means  of  constriction,  and  the  mark, 
or  depression  may  sometimes  present  an  appearance  of  ecchymosis. 
^mong  various  cases  which  might  be  quoted  in  support  of  this  statement, 
is  the  following  :  In  1846  Foster  was  summoned  to  attend  a  lady  in  labor 
with  her  first  child.  The  labor  was  a  lingering  one,  owing  to  the  size  of 
the  head  ;  and  the  child  came  into  the  world  dead.  The  navel-string  was 
found  coiled  three  times  round  the  neck,  passing  under  the  right  armpit ; 
and  upon  removing  it  three  parallel  discolored  depressions  were  distinctly 
evident.  These  extended  completely  round  the  neck,  and  corresponded  to 
the  course  taken  by  the  coils.  The  child  appeared  as  if  it  had  been 
strangled  (Lond.  Med.  Gaz.,  vol.  xxxvii.  p.  485.)  Had  this  child  been 
born  secretly,  this  state  of  the  neck  might  have  created  a  strong  suspicion 
of  homicidal  violence.  Strangulation  after  birth  could  not,  however,  have 
been  alleged,  because  there  would  have  been  no  proof  of  respiration.  When 
a  blue  mark  is  found  on  the  neck  of  a  child  whose  lungs  retain  their  foetal 
characters,  it  is  fair  to  presume,  cseteris  paribus,  that  it  has  been  acciden- 
tally occasioned  by  the  twisting  of  the  navel-string  during  delivery. 
Price  communicated  to  the  same  journal  the  account  of  a  case  in  which 
the  cord,  which  was  short,  was  so  tightly  twisted  around  the  neck  of  a 
child  that  he  was  compelled  to  divide  it  before  delivery  could  be  accom- 
plished. There  was  in  this  instance  a  deep  groove  formed  on  the  neck, 
conveying  the  impression  to  himself  and  another  medical  man  that,  in  the 
absence  of  any  knowledge  of  the  facts,  they  would  have  been  prepared  to 
say  that  the  child  had  been  wilfully  strangled  by  a  rope.  (Lond.  Med. 
Gaz.,  vol.  xxxviii.  p.  40.)  A  diagnosis  might  have  been  formed,  as  in  the 
preceding  case,  by  examining  the  state  of  the  lungs.  Mutter  met  with  a 
case  in  which  a  child  was  born  dead,  and  the  cord  was  tightly  twisted 
round  its  neck  ;  when  removed,  the  neck  exhibited  a  livid  circle  of  a  finger's 
l>readth,  smooth  and  shining ;  but  on  cutting  into  this  mark  no  ecchy- 
mosis was  found.  (Xorth.  Jour.  Med.,  1845,  p.  190.)  In  Leg.  v.  Martin 
(Lewes  Lent  Ass.,  1860),  the  material  question  was  whether  a  mark  round 
the  neck  had  been  caused  accidentally  by  the  navel-string ;  this  was  denied 
l»y  the  medical  witness.  A  similar  question  also  arose  in  another  im- 
portant case,  Reg.  v.  Pyne  (Gloucester  Winter  Ass.,  1858). 

Williamson  has  directed  attention  to  an  important  fact  connected  with 
the  state  of  the  lungs  in  a  newborn  child,  and  the  medical  opinions  which 
may  be  expressed  from  their  condition  as  furnishing  evidence  of  live  birih. 
Pvcferring  to  Price's  ease  (svpra),  in  which  the  cord  was  tightly  twisted 
round  the  neck  of  the  child,  he  states  that  in  similar  cases  which  have 
occurred  to  himself,  the  child  has  breathed  immediately  on  the  birth  of  the 
head ;  but,  owing  to  the  shortness  of  the  cord,  the  child  would  have  been 
strangled  and  born  dead  unless  he  had  divided  it.  Thus,  then,  a  child 
might  die  apparently  strangled,  and  not  be  born  alive,  although  it  might 
have  so  breathed  during  birth  that  the  lungs  would  present  the  usual 
characters  of  respiration.  If  the  circumstances  were  not  known,  a  medical 
man  mijrht  be  led  to  say  that  the  child  had  been  born  alive  and  had  been 
destroyed  by  .strangulation.  (Edin.  Med.  Jour.,  1858,  p.  714.)  The  proof 
of  respiration,  as  it  has  been  elsewhere  stated,  is,  however,  not  necessarily 
a  proof  of  live  birth.  From  these  cases  it  will  be  perceived  that  ecchy- 
mosis in  the  depression  on  the  nock  furnishes  no  distinction  between  con- 
striction produced  by  criminal  means,  and  that  which  may  result  acciden- 


STRANGULATION    BY    THE    NAVEL-STRING.  683 

tally  from  the  navel-string.  In  the  following-  case  (Ann.  d'Hyg.,  1841,  t. 
1,  p.  127),  a  woman  charged  with  the  murder  of  her  child  by  strangulation 
appears  to  have  been  unjustly  condemned.  The  child  had  fully  and 
perfectly  breathed  ;  the  lungs  weighed  one  thousand  grains,  and,  when 
divided,  every  portion  floated  on  water,  even  after  firm  compression. 
There  was  a  circular  depression  on  the  neck,  which  was  superficially 
ecchymosed  in  some  parts.  From  an  investigation  of  the  facts,  this  ap- 
peared to  have  been  a  case  in  which  a  mark  on  the  neck  was  accidentally 
produced  by  the  cord  during  attempts  at  self-delivery  on  the  part  of  the 
woman  ;  she  was,  nevertheless,  convicted,  chiefly  from  the  opinion  ex- 
pressed by  two  medical  witnesses,  that  a  soft  and  yielding  substance  like 
the  cord  could  not  produce  a  depression  and  ecchymosis  on  the  neck  of  a 
child  during  birth.  They  attributed  the  mark  to  the  wilful  application  of  ■ 
a  ligature  like  a  garter ;  but  the  experiments  of  Ne'grier  clearly  show  that 
the  navel-string  has  sufficient  strength  to  produce  a  mark,  and  with  it  a 
fatal  constriction. 

In  the  same  volume  of  the  Ann.  d'Hyg.  (at  p.  428)  will  be  found  the 
report  of  another  case,  suggesting  many  important  reflections  in  regard  to 
the  medical  jurisprudence  of  infanticide.  In  this  instance  the  navel-string 
and  the  membranes  were  actually  used  by  a  woman  as  a  means  of  strangu- 
lation ;  the  child  had  not  breathed,  but  was  by  this  act  of  violence  pre- 
vented from  breathing.  There  was  superficial  ecchymosis  on  each  side 
over  the  muscles  of  the  neck.  The  defence  was  that  the  child  was  born 
with  the  cord  around  its  neck,  and  that  it  was  from  this  circumstance  acci- 
dentally strangled;  but  the  medical  evidence  tended  to  show  that  the  cord 
had  been  violently  stretched  and  employed  as  a  means  of  strangulation. 
The  child  had  not  breathed,  and  the  medical  witnesses  considered  that  it 
had  been  born  dead,  owing  to  the  violence  used  by  the  woman.  The  cause 
of  death  here  was  certainly  not  strangulation,  but  arrested  circulation.  In 
the  mean  time,  the  case  proves  that  ecchymosis  (a  blue  mark)  may  be  the 
result  of  violent  constriction  produced  by  the  navel-string.  A  case  oc- 
curred to  M'Cann,  in  which  the  navel-string,  which  was  of  its  full  length, 
had  been  also  used  as  the  means  of  strangulation.  It  was  twisted  once 
round  the  neck,  passed  under  the  left  arm,  over  the  shoulders,  and  round 
the  neck  again,  forming  a  noose  or  knot,  which,  pressing  upon  the  throat, 
must  have  caused  strangulation,  as  the  tongue  was  protruded,  and  there 
were  other  clear  indications  of  the  child  having  been  strangled.  The 
hydrostatic  test  applied  to  the  lungs  proved  that  respiration  had  been  per- 
formed. 

When  the  mark  on  the  neck  is  deep,  broad,  much  ecchymosed,  and  there 
is  extravasation  of  blood  beneath,  with  injury  to  the  muscles  or  windpipe, 
and  ruffling  or  laceration  of  the  skin,  it  is  impossible  to  attribute  these 
appearances  to  accidental  compression  by  the  navel-string.  The  lividity 
produced  by  it  in  the  cases  hitherto  observed  has  been  only  slight  and  par- 
tial, and  unaccompanied  by  laceration  of  the  skin  or  injury  to  deep-seated 
parts.  On  the  other  hand,  as  much  more  violence  is  commonly  used  in 
homicidal  stranirulation  than  is  necessary  for  destroying  life,  we  may  ex- 
pect to  find  great  ecchymosis  and  exten.sive  injury  to  the  surrounding  soft 
parts.  On  some  occasions  all  difficulty  is  removed  by  the  discovery  of  a 
ligature  tied  tightly  round  the  neck  ;  or,  if  this  be  not  found,  the  proofs 
of  some  ligature  having  been  used  will  be  discovered  in  the  indentations 
or  irregularly  ecchymosed  spots  left  on  the  skin — the  depressed  portions 
of  skin  being  generally  white  and  the  raised  edges  livid  or  cedematous. 

It  has  been  doubted  whether  a  child  can  be  born  with  the  navel-strino: 
so  tightly  round  the  neck  as  to  produce  great  depression  of  the  skin  and 


58-1:  MARKS    ON    THE    NECK. 

ecchymosis,  i.  e.  to  simulate  homicidal  strangulation,  and  at  the  same  time 
perform  the  act  of  respiration  tully  and  completely.  It  is  important,  there- 
fore, when  this  hypothesis  is  raised  in  order  to  account  for  a  suspicious 
mark  on  the  neck,  to  examine  closely  the  state  of  the  lungs.  Unless  the 
cord  be  designedly  put  round  the  neck  of  the  child  after  the  head  has  pro- 
truded, the  effect  of  the  expulsive  efforts  of  the  womb,  when  a  coil  has 
become  acczWe??^aZ/v  twisted  round  the  neck,  would  be  to  tighten  the  cord, 
compress  the  vessels,  and  kill  the  child  by  arresting  the  maternal  circula- 
tion, at  the  same  time  that  this  pressure  would  effectually  prevent  the  act 
of  breathing.  Hence  the  lungs  usually  present  the  appearances  met  with 
in  stillborn  children  generally;  but  the  case  which  occurred  to  William- 
son (p.  582)  shows  that  this  state  of  things  may  sometimes  occur,  and 
that  a  child  may  breathe  and  die  strangled  by  the  cord  before  its  body  is 
entirely  born.  Medical  witnesses,  however,  should  not  be  too  ready  to 
accept  such  a  suggestion  ;  a  careful  examination  of  the  neck  will  generally 
show  whether  a  ligature  has  or  has  not  been  wilfulh"  applied  after  birth. 
In  Reg.  V.  Robinson  (Lewes  Sum.  Ass.,  1853),  there  was  around  the  neck 
the  mark  of  a  ligature  which  had  been  tied  very  tightly.  The  child  had 
fully  breathed,  and,  according  to  the  medical  evidence,  it  had  died  from 
strangulation  owing  to  an  accidental  twisting  of  the  cord  during  delivery. 
In  examining  a  suspicious  mark  on  the  neck  of  a  newborn  infant,  it  should 
be  noticed  whether  it  does  not,  by  its  form  or  course,  present  some  pecu- 
liar indentations  which  may  render  it  certain  that  a  ligature  has  been 
wilfully  employed  after  birth.  When  it  is  found  that  a  child  has  fully 
breathed,  the  presence  of  a  deepl}''  ecchymosed  or  an  oedematous  mark  on 
the  neck,  with  injurv  to  the  skin  and  muscles,  is,  cseteris  paribus,  pre- 
sumptive of  homicidal  strangulation.  Death  from  accidental  constriction 
of  the  cord  during  delivery  should,  as  a  general  rule,  leave  the  lungs  in 
their  foetal  condition. 

Marks  on  the  neck  of  a  child  may  be  accidentally  produced  by  the  navel- 
string  without  necessarily  destroying  the  child's  life.  Two  cases  of  this 
kind  are  reported  by  Busch  (Brit,  and  For.  Med.  Rev.,  vol.  x.  p.  579) ; 
and  a  child  may  be  destroyed  w'ithout  ecchymosis  being  a  necessary  con- 
sequence of  the  constriction  produced  by  it.  There  is  much  less  risk  of 
strangulation  from  twisting  of  the  cord  during  birth  than  is  commonly 
believed.  Out  of  190  cases,  Churchill  found  the  cord  round  the  neck  in 
fifty-two  children,  and  the  shortest  cord  so  disposed  was  eighteen  inches 
long;  Kegrier  found  it  round  the  neck  in  twenty  cases  out  of  166  natural 
labors.     (Ann.  d'Hyg.,  1841,  t.  1,  p.  137.) 

The  appearances  met  with  in  the  body  in  death  from  strangulation  have 
been  elsewhere  fully  considered  (p.  411,  ante).  The  facts  of  a  case  com- 
municated to  the  author  by  Cann  will,  however,  serve  to  show  the  ap- 
pearances which  may  present  themselves  in  a  newborn  child.  A  woman 
was  secretly  delivered  of  a  child.  When  the  body  was  found  it  was  ob- 
served to  be  full-grown,  and  there  was  a  piece  of  tape  which  had  been  tied 
tightly  in  a  bow  twice  round  the  neck.  The  tongue  protruded  between 
the  lips;  two  deep  furrows  were  found  round  the  neck  after  the  removal 
of  the  tape;  there  was  great  cedema,  with  swelling  of  the  skin  between 
and  aljove  them,  and  the  right  hand  was  clenched.  The  lungs  were  of  a 
light-red  color ;  they  filled  the  chest,  were  highly  crepitant,  and  floated 
readily  on  water,  even  when  divided  into  sixteen  pieces,  and  these  had 
Ijeen  submitted  to  strong  pressure.  They  weighed,  however,  only  G2('> 
grains.  The  heart  was  healthy ;  the  right  side  contained  some  clots  of 
l)lood;  the  left  side  was  empty;  the  foramen  ovale  was  open.  The  scalp 
was  much  congested,  the  congestion  almost  amounting  to  small  effusions 


ACCIDENTAL    MARKS    ON    THE    NECK.  585 

of  blood;  the  pia  mater  was  also  congested.  The  inferences  drawn  from 
these  facts  were  that  the  child  had  been  born  alive,  and  that  it  had  died 
from  strangulation.  The  lungs  were  as  light  as  they  usually  are  in  the 
foetal  state,  showing  that  although  they  had  received  air  the  pulmonary 
circulation  had  not  been  perfectly  established.  Juries  take  a  very  lenient 
view  of  these  cases  of  death  by  strangulation.  In  Reg.  x;.  Cre^sswell 
(Gloucester  Spring  Ass.,  1878),  the  child  was  found  dead  with  a  cord  tied 
tightly  round  its  throat.  It  was  clear  that  it  had  been  born  alive  and  had 
died  from  strangulation.  It  was  suggested  for  the  defence  that  the  cord 
was  tied  round  the  throat  to  conceal  the  birth,  and  not  with  intent  to 
murder.     The  woman  was  found  guilty  of  manslaughter. 

Accidental  Mxrkii  t^esembling  those  of  Strangulation. — In  the  fore- 
part of  the  neck  of  a  child  a  mark  or  depression  is  sometimes  accidentally  , 
produced  by  forcibly  bending  the  head  forwards  on  the  chest,  especially 
when  this  has  been  done  repeatedly  and  recently  after  death,  while  the 
body  is  warm  ;  especially  if  it  be  fat.  It  may  occur  also  as  an  accident 
during  labor.  Such  a  mark  must  not  be  mistaken  for  the  effect  of  homi- 
cidal violence.  It  has  been  a  question  whether,  independently  of  the  con- 
striction produced  by  the  cord,  the  neck  of  the  womb  might  not  cause, 
during  its  contractions,  an  ecchymosed  mark  on  the  neck.  We  are  not 
aware  that  there  is  any  case  reported  which  bears  out  this  view  ;  and  it 
seems  highly  improbable  that  any  such  result  should  follow. 

The  discoloration  may  be  in  detached  spots  or  patches  situated  in  the 
forepart  of  the  neck,  and  evidently  not  arising  from  the  employment  of 
any  ligature.  These  marks  may  depend  on  the  forcible  application  of  the 
fingers  to  the  forepart  of  the  neck  of  the  child,  and  the  indentations  have 
been  known  to  correspond — a  fact  which  has  at  once  led  to  a  suspicion  of 
the  cause  of  pressure  and  the  mode  of  death.  At  the  same  time  it  should 
be  borne  in  mind  that  a  superficial  mottling  of  the  skin  occurs  after  death 
in  newborn  infants  in  parts  where  moderate  pressure  only  may  have 
been  accidentally  produced.  This  would  not  be  attended  with  ecchymosis, 
and  its  true  nature  would  be  at  once  determined  by  comparing  the  dis- 
colored spots  with  the  surrounding  skin.  It  may  be  alleged,  in  defence, 
that  such  marks  might  have  been  accidentally  produced  :  1.  By  the  forcible 
pressure  produced  by  the  child's  head  during  labor.  2.  They  will  be  more 
commonly  referred  to  violent  attempts  made  by  a  woman  at  self-delivery 
during  a  paroxysm  of  pain.  This  explanation  is  admissible  so  long  as  it 
is  eonfiued  to  injuries  which,  by  any  reasonable  construction,  might  be 
caused  during  labor ;  but  supposing  the  marks  to  have  been  certainly  pro- 
duced after  the  complete  birth  of  the  body,  it  will,  of  course,  not  apply 
(see  also  p.  565). 

Among  marks  simulating  violence,  sometimes  found  on  the  necks  of 
newborn  children,  Harvey  has  pointed  out  one  of  a  singular  kind.  He 
was  present  at  a  delivery  in  which  a  child  was  expelled  rather  suddenly; 
and,  after  making  two  or  three  convuLsive  gasps,  it  died.  Whilst  en- 
deavoring to  restore  animation  he  observed  a  bright-red  mark  extendintr 
completely  across  the  upper  and  forepart  of  the  neck,  from  one  angle  of 
the  lower  jaw  to  the  other,  as  though  it  had  been  produced  by  strangu- 
lation with  a  cord,  except  that  the  mark  was  not  continued  round  to  the 
back  of  the  neck.  It  was  of  a  vivid  red  color,  and  not  like  a  bruise  or 
ecchymosis,  but  it  had  very  much  the  appearance  of  a  recent  excoriation. 
It  was  most  clearly  defined  in  front,  where  it  was  about  a  quarter  of  an 
inch  in  breadth,  and  it  became  diffused  at  the  sides.  The  face  was  not 
swollen,  and  there  was  no  fulness  of  the  veins.  (Lond.  Med.  Gaz.,  vol. 
xxxvii.  p.  379.)     A  distinction  in  this  instance  might  have  been  based 


686  ACCIDENTAL    MARKS    ON    THE    NECK. 

upon  the  color  of  the  mark,  the  uninjured  state  of  the  cuticle,  and  the 
absence  of  congestion  of  the  iace  and  venous  system.  JsTevertheless,  the 
fact  is  of  some  importance,  and  should  be  borne  in  mind  during  the  ex- 
amination of  the  body  of  a  newborn  child  alleged  to  have  been  strangled. 
Another  case,  which  was  the  subject  of  a  coroner's  inquest,  was  published 
in  the  same  journal  (vol.  xxxvii.  p.  530),  in  which  red  marks  on  each  side 
of  the  nose  of  a  newborn  child  were  mistaken  for  the  effects  of  violence 
applied  to  the  nostrils  during  a  supposed  attempt  at  suffocation.  Rose 
examined  them  closely,  and  considered  that  they  w^ere  naevi  (mother's 
marks),  and  had  nothing  to  do  with  the  death  of  the  infant. 

A  medical  witness  niay  be  asked  on  these  occasions  whether  he  will 
undertake  to  swear  that  the  ligature  or  the  fingers  had  been  applied  to 
the  neck  before  or  after  death,  or  before  or  after  the  child  had  breathed. 
So  far  as  external  marks  of  strangulation  are  concerned,  there  is  no  differ- 
ence in  the  appearances,  whether  the  constriction  is  made  during  life  or 
immediately  after  death  while  the  body  is  warm.  Casper's  experiments 
render  it  highly  probable  that,  when  a  constricting  force  is  applied  to  the 
neck  of  a  dead  child,  at  any  time  iviihin  an  hour  after  death,  the  marks 
cannot  with  certainty  be  distinguished  by  any  appearance  from  those  made 
on  a  living  body.  With  regard  to  the  second  point,  it  may  be  stated  that, 
whether  the  child  has  breathed  or  not,  provided  it  be  living  and  the  blood 
circulating,  marks  of  violence  on  the  neck  will  present  precisely  the  same 
characters.  In  the  absence  of  any  visible  discoloration  of  the  skin,  it  may 
be  a  question  whether  this  should  be  taken  as  evidence  of  the  means  of 
constriction  not  having  been  applied  during  life.  What  we  are  entitled  to 
say  from  observed  facts  is  that  ecchymosis  from  the  ligature  is  not  a 
necessary  consequence  of  constriction,  either  in  a  living  or  a  recently  dead 
child  ;  although  we  might  expect  that  there  would  be  few  cases  of  deliberate 
child-murder  in  w^hich,  when  strangulation  was  resorted  to,  there  would 
not  be  some  ecchymosed  mark  or  discoloration,  chiefly  from  the  presump- 
tion that  great  and  unnecessary  force  is  suddenly  applied.  Besides  it  is 
not  improbable  that  a  slighter  degree  of  force  would  cause  ecchymoses  on 
the  skin  of  a  newborn  infant  than  would  be  required  to  produce  such  an 
appearance  on  that  of  an  adult. 

Another  question  has  been  put — namely,  whether  a  medical  witness 
\\\\\  undertake  to  say  that  the  constricting  force  has  not  been  applied  to 
the  neck  of  the  child  until  after  its  body  has  been  entirely  born.  This  of 
course  must  be  a  pure  matter  of  speculation.  The  appearance  caused  by 
a  ligature  applied  to  the  neck  of  a  living  child  would  not  be  different 
whether  the  child  was  partially  or  entirely  born.  If  the  child  had  actu- 
ally breathed  the  appearances  in  the  body  would  be  the  same,  and  there 
are  no  medical  facts  by  which  it  could  be  determined  whether  the  act  of 
strangulation  proved  fatal  during  birth  or  afterwards.  A  medical  witness 
has  also  had  this  question  put  to  him — whether  the  strangulation  occurred 
before  or  after  the  navel-string  w^as  severed.  It  would  appear  that  the 
severance  of  the  cord  has  been  sometimes  regarded  as  a  legal  test  of  an 
independent  circulation  beinir  established  in  the  child  ;  but  this  is  obviously 
an  error,  depending  on  a  want  of  proper  information  respecting  the  phe- 
nomena which  accompany  birth.  Respiration,  and  therefore  an  inde- 
pendent circulation,  may  take  place  before  the  cord  is  divided  ;  and  its 
severance,  which  is  never  likely  to  occur  until  after  entire  birth,  cannot 
consequently  be  considered  as  a  boundary  between  a  child  which  is  really 
born  alive  and  one  which  is  born  dead.  A  premature  severance  might 
possibly  endanger  the  life  of  a  child  instead  of  giving  it  an  independent 
existence,     A  healthy  and  vigorous  child  may  continue  to  live  and  breathe 


INFANTICIDE — POISONING.  587 

indejiendently  of  the  mother  before  the  division  of  the  cord,  and  the  time 
at  which  the  severance  is  made  depends  on  mere  accident.  Hence  the 
marks  of  stranguhvtion  on  the  neck  of  a  living-  and  breathing  child  must 
be  the  same  whether  the  cord  has  been  divided  or  not.  The  entire  birth 
of  the  body  is,  however,  now  considered  to  be  legally  complete,  although 
the  navel-string  has  not  been  divided. 

8.  Poisoning. — This  is  placed  among  the  possible  means  of  perpetrating 
child-murder,  but  we  rarely  hear  of  newborn  children  being  thus  destroyed. 
Children  destroyed  within  a  week  of  birth  generally  die  from  some  acts 
of  violence  like  those  already  described,  the  object  of  the  perpetrators  of 
the  crime  being  to  insure  a  rapid  and  certain  death.  Hofman  describes 
a  case  in  which  a  girl  destroyed  her  child  by  nux  vomica  on  the  second 
day  after  birth.  She  mixed  the  powder  with  chamomile  tea  and  gave  it- 
to  the  child.  It  had  convulsions  and  died  in  three  hours.  Cadaveric 
rigidity  was  strongly  developed  in  the  body  of  the  child  when  found  on 
the  third  day.  No  particular  appearances  were  met  with  except  those  in 
the  chest  of  asphyxia.  No  trace  of  strychnine  Avas  detected  in  the 
stomach  or  liver.  A  trial  took  place  for  the  murder  of  a  child  by  poison 
at  two  months.  (Rex  v.  South,  Norf.  Aut.  Circ,  1834.)  Arsenic  was 
given  to  an  infant  and  it  died  in  three  hours  and  a  quarter  after  the  ad- 
ministration of  the  poison.  The  editor  gave  evidence  as  to  the  adniinis- 
tration  of  butter  of  antimony  to  an  illegitimate  child  four  days  old, 
whereby  its  death  was  caused.  The  mother  and  grandmother  w^ere  tried 
for  murder  (Reg.  v.  Wallis  and  Wallis,  Worcester  Sum.  Ass.,  1883),  but 
were  acquitted,  there  being  no  sufficient  evidence  as  to  the  actual  adminis- 
tration of  the  poison  by  the  prisoners.  If  in  a  case  of  child-murder  death 
from  poison  should  be  suspected,  it  must  be  sought  for  in  the  usual  way. , 
Some  cases  have  occurred  in  which  children  have  been  wilfully  destroyed 
a  week  or  two  after  birth  by  the  administration  of  opium  or  excessive 
doses  of  purgative  medicine.  Oil  of  vitriol  has  been  also  used  to  destrov 
life. 

In  cases  in  which  infants  are  destroyed  by  poison  there  is  generally 
great  difficulty  in  tracing  the  act  of  administration  to  the  guilty  person. 
The  fluid  food  given  to  them  renders  the  admixture  of  poison  easy,  and 
as  many  ])ersons  may  have  access  to  this  food  it  is  often  impossible  to  fix 
upon  the  criminal.  In  one  instance  which  came  to  the  author's  knowledge 
an  illegitimate  child  had  been  placed  out  to  nurse  by  its  mother,  a  woman 
in  a  good  social  position.  It  was  noticed  that  after  each  visit  paid  by 
the  mother  the  child  was  sick,  and  after  repeated  attacks  of  illness  the 
child  died.  On  inspection  arsenic  was  found  in  the  body,  and  this  Avas 
beyond  doubt  the  cause  of  death.  There  was  no  suspicion  against  the 
nurse;  but  suspicion  fell  on  the  mother,  from  the  circumstances  above 
mentioned.  There  was  evidence,  however,  that  the  child  was  not  at  any 
time  fed  by  the  mother  when  she  visited  it,  and  that  the  mother  had  no 
access  to  the  child's  food.  No  poison  could  be  traced  to  her  possession, 
and  she  was  not  seen  by  the  nurse,  who  was  present,  to  give  anything  to 
the  infant.  The  only  fact  that  transpired  was  that  at  each  visit  she  took 
it  in  her  arms  and  was  observed  to  rub  its  gums  with  her  fingers,  and 
soon  after  her  visits  sickness  followed.  There  was  reason  to  believe  that 
phe  had  concealed  small  quantities  of  arsenic  under  her  finger-nails,  and 
that  she  had  administered  the  poison  while  rubbing  the  gums  of  the  child. 

Conclusions. — The  following  conclusions  may  be  drawn  from  the  pre- 
ceding remarks: — 

1.  That  congestion  of  the  face  and  head  in  a  newborn  child  is  not  a 
proof  of  death  from  strangulation. 


588       EVIDENCE    FROM    THE    EXAMINATION    OF    THE    AVOMAN. 

2.  That  strangulation  can  take  place  only  in  children  which  have 
breathed. 

o.  That  a  child  may  be  strangled  during  birth  by  the  accidental  twisting 
of  the  navel-string  round  its  neck. 

4.  That  the  navel-string  may  produce  a  livid  or  ecchymosed  depression 
on  the  neck,  like  any  other  ligature. 

5.  That  marks  on  the  neck  produced  by  accidental  causes  may  resemble 
those  which  arise  from  strangulation. 

6.  That  the  effect  of  constriction  on  the  neck,  either  by  the  navel-string 
or  any  other  ligature,  is  the  same  if  the  child  be  living,  whether  it  has  or 
has  not  breathed. 

7.  That  the  effect  is  the  same  whether  the  child  has  been  partially  or 
entirelij  born. 

8.  That'  the  effect  of  a  ligature  on  the  neck  of  a  living  child  is  the  same 
whether  the  navel-string  has  or  has  not  been  severed. 

9.  That  a  newborn  child  may  die  from  strangulation  without  this  fact 
being  necessarily  indicated  by  ecchymosis  on  the  neck.  This  depends  on 
the  nature  of  the  ligature  and  the  amount  of  force  used. 

Examination  of  Women.  Medical  Besponsibility. — In  general,  it  is 
the  mother  of  the  child  who  is  charged  with  the  murder,  and  in  this  case 
it  may  be  necessary,  in  order  to  connect  her  with  the  child,  to  determine 
whether  she  has  or  has  not  been  recently  delivered,  Medical  evidence 
may  show  that  the  date  of  delivery  does  or  does  not  correspond  with  the 
date  of  the  birth  and  death  of  the  child.  The  usual  appearances  in  cases 
of  recent  delivery,  both  in  the  living  and  dead  body,  have  been  elsewhere 
fully  described.  (See  Delivery,  ante,  pp.  499-502.)  These  appearances 
necessarily  vary  according  to  the  time  at  which  the  examination  is  made. 
Toulniouche  has  reported  in  detail  several  cases  showing  the  post-mortem 
appearances  met  with  at  different  dates.      (Ann.  d'H3^g.,  1864,  t.  2,  349.) 

If  the  reputed  mother  of  the  child  is  dead  a  coroner  or  magistrate  may 
issue  an  order  for  a  post-mortem  examination  of  the  body,  and  the  case 
will  present  no  difficulty  ;  if  living,  a  serious  question  may  arise  as  to 
medical  responsibility.  In  general,  a  woman  consents  to  be  examined,  but 
it  miy  happen  that  she  will  refuse  to  submit  to  a  physical  examination. 
An  innocent  woman  is  ju.st  as  likely  to  refu.se  permission  as  one  who  is 
guilty  ;  but,  if  circumstances  point  to  one  out  of  several  women  in  a 
household,  the  refusal  to  permit  an  examination  would,  of  course,  be  in- 
terpreted against  her.  It  has  happened  on  more  than  one  occasion  that 
medical  men  have  assumed  to  themselves  the  right  of  enforcing  an  exam- 
ination of  suspected  women,  and,  by  threats  or  otherwise,  they  have  com- 
pelled them  to  undergo  this.  Such  a  course  of  conduct  is  in  the  highest 
dagree  indecent  and  improper  ;  but  when  a  woman  willingly  consents  to 
be  examined  a  medical  man  is  justified  in  making  an  examination,  and 
giving  evidence  thereon.  It  would,  however,  be  only  fair  in  such  a  case 
to  give  her  the  warning  which  every  magistrate  and  coroner  is  bound  to 
give  to  any  woman  charged  with  murder,  before  requiring  an  answer  to 
a  question  which  may  be  used  in  evidence  against  her  at  the  subsequent 
trial.  The  case  is  widely  different,  however,  when  a  medical  man  takes 
this  authority  upon  him.-^elf,  and  compels  a  suspected  woman,  unwillinglv, 
or  under  duress,  to  submit  to  a  physical  examination.  Bv  taking  this 
illegal  course,  he  is  forcil)ly  compelling  a  woman  accused  of  murderto  pro- 
duce positive  proof  of  her  guilt ;  such  a  course  is  entirely  opposed  to  the 
spirit  and  practice  of  English  jurisprudence  The  mischievous  results  of 
such  officio usness  on  the  part  of  a  medical  man  are  well  illustrated  by  the 


MEDICAL    RESPONSIBILITY.  589 

following-  cases.  A  surgeon  and  an  inspector  of  police  insisted  upon  ex- 
amining two  women,  a  mother  and  daughter,  in  order  to  determine 
whether  either  of  them  had  been  lately  delivered  of  a  child.  This  was 
against  their  consent,  and  in  the  absence  of  the  husband  and  father.  He 
brought  an  action  against  them,  and  recovered  damages.  (Lancet,  1871, 
ii.  p.  333.)  The  other  case  was  that  of  Weir  and  Wife  v.  Hodgson  (Liv- 
erpool Wint  Ass.,  1861).  The  dead  body  of  a  child  had  been  found  near 
the  house  of  the  plaintiff.  The  defendant,  a  surgeon,  went  with  an  in- 
spector of  police  to  see  Mrs.  Weir,  and,  having  informed  her  that  she  was 
suspected  of  having  had  a  child,  told  her  that  he  had  come  to  examine  her 
by  the  authority  of  the  law,  and  that  she  must  submit.  She  refused  at 
first,  and  proposed  to  send  for  a  medical  man  whom  she  knew.  In  the 
end  the  defendant  examined  her,  and  found  that  there  was  no  ground  for- 
the  charge.  The  jury  returned  a  verdict  of  200/.  damages  for  the  assault. 
The  police  can  give  no  legal  power  to  a  medical  man  to  make  such  an 
examination  in  a  suspected  case,  and  the  ultimate  consent  of  the  woman, 
if  extorted  by  threats  or  intimidation,  will  be  no  answer  to  a  charge  of 
indecent  assault.  A  later  case  (Warne  v.  Serjeant)  was  tried  at  the 
Manchester  Wint.  Ass.,  1878.  It  was  here  doubtful  whether  the  woman 
had  given  her  consent  to  an  examination,  and  the  jury  found  a  verdict  for 
the  defendant.  The  judge  observed  that,  even  if  the  surgeon  had  been 
honestly  misled  by  the  woman's  conduct,  it  would  still  be  an  assault.  In 
all  cases,  whether  the  charge  against  a  woman  be  one  of  concealment  of 
birth,  abortion,  or  child-murder,  a  medical  man  must  act  upon  bis  own 
discretion.  An  examination  of  her  person,  with  a  view  to  obtain  evi- 
dence against  herself,  is  unlawful,  except  with  her  free  consent. 

A  coroner  issuing  an  order  for  the  compulsory  examination  of  a  woman 
under  these  circumstances  would  be  acting  vU7-a  vires,  and  any  medical 
man  obeying  it  would  incur  a  serious  responsibility.  In  1871  a  case  oc- 
curred that  placed  this  question  in  cases  of  alleged  infanticide  in  a  painful 
light.  A  young  lady  committed  suicide  rather  than  submit  to  a  physical 
examination  by  two  medical  men  under  the  order  of  a  coroner.  The 
coroner  held  an  inquest  on  the  body  of  a  child  in  a  case  of  alleged  child- 
murder.  A  suspicion  arose  that  this  young  lady  had  been  recently  de- 
livered. Two  medical  gentlemen,  provided  with  a  written  order  from  the 
coroner,  went  to  the  house  where  the  lady  resided,  and  requested  an  in- 
terview with  her  for  the  purpose  of  ascertaining  whether  she  had  re- 
cently had  a  child.  She  refused  to  see  them,  and  subsequently  destroyed 
herself.  All  the  particulars  of  this  tragedy  were  not  made  known,  but 
the  attempt  to  examine  this  young  woman  for  the  purpose  of  obtaining 
evidence  against  her  on  a  charge  of  child  murder  appears  to  have  had 
such  an  effect  on  her  mind  as  to  lead  to  suicide.  The  fragmentary  partic- 
ulars of  this  sad  case  will  be  found  in  the  Lancet  for  1871,  vol.  ii.  pp.  333, 
4U,  and  477.  The  6  and  7  Will.  IV.,  c.  89 — now  repealed,  except  for 
Irelaml — under  which  an  order  was  issued  by  the  coroner  on  this  occa- 
sion, empowers  a  medical  man  to  examine  a  dead  body,  and  give  evidence 
touching  the  cause  of  death  ;  but  it  says  nothing  about  the  examination 
of  living  women.  Such  an  order  would  be  obviously  illegal,  and  a  medi- 
cal man  acting  under  it  would  render  himself  liable  to  an  action  for  an 
indecent  assault.  The  Coroners'  Act,  1887.  empowers  a  coroner  to  order 
examinations  of  a  dead,  not  of  a  living  body. 

It  can  be  only  by  the  free  consent  of  the  person  inculpated  that  a  per- 
sonal examination  for  evidence  can  be  made.  The  Tichborne  trial  fur- 
nished a  good  illustration  of  the  care  taken  by  our  judges  that  an  accused 
person   shall   not  unknowingly  furnish  evidence  against  himself.     It  Avas 


590  MEDICAL    RESPONSIBILITY. 

alleged  on  this  oecasion  that  if  the  "claimant "  had  been  bled  in  the  tem- 
poral artery  a  scar  would  remain  ;  and  a  proposition  was  made  that  he 
should  be  then  examined  by  two  medical  witnesses  who  had  been  called 
for  the  prosecution.  Cockburn,  L.  C.  J.,  ruled  that  such  an  examination 
could  not  be  made  except  by  the  consent  of  the  accused.  This  was  given, 
and  the  examination  accordingly  took  place  in  court.  A  similar  rule  has 
been  long  acted  on  in  the  Scotch  courts.  Thus  in  a  divorce  case,  tried  in 
1860  (Edin.  Sess.  cases,  1860),  the  court  refused  to  receive  certain  evi- 
dence which  was  tendered  regarding  the  condition  of  a  woman,  on  the 
ground  that  they  could  not  compel  her  to  submit  to  another  examination, 
and  the  evidence  tendered  w-ould  therefore  have  been  entirely  ex  parte. 
In  a  suit  of  nullity  in  the  Divorce  Court,  Hannen,  J.,  was  obliged  to  de- 
cide the  case  upon  the  evidence  of  the  husband  only.  The  wife  refused  to 
submit  to  an  examination,  and  there  was  no  legal  power  to  compel  her  to 
undergo  this  against  her  will.  (Hewitt  v.  Pery,  falsely  called  HeAvitt, 
July,  1873.)  These  cases  suffice  to  show  the  course  which  a  medical  wit- 
ness should  pursue  on  all  occasions  in  which  a  Derson  does  not  voluntarily 
consent  to  a  personal  examination. 


PARTIAL    AND    ENTIRE    BIRTH.  591 


BIRTH.    INHERITANCE. 


CHAPTER    LV. 

LIVE    BIKTH    IX    CIVIL    CASES. DATE    OF    BIRTH. SIGNS    OF    LIVE    BIRTH    INDEPENDENTLY  OF 

RESPIRATION    OR    CRYING. VAGITUS     UTERINUS. TENANCY    BY  CURTESY. LEGAL    BtRTH. 

POST-MORTEM    BIRTHS. MINORITY  AND   MAJORITY. PLURAL  AND  MONSTROUS  BIRTHS. 

Date  of  Birth. — Medical  evidence  has  occasionally  been  demanded  in 
courts  of  law  respecting  the  actual  date  of  birth  in  those  cases  in  which  a 
period  of  a  few  days,  hours,  or  even  minutes  was  required  to  prove  the 
attainment  of  majority — and  therefore  a  legal  responsibility  for  the  per- 
formance of  civil  contracts  iato  which  the  parties  had  entered,  either 
knowingly  or  ignorantly,  when  minors.  Some  such  cases  have  been  de- 
cided by  the  evidence  of  the  accoucheur  himself;  others,  when  the 
accoucheur  was  dead,  by  the  production  of  his  case-books ;  and  it  is 
worthy  of  notice  that  the  strictness  and  punctuality  of  some  medical 
practitioners,  in  making  written  memoranda  of  cases  attended  by  them, 
have  in  more  than  one  instance  led  to  a  satisfactory  settlement  of  such 
suits  and  the  avoidance  of  costly  litigation.  The  proof  of  the  exact  date 
of  birth  is  also  of  considerable  importance  in  certain  cases  of  contested 
legitimacy. 

Medico-legal  questions  connected  with  this  subject  arise  in  contested 
suits  relative  to  succession  or  the  inheritance  of  property.  A  child  that  is 
born  alive,  or  has  come  entirely  into  the  world  in  a  living  state,  may  by 
the  p]nglish  law  inherit  and  transmit  property  to  its  heirs,  even  though 
its  death  has  immediately,  and  perhaps  from  morbid  causes  necessarily, 
followed  its  birth.  Should  the  child  be  born  dead,  whether  it  died  in  the 
womb  or  during  the  act  of  birth,  it  does  not  acquire  any  civil  rights  ;  for 
it  is  not  regarded  as  a  life  in  being  unless  it  manifests  some  sign  of  life 
after  it  is  entirely  born  and  separated  from  the  mother.  Some  have  con- 
sidered that  partial  birth,  provided  a  child  is  living",  should  suffice  to  confer 
the  same  rights  on  the  offspring  as  the  proof  of  entire  birth  ;  but  great 
difficulty  might  arise  in  civil  cases  if  the  bore  extrusion  of  a  part  of  the 
body  sufficed  for  all  the  legal  purposes  of  entire  birth.  It  might  become  a 
casuistical  question,  as  to  how  much  of  a  body  should  be  in  the  world  in 
order  to  constitute  legal  birth  ;  for  there  is  no  reason  why,  in  a  medical 
sense,  the  extrusion  of  the  head  and  shoulders  should  constitute  birth  any 
more  than  the  extrusion  of  a  hand  or  a  foot.  If  it  be  said  that  the  act  of 
breathing  should  be  combined  with  a  partial  extrusion  of  the  bodv,  this 
would  be  unjust ;  because  a  child  is  alive — its  heart  is  evidently  pulsating, 
and  its  blood  circulating,  as  freely  before  the  act  of  breathing  as  after- 
wards. Besides,  it  is  admitted  that  children  may  be  born  alive  and  live 
for  some  time  without  respiring;  and  this  want  of  respiration  is  no  ob- 
jection to  these  children  being  considered  living  in  law.  In  a  case  referred 
to   hereafter,  a  child  was  pronounced  to  have  been  legally  born  alive. 


692         PROOF  OF  LIVE  BIRTH  IN  CIVIL  CASES. 

although  it  had  certainly  not  breathed ;  and  that  a  child  may  manifest  life 
for  a  certain  time  without  leaving  iu  its  hody  any  evidence  of  respiration 
is  clear  from  numerous  reported  cases  (pp.  545,  546,  ante).  If,  then,  proof 
of  respiration  be  not  demanded  in  cases  of  entire,  it  could  scarcely  be  re- 
quired in  cases  of  partial  birth.  In  the  event  of  partial  being  treated  as 
synonymous  with  entire  birth,  there  would  be  no  end  to  litigation  ;  and 
medical  opinions  would  vary  in  every  case.  It  is  doubtful  whether,  under 
such  circumstances,  the  law  could  be  administered  with  any  degree  of 
certainty  or  impartiality.  Admitting,  then,  that  a  child  must  be  er^hrely 
born  in  order  that  it  should  acquire  civil  rights,  it  will  next  be  necessary 
to  examine  the  proofs  required  to  show  that  it  has  been  horn  alive  in 
a  legal  sense.  The  question  here  is  different  from  that  of  live  birth  in 
reference  to  child-murder  We  may  presume  that  a  practitioner  is  present 
at  a  delivery  in  which  a  child  is  born  in  a  doubtful  state,  or  where  its 
death  speedily  follows  its  birth  The  civil  rights  of  the  child  and  its  heirs 
will  depend  upon  the  careful  observation  made  by  a  practitioner  of  the 
circumstances  attending  the  deliverv.  He  should  note  the  time  when  the 
birth  is  completed,  by  the  body  of  the  child  being  entirely  out  of  the  body 
of  the  mother.  Children  born  at  or  about  midnight  are  liable  to  have  the 
date  of  birth  wrongly  registered;  and  the  lepal  difference  of  twenty-four 
hours,  which  a  few  seconds  or  minutes  make,  may  h,ereafter  affect  their 
own  rights,  if  they  survive,  or  those  of  others  if  they  die, 

[By  English  and  American  law,  being  "  born^^  means  that  the  whole 
bod}^  is  brought  into  the  world,  and  it  is  not  sufficient  that  the  child 
respires  in  the  progress  of  birth  :  Eex  v.  Poulton,  5  C.  &  S.  329.  There 
must  be  independent  circulation:  Rex  v.  Enoch,  5C  &  P.  529,  The 
whole  body  must  have  come  forth  from  the  body  of  the  mother :  Rex  v. 
Crutchle}^  7  C.  &  P.  814.  The  umbilical  cord  need  not  have  been  sepa- 
rated or  cut :  Regina  v.  Reeves,  9  C.  &  P.  25.] 

Signs  of  Live  Birth  ivdependenlly  of  Bespiration  or  Crying. — The 
visible  breathing  of  a  child  after  its  birth  or  as  it  may  be  manifested  by 
its  crying  is  an  undoubted  sign  of  its  having  been  born  alive ;  but,  as  it 
has  just  been  stated,  a  child  may  acquire  its  civil  rights,  although  it  may 
be  neither  seen  to  breathe  nor  heard  to  cry.  The  pulsation  of  a  child's 
heart  or  even  the  spasmodic  twitching  of  any  of  the  muscles  of  the  body 
has  been  regarded  as  a  satisfactory  proof  of  live  birth  (p.  593).  The 
latter  sign  has  been  judicially  so  pronounced  ;  a  fortiori,  therefore,  the 
motion  of  a  limb  will  be  considered  sufficient  legal  evidence  of  life  after 
birth  in  an  English  court  of  law.  It  is  to  be  observed  that  the  length 
of  time  during  which  these  signs  of  life  continue  after  a  child  is  born  is 
wholly  immaterial ;  all  that  is  required  to  be  established  is  that  they  were 
positively  manifested.  A  child  which  survives  entire  birth  for  a  single 
instant  acquires  the  same  civil  right  as  if  it  had  continued  to  live  for  a 
month  or  longer. 

In  Brock  v.  Kelly  (April,  1861),  involving  a  claim  by  the  widow  to  the 
estate  of  her  husband  on  the  ground  that  a  child  born  twenty  years  before 
had  been  born  living,  although  it  was  at  first  supposed  to  have  been  still- 
Ijorn,  Stuart,  V.  C,  decided  that  proof  of  breathing  was  not  necessary, 
and  held  that  there  was  sufficient  legal  evidence  of  life  after  birth  in  the 
pulsations  of  the  cord  observed  by  the  accoucheur.  This  decision  is  in 
accordance  with  law  and  common  sense.  Pulsations  indicate  an  inde- 
pendent action  of  the  foetal  heart  as  much  as  a  motion  of  the  chest  indi- 
cates an  action  of  the  intercostal  muscles  Why  it  should  be  maintained 
that  there  is  life  with  contractility  of  the  intercostal  muscles  but  not  with 
a  contractile  power  of  the  heart  is  not  apparent;  that  this  view  is  not  in' 


TENANCY    BY    CURTESY.  593 

accordance  with  facts  is,  however,  proved  by  several  cases  which  are  de- 
scribed under  Infanticide.     (See  Atelectasis,  p.  544,  ante.) 

There  is  no  doubt  that  the  best  test  to  apply  to  such  cases  for  the 
determination  of  physiological  life  is  auscultation.  The  beating  of  the 
heart  as  determined  by  the  ear  or  the  stethoscope,  applied  even  for  five 
consecutive  minutes,  is  an  undoubted  sign  of  life  in  a  physiological  sense, 
whether  the  child  breathes,  cries,  or  moves.  Bouchut  noticed  on  one 
occasion  of  this  kind  that  passive  life  continued  in  an  infant  for  twenty- 
three  hours  after  its  birth.  Feeble  but  distinct  pulsations  were  heard  at 
long  intervals,  but  there  was  no  motion  of  the  ribs.  Attempts  at  resus- 
citation were  made,  but  the  motions  of  the  heart  became  more  and  more 
feeble  until  they  entirely  ceased.  An  examination  showed  that  the  lungs 
had  riot  received  air.  As  we  take  the  cessation  of  the  heart's  action  to 
be  the  only  certain  evidence  of  death,  so  the  existence  of  pulsations  in 
the  heart  or  arteries  when  clearly  perceived  by  the  ear,  stethoscope,  or 
finger  is  positive  evidence  of  life  in  a  physiological  sense.  Is  this  legal 
life?  Would  the  wilful  destruction  of  such  a  child  constitute  murder? 
Would  this  proof  of  pulsation  without  motion,  respiration,  crying,  or 
any  other  sign  of  active  life,  confer  tenancy  by  curtesy  or  transfer  an 
estate  by  inheritance  or  survivorship  ?  Bouchut  justly  observes  that  ap- 
pai'ent  death  succeeding  to  birth  and  characterized  by  the  presence  of  a 
beating  of  the  heart  and  an  absence  of  breathing  is  only  a  morbid  condi- 
tion of  the  newborn  child  (see  p.  546,  ante)  ;  and  whether  it  is  cured  of 
this  or  dies  it  is  living,  although  it  has  not  breathed — or  as  a  German 
jurist  remarks,  "  Scheintod  ist  Scheinleben.-''  They  who  contend  that 
crying  or  breathing  alone  should  be  taken  as  a  sign  of  life  after  birth 
would  of  course  pronounce  such  a  child  to  have  been  born  dead,  even 
at  the  time  that  they  might  be  listening  to  the  pulsations  of  its  heart. 
(Camper,  Klin.  Novel'.,  1883,  p.  564.) 

Vagitus  Uterinus. — Let  us  suppose  that  the  evidence  of  a  child  having 
been  born  alive  is  stated  to  be  that  it  was  heard  to  cry  ;  it  may  be  a 
question  for  a  medical  witness  in  cross-examination  whether  this  is  to  be 
taken  as  an  absolute  proof  of  live  birth.  The  answer  must  be  in  the 
negative,  because  a  child  may  cry  before  its  body  is  entirely  born  ;  or 
there  may  have  been  what  is  called  vagitus  uterinus — a  uterine  cr\^  after 
the  rupture  of  the  membranes.  (See  Infanticide.)  It  is  quite  certain 
that  a  child  may  breathe  without  crying,  but  it  cannot  cry  without 
breathing;  yet  neither  the  crying  nor  the  breathing  is  a  necessary  proof 
that  the  child  was  actually  born  alive.  A  child  may  breathe  in  the  womb 
or  vagina  or  with  its  head  at  the  outlet  and  die  before  its  body  is  born : 
the  discovery  of  its  having  breathed  would  not,  therefore,  be  proof  of  its 
having  enjoyed  what  has  been  termed  "extra-uterine  life."  As  in  all 
eases  of  this  description  there  must  be  eye-witnesses,  either  professional 
or  not,  the  evidence  will  not  rest  solely  upon  a  merely  medical  possibility 
of  the  occurrence  of  such  a  cry  before  birth,  and  proof  will  then  be  re- 
quired of  the  crying  of  the  child  after  it  was  born.  The  determina- 
tion of  the  momentary  existence  of  children  after  birth  is  of  importance 
in  a  legal  point  of  view  in  reference  to  the  following  subject. 

Tenancy  by  Curtesy. — This  signifies,  according  to  Blackstone,  a  tenant 
by  the  courts  of  England.  When  a  married  woman  possessed  of  estate 
dies  the  estate  passes  from  the  husband  to  her  heir-at-law  unless  there 
has  been  a  child  born  living  of  the  marriage  during  the  life  of  the  wife, 
in  which  case  the  husband  acquires  a  life-interest  in  the  property.  This 
custom  is  of  great  antiquity.  Incurable  sterility,  a  protracted  labor,  de- 
formity in  the  pelvis  of  the  wife,  or  the  necessary  performance  of  erani- 
'38 


594  TENANCY    BY    CURTESY. 

otomy  on  a  healthy  well-formed  child  may,  under  this  custom,  lead  to  an 
aversion  of  the  inheritance.  The  tenancy  in  contested  cases  is  generally 
established  or  disproved  by  medical  evidence  :  and  the  following  are  the 
conditions  which  the  law  requires  in  order  that  the  right  should  exist : — 

1.  The  child  must  be  born  alive.  Cases  have  been  already  referred  to 
in  which  the  motion  of  a  lip  and  the  pulsations  of  the  navel-string  were 
held  to  be  sufficient  legal  proofs  of  live  birth.  Some  physiologists  have 
objected  to  these  as  inadequate  proofs  of  life  in  a  medical  sense;  and 
if  the  question  were  one  of  pure  physiology  and  not  of  law  there  might 
be  some  ground  for  the  objection.  The  law,  however,  does  not  require 
proof  of  active  life  in  a  child,  but  merely  some  evidence,  however  slight, 
that  it  has  been  born  living. 

The  crying  of  a  child,  properly  attested  by  disinterested  witnesses,  has 
been  held  in  cases  of  disputed  tenancy  to  be  sufficient  evidence  of  live 
birth ;  this  is,  in  fact,  one  of  the  tests  given  by  Lord  Coke.  At  pp.  545,' 
546,  ante,  som.a  cases  are  related  in  which  newborn  children  survived  birth 
several  hours,  but  manifested  no  sign  of  active  life  either  by  crying  or  in 
any  other  mode,  and  after  death  there  was  no  air  in  the  lungs.  As  in 
cases  of  infanticide,  if  the  evidence  of  live  birth  rests  entirely  on  an  exami- 
nation after  death,  the  absence  of  air  from  the  lungs  will  not  necessarily 
show  that  a  child  has  come  into  the  world  dead  ;  nor  v,nll  the  presence  of 
air  in  these  organs  prove  that  it  has  been  born  alive;  because  it  may  have 
breathed  and  died  before  birth.  The  child  must  be  heard  to  cry,  or  be 
seen  to  breathe  or  move  after  birth.  The  fact  that  the  lungs  are  not  dis- 
tended with  air,  and  that  they  sink  in  v\ater,  either  when  entire  or  when 
divided  into  small  pieces,  is  no  proof  that  a  child  has  not  breathed  and 
cried  during  birth  .and  afterwards.  It  does  not  require  full  inflation  of 
the  lungs  for  these  conditions  to  exist.  Barnes  found  that  the  lungs  of 
children  which  had  cried  during  birth  sank  in  water  A  woman  was  sud- 
denly delivered  at  five  months  and  a  half.  The  child  cried  loudly  when 
born.  It  survived  forty-four  hours.  The  eyelids  were  perfectly  closed. 
It  weighed  one  pound  and  a  quarter,  and  was  eleven  inches  in  length. 
(Obst.  Trans.,  1875,  vol.  xvi.  p.  86.)  At  page  221  of  the  same  volume, 
there  is  another  case  of  a  child  born  at  the  sixth  month,  which  cried  loudly 
several  times  and  lived  twenty-one  hours.  It  weighed  one  pound  six 
ounces,  and  measured  twelve  inches  in  length.  In  a  third  case,  which 
occurred  to  Yernon  (p.  545,  ante),  a  six  months'  child  was  strong  enough 
to  cry;  yet  the  lungs  contained  no  air  and  sank  in  water.  ^  child  born 
at  the  fifth  month  has  been  known  to  cry,  but  the  state  of  its  lungs  is  not 
recorded.  In  the  case  of  Gardner  v.  Llewellyn  (1856),  a  medical  witness, 
who  appeared  for  the  plaintiff,  stated  as  his  belief  that  a  child  born  at  the 
fifth  month  could  not  resjnre,  and  if  it  could  not  breathe  (so  as  to  fill  the 
lungs)  it  could  not  cr3^  This  is  not  consistent  with  facts  observed  by 
others. 

2.  The  child  must  be  born  while  the  mother  is  living.  From  this  it 
appears  that,  if  a  living  child  were  removed  from  the  outlet,  or  extracted 
from  the  womb  by  the  Cassarean  operation  after  the  death  of  the  mother, 
the  husband  would  not  become  entitled  to  enjoy  his  wife's  estate  ;  although 
the  child  might  survive  its  removal  or  extraction,  and  succeed  to  the  estate 
on  attaining  its  majority.  How  such  a  case  would  be  decided  in  the 
present  day  it  is  difficult  to  imagine;  but  one  instance  is  quoted  by  most 
medico-legal  writers  from  Lord  Coke,  in  which,  about  three  centuries 
since,  the  decision  went  against  the  husband,  in  consequence  of  the  child 
having  been  removed  from  the  womb  by  the  Cassarean  section  after  the 
death  of  the  wife.     (For  a  case  involving  this  question  in  France,  see 


TENANCY    BY    CURTESY.  505 

Ann.  d'Hyjr.,  1838,  t.  1,  p.  1)8.)  In  the  case  of  Llewellyn  (supra)  Alder- 
son,  B.,  ruled  thiit  the  hu.-^ljand  could  not  take  the  estate  unless  the  child 
was  proved  to  have  been  born  durin,^'  the  marriage,  i.  e.  during  the  life  of 
the  woman.  This  question  was  raised  on  appeal  in  the  case  of  Treheren 
V.  Layton,  June,  1875.  An  estate  hail  been  left  to  the  wife  by  her  grand- 
father, after  her  death  to  her  children,  and  in  ease  she  died  leaving  no 
issue,  then  to  his  ne.Yt  of  kin.  She  had  a  child,  which  just  breathed  and 
then  died,  and  after  her  own  death  the  estate  was  claimed  by  the  next  of 
kin,  while  the  husband,  the  father  of  the  child,  claimed  it  as  his  child's 
heir-at-law.  It  was  not  disputed  that  the  wife  died  "leaving  no  issue," 
but  it  was  contended  for  the  husband  that  the  estate  was  vested  in  his 
child  by  its  momentary  life,  and  all  the  judges  held  that  it  could  not  be 
devested  by  the  child's  death.  The  old  cu.stom  of  tenancy  by  curtesy 
was  thus  confirmed,  in  spite  of  the  words  in  the  grandfather's  will. 

[Tenancy  by  the  curtesy,  legally  defined,  is  an  estate  for  life  created  by 
the  act  of  the  law.  When  a  man  marries  a  woman  seised  at  any  time 
during  the  coverture  of  an  estate  of  inheritance  in  severalty,  in  coparce- 
nary, or  in  common,  and  hath  issue  by  her  born  alive,  and  which  might 
by  possibility  inherit  the  same  estate  as  heir  to  the  wife,  and  the  wife  dies 
in  the  lifetime  of  the  husband,  he  holds  the  land  during  his  life  by  curtesy : 
4  Kent's  Com.,  13th  ed.  25  ;  Litt.,  §  35  ;  2  Blackstone,  126  ;  1  Bishop,  M. 
&  W.,  §  473;  Heath  v.  White,  5  Com.  228;  Rawlins  v.  Adams,  1  Md. 
26;  Carrington  v.  Richardson,  79  Ala.  101,  et  seq. 

The  law  imposes  four  requisites  before  the  husband  can  take  by  the 
curtesy,  viz  :  1,  there  must  be  a  legal  marriage  ;  2,  there  must  be  seisin 
by  the  wife  during  coverture:  3,  there  must  be  issue  capable  of  inheriting 
the  estate;  4,  the  wife  must  be  dead:  Jackson  v.  Johnson,  5  Co  wen 
(N.  Y.),  74,  95,  102  ;  s.  c.  15  Am.  Dec.  433  ;  Hunter  ^;.Whitworth,  9  Ala. 
967  ;  Furguson  v.  Tweedy,  43  N.  Y.  543  ;  Stewart  v.  Rees,  50  Miss. 
776;  Monroe  v.  Yan  Meter,  100  111.  347  ;  Wheeler  v.  Hotchkiss,  10  Conn. 
225;  Withers  v.  Jenkins,  14  S.  Car.  597;  McDaniel  v.  Grace,  15  Ark. 
465  :  Carpenter  v.  Garrett,  75  Ya.  129-133  ;  Winkler  v.  Winkler,  18  W. 
Ya.  455. 

The  marriage  must  be  a  lawful  one.  If  it  be  declared  void  during  the 
wife's  life  the  tenancy  fails.  If  valid  at  the  death  of  the  wife  the  husband 
takes  by  the  curtesy.  It  could  not  be  declared  void  after  her  death  to 
affect. his  right:  Washburn  on  Real  Prop.,  5th  ed.  172;  Stewart  on  Hus- 
band and  Wife,  §  153  ;  Wheeler  v.  Hotchkiss,  10  Conn.  225  ;  Mattocks 
V.  Stearns,  9  Yt.  326  ;  vid.  also  Smoot  v.  Leggate,  1  Stew.  (Ala.)  590. 

The  wife  must  have  been  seised  of  the  estate  some  time  during  cover- 
ture ;  it  need  not  be  at  the  time  of  her  death  or  at  the  time  of  the  birth  of 
the  child:  Mercer  v.  Sheldon,  1  How.  (U.  S.)  37  ;  McDaniel  v.  Grace,  15 
Ark.  465  ;  Withers  v.  Jenkins,  14  S.  Car.  597  ;  Upchurch  v.  Anderson, 
59  Tenn.  410;  Haynes  v.  Baum,  42  Yt.  686  ;  Jackson  v.  Johnson,  5  Cow. 
(N.  Y.)  74;  Comer  v.  Chamberlain,  6  Allen  (Mass.),  166. 

Before  the  death  of  the  wife,  after  marriage,  birth. of  issue  and  seisin, 
the  right  of  the  estate  by  the  curtesy  is  called  "initiate,^''  and  it  is  contin- 
gent then  on  the  death  of  the  wife,  and  is  then  assignable:  Rice  v.  Hoff- 
man, 35  Md.  344  ;  Foster  v.  Marshall,  22  N.  H.  401  ;  Winne  v.  Winne,  2 
Laws  (N.  Y.),  439  ;  Briggs  v.  Titus,  13  R.  I.  136  ;  Gardner  v.  Hooper!  3 
Gray  (Mass.),  438;  Mechanics' Bk.  v.  Williams,  17  Pick.  (Mass.)  438; 
Wicks  V.  Clarke,  8  Paige  (K  Y.),  161  ;  Yan  Duirer  v.  Yan  Duger,  6 
Paige  (N.  Y.)  366. 

After  the  death  of  the  wife  curtesy  "initiate''^  becomes  curtesy  "con- 
summate.''^    The  estate  is  then  vested.     It  vests  by  operation  of  "law  and 


596  CESAREAN    EXTRACTION. 

without  assignment:  Wheeler  v.  Hotchkiss,  10  Conn.  225;  Watson  v. 
Watson,  13  Conn.  83;  Oldham  v.  Henderson,  5  Dana  (Ky.),  254;  Rice 
V.  Hoffman,  15  Md.  344  ;  Williams  v.  Perkins,  2  Me.  400.  " 

In  the  American  States  this  estate  is  greatly  modified  bv  State  statutes. 
In  some  States  it  is  abolished.  In  some,  where  the  statutes  are  silent, 
the  common  law  rule  prevails,  and  in  some  States  the  common  law  rule  is 
modified  by  statute  :  Vid.  Stimson  on  Am.  Stat.  Law,  §  3300,  et  seg.  ; 
also  Stewart  on  Husband  and  Wife,  §  160.] 

Ceefiarean  Extraction. — The  Csesarean  operation  has  rarely  been  per- 
formed in  England,  except  when  a  woman  was  actually  dying  or  dead. 
A  medical  man  wishing  to  perform  it  may  find  that  the  husband  or  repre- 
sentative of  the  deceased  parturient  woman  will  object  to  its  performance, 
although  the  child  may  be  living  in  the  womb,  and  there  maj'  be  a  reason- 
able hope,  by  an  immediate  operation,  of  extracting  it  living.  On  two 
occasions  in  1858,  the  husljand-^  thus  refused  to  allow  Lever  to  operate  on 
the  dead  body  of  the  wife.  We  apprehend  that  no  medical  man  would 
proceed  to  operate  by  force,  or  against  the  will  of  the  husband;  at  the 
same  time,  in  refusing  his  permission,  the  husband  is  not  guilty  of  any 
legal  offence.  The  practice  now  is  to  undertake  it  while  the  woman  was 
living,  and  the  result  has  shown  that  it  may  be  performed  successfully  both 
with  regard  to  mother  and  child.  In  cases  in  which  a  tenancy  by  cur- 
tesy would  be  likely  to  arise,  it  would  be  to  the  interest  of  the  husband  to 
allow  the  operation  of  extraction  to  be  performed  while  the  wife  was  liv- 
ing ;  but  be  would  have  no  such  interest  in  its  performance  after  her 
death ;  and  if  the  child  has  not  attained  a  sufficient  stage  of  maturity  to 
survive,  there  can  be  no  reasonable  object  in  performing  it.  Important 
legal  consequences  may  hereafter  ensue  from  a  more  general  adoption  of 
this  practice  in  England  in  respect  to  deformed  women.  Thus,  supposing 
in  any  case  a  child  were  removed  alive  while  the  woman  was  living,  both 
of  them  dying  shortly  afterwards,  would  the  husband  become  a  tenant  by 
her  curtesy?  The  law  says  the  child  must  he  born  ;  and  it  might  be 
argued  whether  extraction  by  the  Caesarean  operation  should  be  regarded 
as  "legal  birth."  "Illud  autem  valde  controversum  est  inter  jurisconsul- 
tos,  an  is  qui  editus  est,  exsecto  matris  ventre,  reputetur  partus  naturalis 
et  legitimus  et  successionis  capax."  (Caranza.)  According  to  Fon- 
blanque,  the  question  is  settled  in  the  affirmative — a  child  extracted  is  a 
child  born.  (Med.  Jur.,  vol.  1,  p.  236.)  Our  ancient  law  authorities  do 
not  appear  to  have  contemplated  that  the  operation  would  ever  be  under- 
taken oji  a  living  female.  The  words  of  Lord  Coke,  which  are  considered 
to  express  the  state  of  English  law,  are:  "  If  a  woman  seised  of  lands  in 
fee  taketh  husband,  and  by  him  is  bigge  with  childe,  and  in  her  travail 
dyeth,  and  the  child  is  ripped  out  of  her  body  alive,  yet  shall  he  not  be 
tenant  by  the  curtesie,  because  the  child  was  not  born  during  the  marriage, 
nor  in  the  life  of  the  wife,  but  in  the  meantime  her  land  descended." 
According  to  Hobler,  the  Csesarean  operation  does  not  divert  the  course  of 
descent,  or  divest  thp  husband  of  the  life-estate,  provided  the  child  be  born 
alive  and  the  mother  was  living  when  the  child  was  born.  (Obst.  Rec, 
vol.  ii.  p.  66.)  Birth,  and  extraction  by  the  Caesarean  operation  are, 
therefore,  treated  by  him  as  similar  conditions. 

There  is  no  law  to  compel  a  man  to  perform  this  operation,  and  no  law 
to  prohibit  it.  Some  years  since  the  duty  of  a  medical  man  on  these  oc- 
casions was  made  a  subject  of  investigation  by  a  committee  of  the  French 
Academy  of  Medicine,  and  the  conclusion  at  which  they  arrived  was  that, 
in  the  case  of  a  pregnant  woman  recently  deceased,  a  medical  man  might 
and  ought  to  perform  the  Cesarean  operation,  if  there  were  any  proba- 


CiESAREAN    EXTRACTION.  597 

bilitj  of  removing  from  her  body  a  child  in  a  viable  state,  i.  e.  with  a 
power  to  maintain  an  extra-uterine  life.  The  date  of  viability,  according- 
to  some  authorities,  is  fixed  at  the  108th  day.  Hence  it  is  advised  that 
no  operation  should  be  performed  on  a  woman  unless  her  pregnancy  has 
reached  this  date.  English  practitioners  would  not  be  guided  by  any 
fixed  period,  but  by  the  circumstauces  attending  each  case. 

As  a  proof  that  the  operation  is  not  always  necessary,  even  when 
circumstances  may  appear  to  call  for  it,  the  following  case,  mentioned  by 
Brodie  as  having  occurred  in  a  French  hospital,  is  of  some  interest.  It 
is  that  of  a  woman  whose  pelvis  was  considered  to  be  too  narrow  for  the 
euTess  of  the  child.  As  she  was  at  the  full  term  of  gestation,  the 
Ciesarean  section  was  proposed ;  but  before  the  operators  were  ready  to 
commence,  the  child  was  expelled  by  the  natural  efforts  of  the  womb,  or, 
"  the  child  preferred  coming  into  the  world  by  the  old  road !"  This,  how- 
ever, is  not  the  only  case  of  the  kind  on  record.  There  is  reason  to 
believe  that  Continental  practitioners  have  been  too  officious  in  suggesting 
the  performance  of  this  operation,  and  that  it  has  been  often  undertaken, 
to  the  serious  risk  of  the  life  of  a  woman,  when,  if  left  to  nature,  she 
would  have  done  well.  A  case  is  reported  to  have  occurred  in  Scotland 
in  1847,  in  which  the  Ciesarean  operation  was  considered  by  several  prac- 
titioners of  experience  to  be  the  only  means  by  which  delivery  could  be 
accomplished.  Fortunately  for  the  woman,  the  labor  was  somewhat 
rapid  and  she  was  delivered  of  a  dead  child,  weighing  about  three  pounds, 
before  the  arrival  of  those  who  had  considered  that  the  operation  would 
be  required.  (Edin.  Month.  Jour.,  1847,  ii.  p.  30.)  The  fact  is,  on  these 
occasions  nature  often  adapts  means  to  ends  in  a  most  unexpected 
manner. 

Medical  jurists  have  differed  respecting  the  period  of  gestation  at  which 
the  operation  should  be  performed.  This  would,  of  course,  depend  on 
the  earliest  period  at  which  a  child  might  be  born  capable  of  living.  In 
reference  to  tenancy  by  curtesy,  a  child  might  be  extracted  alive  as  early 
as  the  fifth  month,  but  it  would  not  be  likely  to  survive  unless  it  were  at 
or  about  the  seventh  month.  When  a  woman  dies  undelivered,  it  is  diffi- 
cult to  say  for  how  long  a  period  the  child  may  survive  in  the  womb.  It 
has  been  stated  that  a  child  may  thus  continue  to  live  for  many  hours,  but 
this  is  not  borne  out  by  any  facts,  and  the  physician  who  makes  the  sug- 
gestion admits  that  no  time  should  be  lost  in  removing  it  from  the  womb. 
In  the  case  of  L'Hotellier  (Ann.  d'Hyg.,  1838,  t.  1,  p.  98),  the  child  was 
removed  alive  a  quarter  of  an  hour  after  the  death  of  the  woman.  Madge 
operated  in  a  case  of  convulsions  twenty  minutes  after  the  death  of  the 
woman,  but  the  child  was  then  dead.  There  were  no  signs  of  uterine 
action  after  the  mother's  death.  (Amer.  Jour.  Med.  Sci.^1872,  p.  585.) 
Some  have  alleged  that,  unless  the  operation  is  performed  immediately 
after  the  death  of  the  woman,  the  child  would  not  be  extracted  living. 
The  condition  of  the  foetus  in  utero  is,  however,  peculiar  and  quite  dis- 
tinct from  that  of  a  child  living  by  the  act  of  breathing.  There  may  be 
a  limited  independent  survivorship,  and  the  operation  may  be  performed 
so  late  as  from  a  quarter  to  half  an  hour  after  the  death  of  the  woman, 
with  the  probability  of  extracting  a  living  child.  There  is  no  doubt  that 
it  will  carry  with  it  the  greatest  chance  of  success  when  performed  imme- 
diately after  the  circulation  between  the  woman  and  the  child  has  ceased. 
This  time  will  be  marked  by  the  cessation  of  the  heart's  action  in  the 
woman.  Lorane  extracted  a  child  from  the  body  of  a  woman,  set.  35,  in 
her  eighth  pregnancy.  She  died  from  eclampsia,  and  immediately  after 
she  drew  her  last  breath  the  abdomen  was  opened  and  a  child  at  full  term 


598  EESPONSIBILITY  ACCORDING  TO  AGE. 

was  extracted.  In  about  a  minute  it  began  to  breathe,  (Amer.  Jour. 
Med.  Sci.,  1873,  p.  561.)  A  woman,  set.  25,  died  of  apoplexy  in  the 
eightli  month  of  her  pregnancy.  With  the  consent  of  the  husband,  the 
Cifisarean  operation  was  performed  within y?fe  minutes  after  the  mother's 
death,  and  a  male  child  weighing  hardly  four  pounds  was  extracted.  It 
was  seemingly  dead,  but  by  artificial  respiration  life  was  restored  and  the 
child  is  reported  to  has^e  done  well.  (Lancet,  1870,  ii.  p.  87.)  A  woman 
died  from  twenty  to  thirty  minutes  before  the  performance  of  the  Cesarean 
section,  which  occupied  only  three  minutes.  The  child  \vas  removed  living. 
The  pulsation  of  the  cord  was  scarcely  perceptible  and  the  heart  acted 
very  feebly.  Artificial  means  were  resorted  to  to  establish  respiration, 
and  in  about  an  hour  they  were  successful.  In  ten  cases  of  Csesarean 
section  there  were  two  recoveries  of  the  mothers;  and  of  six  living  children 
recovered,  three  survived  two  months.  (Brit.  Med.  Jour.,  1877,  ii.  p.  135.) 
It  has  been  said  that  intra-uterine  life  maybe  maintained  for  two  hours  or 
more  after  the  death  of  the  mother,  but  this  is  doubtful. 

3.  The  child  must  be  born  capable  of  inheriting;  therefore,  if  it  be  a 
monster,  which  cannot  legally  take  an  estate,  the  husband  does  not  acquire 
a  right  of  tenancy. 

Minority  and  Majority. — The  word  minor  is  synonymous  with  that  of 
infant  (infans),  and  is  applied  in  law  to  any  one  under  the  age  of  twenty- 
one  years.  The  age  of  a  person  may  render  him  incompetent  to  the  per- 
formance of  certain  duties.  Minors  are  frequently  called  upon  to  act  as 
witnesses  in  civil  and  criminal  cases.  The  law  has  fixed  no  age  for  testi- 
monial competency  and  we  have  never  heard  of  the  question  being  re- 
ferred to  a  medical  practitioner. 

[At  the  age  of  fourteen  the  law  presumes  every  person  has  common 
discretion  and  understanding  until  the  contrary  appears;  under  that  age 
there  is  no  such  legal  presumption:  Greenleaf  on  Evidence,  §  367;  Whar- 
ton's Ev.,  §  398  ;  Schone's  Domestic  Relations,  §  898;  Rapalge  on  Wit- 
nesses, §  7. 

When  a  child  under  fourteen  years  of  age  is  offered  as  a  witness,  a  pre- 
liminary inquiry  by  the  judge  into  the  degree  of  understanding  of  the 
child  is  necessary.  If  it  appear  that  the  child  has  sufficient  natural  intelli- 
gence and  knoAvledge  to  under.stand  the  nature  and  effect  of  an  oath,  it 
is  the  dutv  of  the  court  or  judge  to  admit  its  testimonv:  Rex  v.  Perkins, 
2  Moodv^C.  C.  135;  State  v.  Whittier,  21  Me.  341  ;  Blackwell  v  State, 
11  Ind.  196  ;  State  v.  Lattin.  29  Conn.  389  ;  McGuire  v.  People,  44  Mich. 
286;  State  v.  EdAvards,  70  N.  Car.  648;  Flanagan  v.  State,  25  Ark,  92; 
People  V.  Bernal,  10  CaL  66;  Com  v.  Le  Blanc,  3  Brev.  (S.  Car.)  339; 
Com.  V.  Mullins,  2  Allen  (Mass.),  295;  Simpson  v.  State,  31  Ind.  90; 
Den  V.  Yan  Cleve,  5  N.  J.  L.  589.] 

A  child  is  always  examined  orally  by  the  court,  and  it  is  soon  rendered 
apparent  by  the  answers  whether  the  witness  possesses  a  proj)er  knowl- 
edge of  the  nature  and  obligations  of  an  oath.  If  not,  his  or  her  testimony 
is  not  received,  except  in  the  case  of  a  rape  on  a  child  under  thirteen  years 
of  age.  The  competency  of  a  child  as  a  witness  does  not  depend  on  age, 
but  upon  its  degree  of  understanding.  In  respect  to  criminal  responsi- 
bility as  affected  by  age,  it  was  held  by  Keating,  J.,  in  a  case  (Reg.  v. 
Cowley,  1860)  in  which  the  prisoner,  a  boy  aged  eight  years,  was  charged 
with  felony,  that  up  to  seven  years  of  age  the  law  presumed  that  a  child 
could  not  distinguish  right  from  wrong  so  as  to  be  legally  capable  of 
crime  ;  and  evidence  was  not  admissible  to  prove  that  he  possessed  that 
capacity.     After  the  age  of  seven  ard  up  to  fourteen  years,  although  the 


RESPONSIBILITY    ACCORDING    TO    AGE.  599 

law  presumed  a  child  to  be  primd.  facie  incapable  of  crime,  this  presump- 
tion mig'ht  be  rebutted  by  evidence  which  showed  that  he  had  what  was 
called  a  mischievous  discretion  {doli  capax).  In  the  case  referred  to, 
there  was  no  evidence  of  that  sort,  and  therefore  he  directed  an  acquittal. 
In  another  case,  tried  before  the  same  judg-e  in  May,  1863  (Whitby  v. 
Hod.^-son),  an  action  for  trespass  and  false  imprisonment  was  brought 
against  a  man  for  giving  into  custody,  on  a  charge  of  stealing,  a  boy  under 
nix  years  of  age.  It  appeared  that  the  child  had  stolen  some  wood  ;  but 
it  was  held  that  at  this  age,  and  under  seven  years,  a  child  was  in  point 
of  law  doli  incapax  ;  hence  the  defendant  was  not  justified  in  giving  the 
boy  into  custody.  The  jury  returned  a  verdict  with  damages  against  him. 
At  the  Bedford  Sum.  Ass.,  1873  (Reg.  v.  Hollis),  a  boy  of  nine  was 
charged  with  the  manslaughter  of  a  boy  of  about  the  same  age  by  striking 
him  a  blow  in  the  thigh  with  the  iron  end  of  a  hoe.  This  led  to  death  in 
about  three  weeks.  Cleasby,  B.,  directed  the  jury  that  they  must  be  sat- 
isfied that  there  was  such  a  wicked  mind  in  the  prisoner  at  the  time  of 
striking  the  blow  as  would  rebut  the  presumption  that  a  child  under  four- 
teen years  of  age  is  incapable  of  committing  a  felony.  The  jury  returned 
a  verdict  of  not  guilty.  According  to  the  law,  a  male  at  fourteen  is  con- 
sidered to  be  at  years  of  discretion,  and  he  then  becomes  responsible  for 
his  actions ;  at  twenty-one  he  attains  majority  and  is  at  his  own  disposal, 
and  may  alienate  his  lands,  goods,  and  chattels  by  deed  or  will.  [At 
common  law,  males  of  fourteen  and  females  of  twelve  could  dispose  of 
personalty  by  will:  Coke  Litt.,  89,  6;  Davis  v.  Baugh,  1  Sneed  (Tenn.), 
477.  Wyoming  and  New  Mexico  have  re-enacted  the  common  law  by 
statute.]  It  is  only  when  this  age  has  been  attained  that  an  individual 
can  be  made  to  serve  on  a  jury. 

A  child  under  fourteen  indicted  for  murder  must  be  proved  to  have 
been  conscious  of  the  nature  of  the  act.  In  the  case  of  Reg.  v.  Vamplew 
(Lincoln  Sum.  Ass.,  1863),  a  girl  under  fourteen  years  of  age  was  con- 
victed of  destroying  the  life  of  a  child  by  strychnine.  It  was  shown  that 
she  was  competent  to  understand  the  nature  of  the  act.  Under  fourteen, 
the  male  infant  is  presumed  to  be  incapable  of  committing  a  felony,  but 
the  intent  may  be  proved  by  the  facts  given  in  evidence.  A  person  may 
be  convicted  of  an  unnatural  crime,  although  the  agent  be  under  fourteen. 
A  female  under  the  age  of  thirteen  years  is  presumed  to  be  incapable  of 
consenting  to  sexual  intercourse.  Boys  at  or  under  fourteen  have  been 
tried  and  convicted  of  rape  on  several  occasions. 

A  person  attains  his  legal  majority,  or  is  completely  of  age,  the  first 
instant  of /!/ie  day  before  the  twenty-first  anniversary  of  his  birthday; 
and  this  mode  of  calculating  age  and  time  is  applicable  to  all  other  ages 
before  and  after  twenty-one.  This  is  on  the  principle  that  a  part  of  a  day 
is,  in  a  legal  point  of  view,  equal  to  the  whole  of  a  day.  A  few  minutes 
or  hours  may  thus  determine  the  attainment  of  majority,  and,  with  this, 
the  responsibility  of  minors  for  civil  contracts  or  the  validity  of  their  wills. 
By  1  Vict.  c.  26,  no  will  made  by  any  person  under  the  age  of  twenty- 
one  years  shall  be  valid;  and  as  the  day  of  a  person's  birth  is  included  in 
the  computation  of  his  age,  and  there  being-  in  law  no  fraction  of  a  day,  a 
valid  will  may  be  made  at  any  time  on  the  day  before  that  which  is 
usually  considered  the  twenty-first  anniversary  of  birth. 

There  is  another  aspect  in  which  this  question  of  age  may  be  viewed 
— namely,  in  reference  to  the  responsibility  of  accused  persons  for  debts, 
or  alleged  criminal  acts.  In  Reg.  v.  Thornhill  (Stafford  Lent  Ass.,  1865), 
the  prisoner  was  indicted  for  a  misdemeanor  in  carnally  knowing  and 
abusing  one  Mary  Sambrook,  being  a  girl  above  the  age  of  ten  and  under 


600  MONSTROUS    BIRTHS, 

the  age  of  twelve  years.  It  appeared  in  evidence  that  the  girl's  birthday 
was  on  Dec.  5,  1852,  and  the  offence  was  alleged  to  have  been  committed 
on  Dec.  4,  1864.  The  question  then  arose  whether  this  girl  was  at  the 
time  under  the  age  of  twelve  years,  so  as  to  bring  the  offence  within  the 
then  statute.  It  was  objected  by  the  prisoner's  counsel  that,  as  on  Dec. 
5  the  girl  would  enter  on  her  thirteenth  year,  she  had  therefore  completed 
her  twelfth  year  on  Dec.  4,  and  that  the  law  did  not  recognize  a  fraction 
of  a  day  in  such  a  case,  so  that  she  was  twelve  years  old  as  much  on  the 
first  hour  of  that  day  as  on  the  last ;  and  Pigott,  B.,  so  held.  The  indict- 
ment contained  counts  alleging  rape  and  assault,  but,  after  the  cross-exam- 
ination of  the  girl,  his  lordship  stopped  the  case,  and  the  prisoner  was 
acquitted.  It- is  obvious  that  this  principle  would  now  equally  apply  to 
charges  of  felony  for  the  carnal  knowledge  of  children  under  thirteen  j^ears 
of  age,  as  well  as  to  the  misdemeanor  of  taking  girls  under  the  age  of  six- 
teen 3'ears  from  the  custod}^  of  their  parents,  or  of  stealing  children  under 
the  age  of  fourteen  years  from  their  parents  or  guardians.  The  proof  of 
the  exact  date  of  birth  sometimes  rests  with  a  medical  man. 

The  subject  oi  plural  births  has  been  regarded  as  appertaining  to  med- 
ical jurisprudence  ;  .but  we  are  not  aware  that  there  is  an}^  case  on  record 
in  which  the  evidence  of  a  medical  man  has  been  required  respecting  it. 
This  is  a  simple  question  of  primogeniture,  which  has  been  generally  set- 
tled by  the  aid  of  depositions  or  declarations  of  relations  or  servants  pres- 
ent at  the  births.  Of  course,  in  the  absence  of  eye-witnesses,  the  question 
of  priority  of  birth  must  be  a  matter  of  conjecture.  It  cannot  be  deter- 
mined by  the  size  or  weight  of  the  child,  but  it  might  be  determined  by 
the  observation  of  certain  marks  or  deformities  in  one  or  more  of  the 
children. 

Monstrous  Births. — The  law  of  England  has  given  no  precise  defini- 
tion of  what  is  intended  by  a  monster.  According  to  Lord  Coke,  it  is  a 
being  "which  hath  not  the  shape  of  mankind  ;  such  a  being  cannot  be  heir 
to,  or  inherit  land,  although  brought  forth  within  marriage."  A  mere 
deformity  in  any  part  of  the  body,  such  as  supernumerary  fingers  or  toes, 
twisted  or  deformed  limbs,  will  not  constitute  a  monster  in  law,  so  far  as 
the  succession  to  property  is  considered,  provided  the  being  still  have 
"  huvioM  sho.pe.''^  From  Lord  Coke's  description,  it  is  obvious  that  the 
law  wall  be  guided  in  its  decision  by  the  description  of  the  monstrous  birth 
given  by  a  medical  witness.  It  would  not  rest  with  a  witness  to  say 
whether  the  being  was  or  was  not  a  monster — the  court  would  draw  its 
inference  from  the  description  given  by  him.  Various  classifications  of 
monsters  have  been  made,  but  these  are  of  no  assistance  to  a  medical 
jurist,  because  each  case  must  be  decided  by  the  peculiarities  attending  it; 
and  his  duty  will  not  be  to  state  the  class  and  order  of  the  monster,  but 
simply  in  what  respect  it  differs  in  shape  and  external  appearance  from  a 
normal  child.  But  the  question  here  presents  itself — What  is  a  normal 
child,  or  indeed  "child"  in  a  legal  sense?  On  this  point  conflicting  deci- 
sions have  been  given  by  different  judges  (p.  511,  ante).  All  will  agree 
that  a  blighted  foetus  or  a  mole  is  not  a  child,  but  difference  has  arisen  on 
the  question  whether  the  partus  should,  in  addition  to  having  human 
shape,  have  reached  a  uterine  age  at  which  it  could  continue  to  live,  i.  e. 
that  it  should  have  viability.  (See  Concealment  of  Birth,  p.  510.)  A 
correct  definition  of  a  normal  child,  therefore,  is  still  a  desideratum  in  law. 
Although  a  monster  may  not  survive  its  birth  more  than  a  few  seconds, 
yet  if  it   be  legally  pronounced  from  the  medical  evidence  to  have  human 


MONSTROUS    BIRTHS.  601 

shape,  it  may  transmit  an  estate  to  its  beirs-at-law,  as  in  the  case  of  nor- 
mally formed  children. 

Malpositions,  transpositions,  or  defects  of  the  internal  organs  of  any  of 
the  cavities  do  not  form  monstrous  births  within  the  meaning  of  the  Eng- 
lish law.  The  legal  question  relates  only  to  external  shape,  not  to  internal 
conformation.  It  is  well  known  that  many  internally  malformed  persons 
live  to  a  great  age,  and  it  is  not  until  alter  death  that  malpositions  and 
defects  of  this  kind  are  discovered.  In  French  jurisprudence  the  case 
appears  to  be  different ;  if  the  malposition  or  defect  was  such  as  to  be- 
come a  cause  of  death  soon  after  birth,  the  child  would  be  pronounced  not 
''viable,^'  and  therefore  incapable  of  acquiring  civil  rights.  Some  medical 
jurists  have  discussed  the  question  of  "viability^''  in  newborn  children, 
i.  e.  their  healthy  organization  with  a  capacity  to  continue  to  live,  as  if, 
it  were  part  of  the  jurisprudence  of  this  country  ;  but  there  are  no  facts 
which  bear  out  this  view.  The  English  law  does  not  regard  internal 
monstrosity  as  forming  a  bar  to  civil  rights  ;  and  the  cases  decided  hitherto^ 
show"  clearly  that  the  simple  question  in  English  jurisprudence  is,  not 
whether  a  child  (partus)  is  or  is  not  "viable,^^  but  whether  it  has  mani- 
fested any  distinct  sign  of  life  after  it  was  entirely  born.  The  French 
law  is  much  more  complex,  and  thows  a  much  greater  degree  of  respon- 
siliility  on  French  medical  jurists. 

No  person  is  legally  justified  in  destroying  a  monster  at  birth  (p.  566, 
ante). 


602  LEGITIMACY  OF  OFFSPRING. 


LEGITIMACY. 


CHAPTER     LVI. 

PKESFMPTION  OF  LEGITIMACY. XATCRAL   PERIOD  OF  GESTATION. DURATION  OF  PREGNANCY 

FROM    ONE    INTERCOURSE. PREMATURE    BIRTHS. SHORT    PERIODS    OF    GESTATION. VIA- 
BILITY.  EARLIEST  PEKIOD  AT  WHICH  A  CHILD  MAY  BE  BORN  LIVING EVIDENCE  FROM  THE 

STATE   OF  THE  CHILD. PROTEACTED  BIRTHS. THE  PEKIOD  OF  GESTATION    NOT    FIXED    BY 

LAW. 

Legal  Presuniplion  of  Legitimacy. — Every  child  born  either  in  lawful 
matrimony,  or  within  a  period  after  the  death  of  the  husband  in  accord- 
ance with  the  natural  period  of  gestation,  is  considered  by  the  English 
law  to  be  the  child  of  the  husband,  unless  the  contrary  be  made  clearly  to 
appear  by  medical  or  moral  evidence,  or  by  both  combined  It  is  only  in 
reference  to  medical  evidence  that  the  subject  of  legitimacy  can  here  be 
considered ;  but  it  is  extremely  rare  to  find  a  case  of  this  kind  determined 
Ijy  medical  evidence  alone.  There  are  generally  circumstances  which 
show  that  a  child  whose  legitimacy  is  disputed  is  the  offspring  of  adul- 
tery, while  the  medical  facts  may  be  perfectly  reconcilable  with  the 
supposition  that  the  claimant  is  the  child  of  the  husband.  These  cases, 
therefore,  have  been  repeatedly  decided  from  moral  evidence  alone — the 
medical  evidence  respecting  the  period  of  gestation  or  physical  capacity 
in  the  parties  leaving  the  matter  in  doubt.  The  present  state  of  the 
English  law  on  this  subject  appears  to  be  this.  A  child  born  during 
marriage  is  deemed  illegitimate  when,  by  good  medical  or  other  evidence, 
it  is  proved  that  it  was  impossible  for  the  husband  to  have  been  the 
father — whether  from  his  being  under  the  age  of  puberty,  from  his  labor- 
ing under  physical  incapacity  as  a  result  of  age  or  natural  infirmity,  or 
from  the  length  of  time  which  may  have  elapsed  since  he  could  have  had 
intercourse,  whether  by  reason  of  absence  or  death.  When  the  question 
turns  upon  any  of  these  conditions,  medical  science  is  required  for  its 
solution,  and  on  these  occasions  skilled  experts  are  usually  selected  by  the 
litigants.  With  proof  of  non-access  of  the  husband  or  immorality  on  the 
part  of  the  mother,  so  important  on  these  occasions,  a  medical  witness  is 
not  in  the  least  concerned.  In  cases  of  contested  legitimacy,  the  English 
law  does  not  regard  the  date  of  conception,  Avhich  cannot  be  fixed,  but  the 
date  of  birth,  which  can  be  fixed.  Medical  evidence  may  relate,  first,  to 
the  actual  length  of  the  period  of  gestation — this  may  be  in  a  given  case 
so  short  or  so  long  as  to  render  it  impossible  that  the  husband  could  be 
the  father ;  second,  there  ma}^  be  physical  incapacit}^  in  the  husband  to 
procreate — he  may  be  too  old  or  too  young,  or  he  may  labor  under  some 
physical  defect  rendering  it  impossible  that  he  should  be  the  father  ;  third, 
there  may  be  sterility  or  incapacity  in  the  wife,  rendering  it  impossible 
that  the  child  should  be  the  offspring  of  a  particular  woman — in  other 
words,  the  claimant  may  be  a  supposititious  child. 


NATURAL    PERIOD    OF    GESTATION.  603 

[The  law  upon  the  subject  of  Legitimacy  may  be  stated  thus  : — 

Legitimacy  is  the  state  of  being  born  in  vvedloclv — that  is,  in  a  lawful 
manner,  or  in  accordance  with  law:  Bouvier's  Law  Dictionary,  tit.  2,  p, 
67  ;  Anderson's  Law  Dictionary,  611  ;  Campbell's  Case,  2  Bland  Gh. 
(Md.)  36. 

An  illegitimate  child  is  one  born  out  of  wedlock,  or  not  within  compe- 
tent time  after  termination  of  coverture  ;  or  if  born  out  of  wedlock,  whose 
parents  do  not  afterwards  intermarry  and  the  father  acknowledge  it,  or 
who  is  born  in  wedlock  where  procreation  by  the  husband  is  impossible: 
Smith  V.  Perry,  80  Va.  563. 

By  the  common  law  the  subsequent  marriage  of  parents  does  not  legiti- 
mize children  born  out  of  wedlock  before  marriage,  but  in  many  of  the 
American  States  the  subsequent  marriage  of  parents  works  by  statute  the 
legitimacy  of  the  child,  notably  Arkansas,  Georgia,  Indiana,  Kentucky, 
Louisiana,  Maryland,  Massachusetts,  Pennsylvania,  New  Hampshire, 
Texas,  and  Virginia.  A  child  born  after  marriage,  no  matter  how  soon, 
is  born  in  wedlock,  and  presumed  to  be  legitimate,  and  all  children  born 
in  wedlock  are  presumed  in  law  to  be  legitimate  :  Bouvier's  Institutes, 
322;  State  v.  Romaine,  88  Iowa,  48;  Rhine  v.  Hoffman,  6  Jones  Eq., 
335;  1  Rolle  Abr.  358;  2  Bac.  Abr.  84;  Rex  v.  Reading,  Lee  Temp. 
Hardw.  83;  King  v.  Luffe,  8  East.  193,  Lord  Ellenborough,  Justice,  sus- 
tained by  authorities  in  many  American  States  :  State  v.  Herman,  13  Ired, 
(N.  Car.)  502;  State  v.  Romaine,  58  Iowa,  46. 

Where  the  mother  has  lived  and  cohabited  with  the  father,  and  has 
been  recognized  by  him  as  his  wife  and  the  child  as  his  offspring,  in  the 
absence  of  any  proof  to  the  contrary,  even  though  there  be  no  evidence 
of  a  legal  marriage,  the  law  presumes  the  issue  to  be  legitimate:  Taylor 
on  Evidence,  Text-Book  Series,  §  649;  Hargrave  i;.  Hargrave,  2  C.  & 
Kir.  701 ;  Shotle  v.  Magervan,  2  i3ush.  (Ky.)'627. 

These  presumptions  may,  however,  be  rebutted,  on  showing  : — 

1.  That  the  husband  was  impotent  or  incompetent,  by  Lord  Ellen- 
borough,  Justice,  in  King  v.  Luffe,  8  East.  207  ;  Head  v.  Head,  1  Sim.  & 
Stu.  150  ;  Cross  v.  Cross,  3  Paige  Chan.  (N.  Y.)  139  ;  23  Am.  Dec.  778. 

2.  Positive  absence  of  the  husband  during  the  period  in  which  the  child 
must,  in  the  course  of  nature,  have  been  begotten,  or  his  death,  or  non- 
access  :  King  V.  Luffe,  supra;  R.  v.  Allerton,  1  Ld.  Raymond,  395; 
Banbury  Peerage,  answer  to  7th  question,  1  Sim.  &  Stu.  157  ;  State 
V.  Britt",  78  N.  Car.  439  ;  Cope  v.  Cope,  Alderson  B  ,  1  En.  &  Rob.  275  ; 
Benny  v.  Philpot,  2  Myl.  &  K.  349;  Com.  v.  Strieker,  1  Browne  (Pa.) 
Appx.  47  ;  Wilson  v.  Babb.  18  S.  Car.  59;  Hargrave  v.  Hargrave,  9 
Beav.  255. 

By  common  law,  if  the  husband  was  within  the  four  seas  at  any  time 
during  the  pregnancy  of  the  wife,  the  presumption  was  conclusive  that 
the  issue  was  legitimate:  R.  v.  Murray,  1  Salk.  122;  R.  v.  Allerton.  1 
Ld.  Raymond,  122. 

While  the  ancient  policy  of  the  English  common  law  remains  unchanged, 
the  courts  have  in  modern  times  taken  evidence,  which,  if  absolutely  con- 
clusive of  non-access  and  free  from  all  doubt,  modified  the  old  rule: 
Head  D.  Head,  1  Sim  &  Stu.  160;  Am.  and  Eng.  Encyclopaedia  of  Law, 
note  under  Legitimacy,  p.  225.] 

Natural  FeiHod  of  Gestation.  Duration  from  One  Intercourse. — The 
first  point  to  be  considered  is — What  is  the  natural  period  of  gestation, 
and  whether  this  is  a  fixed  or  variable  term.  According  to  the  testimony 
of  experienced  accoucheurs,  the  average  duration  of  gestation  in  the 
human  female  is  comprised  between  the  thirty-eighth  and  fortieth  weeks 


604:  LEGITIMACY  —  ONE    INTERCOURSE. 

after  conception.  Numerous  facts  show  that  the  greater  number  of  chil- 
dren are  naturally  born  between  these  two  periods.  Out  of  186  cases 
reported  b}^  Murph}',  the  greater  number  of  deliveries  took  place  on  the 
285th  day  (Obst.  Rep.,  1844) ;  but  his  opinion  is  that  301  days  may  be 
taken  as  the  average  limit  ■  of  gestation.  (Lancet,  1844,  ii.  p.  284.) 
Blundell  considered  that  the  average  period  was  274  days.  Simpson 
(Bromwich  v.  Waters,  Chester  Lent  Ass.,  1863),  277  days,  i.e.  nine  cal- 
endar months  and  a  week ;  and  other  accoucheurs  of  repute  have  fixed 
upon  280  days.  Among  500  cases  observed  by  Reid  there  Avere  283  in 
which  the  period  of  gestation  was  within  280  days,  and  217  cases  in 
which  it  went  beyond  this  period.  Duncan  found,  in  a  group  of  forty-six 
cases,  that  275  days  is  the  average  interval  between  that  which  he  terms 
"  insemination  "  (intercourse)  and  parturition.  The  largest  number  of 
cases  on  any  particular  day  was  seven  on  the  274th  day.  (Edin.  Month. 
Jour.,  1854,  vol.  ix.  p.  230.)  The  most  common  cause  of  this  variation 
in  time  is  that  the  usual  mode  of  calculation,  by  refeience  to  the  suppres- 
sion of  the  menstrual  discharge,  even  in  a  healthy  woman,  may  lead  to  a 
.possible  error  of  two,  three,  or  even  four  weeks,  since  there  is  no  sif^n 
whereby  in  the  majority  of  women  the  actual  time  of  conception  can  be 
determined.  Some  have  been  able  to  determine,  by  peculiar  sensations, 
the  time  at  which  they  have  conceived  ;  but,  as  a  general  rule,  this  mu^t 
be  a  matter  of  pure  conjecture  when  they  are  living  in  connubial  inter- 
course. 

On  the  other  hand,  accidental  and  isolated  cases  have  clearlj^  proved 
that  a  great  difference  naturally  exists  among  women  with  respect  to  the 
period  of  gestation  ;  and  it  is  probable  that  in  no  two  is  it  necessarily  the 
same.  When  there  has  been  only  one  intercourse  the  duration  of  pregnancy 
may  be  certainly  calculated  without  reference  to  an}'  chances  in  the  female 
constitution;  for  the  date  of  conception,  within  certain  limits  to  be  pre- 
sently mentioned,  would  be  fixed.  Observations  of  this  kind  have  shown 
that  women  have  differed  from  each  other  ;  and  in  several  instances  the  time 
has  exceeded  or  fallen  short  of  the  period  of  forty  weeks,  which  has  been 
usually  set  down  as  the  legal  limit  of  natural  gestation.  In  three  cases 
of  single  intercourse  known  to  Rigby,  labor  came  on  in  260,  264,  and  276 
days,  making  a  difference  of  sixteen  days.  (Med.  Times,  1846,  i.  p.  471.) 
In  three  other  instances  which  were  communicated  by  Merriman,  labor 
commenced  at  281,  283,  and  286  days  respectively  after  one  intercourse  ; 
and  in  a  case  which  occurred  to  Reid  the  labor  did  not  commence  until 
after  the  lapse  of  293  days  from  a  single  intercourse.  (Lancet,  1850,  ii. 
p.  79.)  In  another  case  accurately  observed  the  gestation  lasted  281 
day.s.  Menstruation  had  ceased  on  the  16th  Sept.,  intercourse  took  place 
on  the  20th,  quickening  occurred  on  the  23d  Jan.,  and  a  full-grown  male 
child  was  born  on  the  28th  June  following.  In  two  cases  the  women 
Avere  delivered  respectively  in  249  and  260  days  after  a  single  intercourse. 
In  a  third,  in  which  pregnancy  was  the  result  of  a  rape,  there  was  an  in- 
terval of  261  days  between  intercourse  and  deliver3^  [C.  Weymouth 
Tidy  reports  eiirht  cases  in  which  the  date  of  coitus  was  fixed.  These  all 
aqree  on  the  278th  day  as  being  as  near  as  possible  the  day  of  delivery: 
Tidy  Legal  Med.,  vol  2,  Phil.  Ed.,  p.  46.]  Hence  it  will  be  perceived 
that  in  well-observed  cases,  where  there  could  be  no  motive  for  misstate- 
ment, and  in  v/hich  the  characters  of  the  women,  some  of  whom  were 
married  and  bad  already  borne  children,  were  beyond  the  reach  of  sus- 
picion, a  difference  of  not  less  than  thirti/-(hree  day.s  has  been  observed  to 
occur,  i.  e.  between  the  earliest  case  reported  by  Rigby,  and  the  latest  re- 
ported by  Reid.     This  is  worthy  of  remark,  because  in  one  case  (Lus- 


VARIATIONS    IN    THE    PERIOD    OF    GESTATION.  605 

combe  v.  Prcttyjohn)  it  was  leg-ally  held  that  299  days,  only  six  days 
longer  than  in  Reid's  observation,  was  an  imjjossible  period  for  human 
gestation.  h\  addition  to  the  above  facts  showing  the  variability  of  the 
period  after  a  single  intercourse,  the  following  may  be  cited.  Macilvain 
has  reported  a  case  of  gestation  which  he  thinks  must  have  extended  to 
296  or  possibly  to  299  days.  (Amer.  Jour.  Med.  Sci.,  1848,  p.  24T.)  We 
are  indebted  to  Oldham  for  nine  cases,  which  have  fallen  under  his  obser- 
vation, in  which  the  duration  of  pregnancy  from  a  single  intercourse  was 
accurately  observed : 

Case. 

1  .  .  . 

2  .  .  . 


Days. 

Case. 

2«6 

6 

268 

7 

271 

8 

280 

9 

280 

Days. 

281 
28.3 
284 
285* 


ISTos.  4,  5,  and  6  represent  the  periods  of  gestation  in  the  same  woman 
at  different  times. 

Idelson,  a  recent  female  medical  authority,  made  observations  on  the 
duration  of  pregnancy  in  4370  cases.  The  usual  duration  was  279  days. 
(Petersburg.  Med.  Wochenschr.,  April  28,  1881.) 

Lockwood  published  the  following  as  the  result  of  his  experience.  The 
actual  duration  of  the  term  of  gestation  in  the  human  subject,  i.  e.  the  in- 
terval between  intercourse  and  delivery,  was  ascertained  by  him  in  four 
cases:  I^o.  1,  aged  19,  duration  272  days  (first  confinement) ;  No.  2,  aged 
30  (first  confinement),  duration  276  days;  No.  3,  aged  17,  duration  270 
days  ;  No,  4,  aged  44  (seventh  confinement),  duration  284  days,  the  child 
weighing  fourteen  pounds.  (Brit.  Amer.  Jour.,  Dec.  1847,  p.  214.) 
Devilliers  also  published  the  particulars  of  nine  cases  in  which  the  inter- 
val from  a  sinirle  intercourse  was  accuratelv  determined.  Delivery  took 
place  at  the  following  periods;  229,  246,  25''7,  267,  3CI,  276-281,  278-283, 
270,  and  266-272  days,  making  an  extreme  difference  of  49  days  in  the 
earliest  and  the  latest  periods  between  intercourse  and  delivery.  (Lond. 
Med.  Gaz.,  1848,  p.  524.)  Ahlfeld  made  observations  on  425  women 
whose  children  seemed  mature,  and,  reckoning  from  the  day  of  conception, 
he  found  that  the  average  duration  of  gestation  was  269.9  davs.  Out  of 
thirty  cases  of  single  or  well-defined  coitus  collected  by  him  gestation 
varied  from  233  days  to  one  case  of  313  days.  The  average  of"  all  was 
269.2  days,  which  corresponds  closely  with  the  period  obtained  by  other 
modes  of  observation.  (Amer.  Med.  Jour.  Sci.,  1870,  p.  566.)  Heckers' 
tables  give  an  average  of  273.5  days.  According  to  Stadtfeldt,  the  mean 
duration  in  sixty-five  pregnanc'es  observed  by  him  was  271.8  days,  and 
the  extent  of  variation  was  from  250  to  293  days.  (Brit.  Med.  Jour., 
1877,  ii.  p.  599.)  Strathy  reports  a  case  (ibid.,  1876,  i.  p.  505)  in  which 
a  married  woman  was  delivered  of  a  child  weighing  about  five  pounds, 
298  days  after  the  last  intercourse  with  her  husband.  A  long  period  of 
gestation,  308  days  accurately  recorded,  is  based  upon  the  observation  of 
Hevvett.  The  duration  was  ascertained  by  the  sudden  death  of  the  hus- 
band, and  rests  obviously  upon  the  statement  of  the  wife.  (Gruy  and 
Ferrier,  Princ.  of  For.  Med.,  6th  edit.,  p.  123.) 

There  is  reason  to  believe  that  the  date  of  conception  after  a  single 
intercourse  varies  in  different  w^oraen  and  in  the  same  woman  at  diff'erent 
times.  It  is  customary  for  physiologists  to  date  conception  from  inter- 
course ;  but  a  variable  interval  may  elapse,  according  to  the  situation  of 
the  ovum  at  the  time.     It  has  also  been  supposed  that  women  conceive 


606  VARIATIO^'S    IN    THE    PERIOD    OF    GESTATION. 

move  readily  at  some  periods  than  at  others,  and  that  intercourse  had 
within  eight  to  twelve  days  from  the  cessation  of  the  menstrual  discharge 
is  more  favorable  to  conception  than  at  any  other  period.  Oldham  met 
with  a  case  in  which  impregnation  took  place  twelve  days  after  menstru- 
ation ;  and  he  states  that  he  has  known  it  to  occur  at  the  respective  times 
of  ten  days,  twelve  days,  and  even  twenty-one  days  after  the  monthly 
period;  and  he  knows  of  no  fact  to  disprove  the  opinion  that  the  human 
female  is  susceptible  of  impregnation  at  any  time  between  her  monthly 
periods.  According  to  Duncan,  a  single  insemination  at  any  period  of  the 
interval  between  two  menstrual  periods  may  result  in  fecundation.  (Edin. 
Month.  Jour.,  1854,  vol.  ix.  p.  233.) 

The  experience  of  Oldham  is  confirmed  by  that  of  Reid.  This  authority 
admits  that  impregnation  is  more  likeh^  to  occur  immediately  after  the 
termination  of  a  menstrual  period  than  at  any  time  during  the  interval. 
The  next  most  likely  period  is  immediately  previous  to  the  occurrence  of 
menstruation,  and  the  probabilit}^  of  conception  becomes  slighter  as  the 
time  is  more  distant  from  this  epoch  ;  but  there  is  no  period  in  the  men- 
strual interval  at  v/hich  impregnation  may  not  occur.  (Lancet,  1853,  ii. 
p.  205.)  According  to  Raciborski,  from  observations  made  on  one  hun- 
dred women,  no  more  than  six  or  seven  had  become  impregnated  at  the 
mid-term  from  the  menstrual  periods.  In  several  cases  of  single  inter- 
course, the  dates  being  certain,  conception  took  place  twelve  and  fourteen 
days  after  menstruation.  It  may  be  therefore  fairly  taken  as  a  fact,  irre- 
spective of  any  theories  of  ovulation,  that  a  woman  may  conceive  from 
intercourse  had  at  the  inter-menstrual  period  (mid-period),  although,  in  a 
given  number  of  instances,  it  is  probable  that  the  conceptions  would  be 
more  numerous  within  six  or  seven  days  after  the  cessation  of  the  menses 
than  at  any  other  time. 

[Sir  William  Hunter  names  nine  months  as  the  vsual  term.  Sir  James 
Simpson  fixes  the  normal  duration  as  between  274  and  280  days.  Dr. 
Robert  Barnes  says  from  273  to  278  days  is  the  most  common  period,  and 
bethinks  275  days  the  average  normal  period.  Dr.  Montgomery  cites  56 
cases  resulting  from  a  single  coitus  (Montgomery,  p.  566),  delivery 
took  place  in  ten  of  them  (17.84  per  cent.)  in  the  39th  week,  twenty-two 
(39.28  per  cent.)  in  the  fortieth  week,  and  in  nine  (16.07  per  cent.)  in  the 
fortv-first  week.  He  gives  280  days  as,  in  hisjudgment,  the  usual  period, 
and  cites  Hippocrates  and  Herodotus  as  of  the  same  opinion.  Schroeder 
fixes  271  davs  as  the  normal  period  of  pregnancy  :  Tidy  Legal  Medicine, 
vol.  2,  p.  47".] 

In  this  case  it  is  assumed  that  intercourse  and  conception  are  synchron- 
ous, but  the  date  of  conception  is  not  fixed  by  the  date  of  intercourse. 
The  time  occupied  by  the  descent  of  the  ovum  along  the  Fallopian  tube 
varies,  while  the  time  required  for  the  passage  of  the  male  fluid  to  meet 
the  ovum  is  also  subject  to  variation.  The  investigations  of  Bischofl'  and 
Valentin  show  that  the  spermatozoa  may  retain  their  movements,  and 
probably  their  fecundating  power,  for  so  long  a  period  as  seven  days 
within  the  body  of  a  woman.  Fecundation  cannot  result  unless  the 
matured  ovum  meets  these  bodies  in  an  active  or  living  condition;  and 
conception  may  be  regarded,  in  the  language  of  Meigs,  as  the  fixation  of  a 
fecundated  ovum  upon  the  living  surface  of  the  woman.  Conception  may 
therefore  take  place  either  in  a  few  hours  or,  according  to  Valentin's  ob- 
servations, at  so  long  a  period  as  seven  days,  after  intercourse.  But  this 
does  not  satisfactorily  explain  such  extreme  differences  as  were  observed 
in  the  cases  of  Rigby  and  Reid  (thirty-three  days),  or  in  those  of  Devil- 
liers  (forty-nine  days) — ante,  p.  606.    We  must,  therefore,  be  prepared  to 


EVIDENCE    FROM    MARKS    OF    DEVELOPMENT.  607 

admit,  either  that  conception  may  in  some  cases  he  delayed  for  so  long  a 
period  as  from  five  to  seven  weeks  after  intercourse,  or  that  there  may  be 
a  difference  of  from  five  to  seven  weeks  in  the  duration  of  pregnancy. 
Whatever  may  be  the  explanation  adopted,  it  is  obvious  that,  in  a  medico- 
le<>-al  view,  the  only  conclusion  at  which  we  can  arrive  is  that  the  period 
of  gestation  in  woman  is  not,  as  it  was  formerly  supposed  to  be,  a  fixed 
and  invariable  term. 

Mistakes  have  arisen  in  the  calculation  of  the  period  by  the  use  of  the 
word  "month" — some  intending  by  this  a  lunar-  and  others  a,  calendar 
month.  Nine  lunar  months  would  be  equal  to  252  days,  while  the  average 
of  nine  calendar  months  would  be  274  days — the  latter  period  varying 
according  to  the  particular  months  of  the  year  over  which  the  pregnancy 
might  extend.  To  prevent  mistakes,  or  that  misunderstanding  of  evidence 
which  has  so  frequently  arisen,  it  is  advisable  that  medical  witnesses 
should  always  express  the  period  of  gestation  in  weeks  or  days,  concerning 
which  there  can  be  no  misunderstanding  ;  and  adopt  the  plan  of  always 
commencing  the  calculation  from  the  period  of  the  last  cessation  of  the 
menses,  rather  than  from  two  weeks  later.  The  latter  rule  is  often  fol- 
lowed, and  this  discrepancy  is  another  cause  of  confusion. 

Premature  Births.  Short  Periods  of  Gestation. — From  the  preceding 
remarks,  we  may  regard  all  births  before  the  thirty-eighth  week  as  pre- 
mature, and  all  those  which  occur  after  the  fortieth  week  as  protracted 
cases;  and  one  great  point  for  a  medical  witness  to  determine  is  whether 
the  external  characters  presented  by  a  child  correspond  to  those  which  it 
should  present,  supposing  it  to  be  legitimately  born.  When  the  birth  is 
premature,  this  sort  of  corroborative  evidence  may  be  sometimes  obtained  ; 
because,  assuming  that  there  has  been  no  access  between  the  parties  before 
marriage,  children  born  at  the  Gfth  or  sixth  month  after  marriage  cannot, 
if  the  offspring  of  the  husband,  present  the  characters  of  those  born  at  the 
full  period.  It  it  not  so  with  protracted  births,  for  children  are  not  more 
developed  in  protracted  cases  than  they  are  in  those  which  occur  at  the 
usual  period.  This  would  lead  to  the  inference  that,  when  a  child  has 
reached  a  certain  stage  of  development,  it  ceases  to  grow — a  view  which 
is  borne  out  by  the  observations  of  Riittel.  (Henke's  Zeitschrift,  1844, 
p.  24T.)  He  observed  that  the  size  of  a  child  did  not  increase  in  pro- 
portion to  the  length  of  gestation.  In  protracted  human  and  animal 
gestation,  the  offspring  is  not  remarkable  for  size  an(t  weight.  Thus 
robust  mothers  have  had  small  children,  and  small  mothers  strong  and 
sometimes  unusually  large  children.  Murphy  states  that  he  met  with  a 
fully- developed  child  which  was  born  after  a  gestation  of  only  251  days. 
(Lancet,  1844,  ii.  p.  284.)  For  an  account  of  the  characters  pi-esented  by 
children  at  different  uterine  ages,  see  Infanticide  (p.  531,  ante). 

Development  of  the  Child. — In  judging  from  marks  of  development  on 
the  body  of  a  child  as  a  test  of  uterine  age,  we  must  make  full  allowance 
for  the  exceptions  to  which  they  are  liable.  The  nearer  the  supposed  pre- 
mature delivery  approaches  to  the  full  period  of  gestation,  the  more  diffi- 
cult will  be  the  formation  of  an  opinion.  Although  the  characters  of  a 
seven  months'  child,  as  a  general  rule,  are  usually  well  marked,  and  may 
be  known  by  common  observation,  it  is  not  possible  to  distinguish  with 
absolute  certainty  a  child  born  at  the  eighth  from  one  born  at  the  ninth 
month.  Burns  observes  that  gestation  may  be  completed,  and  the  child 
perfected  to  its  natural  size,  a  week  or  two  sooner  than  the  end  of  the 
ninth  month  ;  and  other  accoucheurs  corroborate  this  view.  (Murphy,  in 
Lancet,  1844,  ii.  p.  284.) 

When,  however,  the  facts  are  such  that  to  be  the  offspring  of  the  hus- 


608        EVIDENCE  FROM  MARKS  OF  DEVELOPMENT. 

band  it  must  be  a  six  months'  child,  and  it  is  born  mature,  there  can  be 
no  reason  to  doubt  that  it  is  illegitimate.  (Eager  v.  Grimwood,  Exch. 
Sittings,  Jan.  1,  184*7.)  But  the  fact  that  a  child  born  at  nine  months  is 
small,  and  resembles  in  size  and  weight  a  seven  or  eight  months'  child, 
cannot  be  taken  as  a  medical  proof  of  illegitimacy.  Children  born  at  the 
full  period  vary  considerably  in  size  and  weight;  yet,  although  small, 
there  is  commonly  about  them  an  appearance  of  development,  which  is 
especially  apparent  in  the  features.  If  there  should  be  a  general  want 
of  development  in  the  body,  and  if  certain  foetal  peculiarities  remain — as, 
for  example,  the  membrana^  pupillares,  or,  in  the  male,  the  testes  do  not 
occupy  the  scrotum — these  facts  lead  to  a  strong  presumption  that  the 
child  has  not  reached  the  full  period.  On  the  other  hand,  when  a  child  is 
born  with  the  full  signs  of  maturity  about  it,  at  or  under  seven  months 
from  possible  access  of  the  husband,  there  is  an  equally  strong  presumption 
that  it  is  illegitimate.  The  great  progressive  stage  of  development  is  dur- 
ing the  last  two  months  of  gestation — the  changes  which  the  foetus  under- 
goes are  greater  and  more  marked  at  this  than  at  any  other  lime.  The 
general  opinion  is  that  an  eight  months'  child  is  not  with  any  certainty  to 
l)e  distinguished  from  one  born  at  the  ninth  month.  If  the  body  of  a  child 
is  large  and  fully  developed,  it  would  be  considered  to  have  been  born  at 
the  full  period  of  gestation,  and  any  opinion  which  had  led  to  the  supposi- 
tion that  it  was  a  seven  months'  child  would  be  attributed  to  some  mis- 
take in  the  calculation.  Beck  states  it  as  barely  possible  that  a  child  born 
at  seven  months  may  occasionally  be  of  such  a  size  as  to  be  considered 
mature,  yet  he  qualifies  this  statement  by  the  remark  that  the  assertion  is 
most  frequently  made  by  those  whose  character  is  in  danger  of  being 
destroyed.  The  important  medical  question  is,  however — Has  a  really 
seven  months'  child  ever  been  born  so  developed  as  to  be  mistaken  by  an 
experienced  person  for  one  that  was  mature  ?  He  adduces  no  case  of  this 
kind  in  support  of  his  opinion.  There  can  be  no  doubt  of  the  correctness 
of  this  statement,  that  a  mature  child,  born  before  seven  full  months  after 
intercourse,  ought  to  be  considered  illegitimate:  but  it  would  be  difficult 
to  maintain  this  proposition  consistently  with  the  above  admission. 

In  Bromwick  v.  Waters  (Chester  Lent  Ass.,  1862),  the  question  of  pre- 
mature development  arose  incidentally  upon  an  alleged  gestation  of  259 
days.  It  was  stated  that  intercourse  had  taken  place  upon  IS'ov.  9,  1861, 
and  a  child  wasfborn  on  July  26,  1862 — a  period  of  259  days,  or  thirty- 
seven  weeks.  The  child  had  the  appearance  of  a  mature  child.  The 
counsel  for  the  defendant  admitted  that  a  child  born  at  this  period,  i.  e. 
three  Aveeks  before  maturity,  might  be  as  large  as  one  born  at  the 
ninth  month,  but  he  denied  that  it  would  be  so  perfectly  developed  in  all 
its  parts.  When  the  question  was  put  to  Simpson,  he  said  that  full  size 
was  generally  combined  with  full  development;  and  he  further  stated  that 
it  was  against  all  the  laws  of  nature  that  children  should  be  born  full 
grown  even  a  fortnight  before  the  usual  term  of  gestation,  which  he  fixed 
at  nine  calendar  months  and  a  week.  According  to  this  view,  if  there  had 
been  intercourse  on  Nov.  9.  1861,  the  day  of  probable  delivery  would  be 
a  week  after  the  9th  of  the  following  August,  i.  e.  on  Aug.  16,  1862. 
Hence,  as  the  child  was  actually  born  in  a  mature  state  on  July  26,  this 
was  three  weeks  before  the  usual  term  ;  and  therefore,  in  his  opinion,  im- 
pregnation from  some  other  person  had  probably  taken  place  three  weeks 
earlier  than  the  period  assigned  by  the  woman  (Whalley).  Simpson  con- 
sidered it  to  be  as  rare  that  a  child  should  be  born  full  grown  three  weeks 
before  the  usunl  period,  as  that  a  man  should  attain  one  hundred  years  of 
age.     (Rep.  of  tlie  Trial  of  Bromwick  v.  Waters,  1863,  p.  33.)     There  are 


VIABILITY.  .  C09 

not  many  medical  witnesses,  however,  who  would  venture  to  affirm  that 
in  tlie  last  three  weeks  of  gestation  tljore  are  such  marked  changes  in  the 
bodv  of  a  child  as  to  render  this  difference  in  time  always  perceptible,  or 
who  would  v^enture  to  bastardize  a  child  or  convict  a  woman  of  adultery 
because,  when  burn  at  the  259th  day  after  intercourse,  the  child  had  about 
it  tbe  usual  appearance  of  maturity.  This  would  be  equal  to  affirming- 
that  variations  in  size  might  take  place  at  the  ninth,  but  not  at  the  eighth 
month  of  gestation.  But  facts  are  adverse  to  the  theory.  Riittel  has  met 
with  several  instances  in  which  women  have  been  delivered  tivo  and  even 
three  wee.k>i  before  the  expiration  of  the  ordinary  term  (280  days),  and  the 
children  were  as  perfectly  developed,  to  all  appearance,  as  other  children 
which  had  been  born  at  the  full  period  ;  at  any  rate,  they  could  not  be 
distinguished  from  them  by  competent  observers. 

In  another  part  of  this  work  (Infanticide,  p.  531,  ante),  some  cases  are 
related  which  prove  that,  at  the  ninth  month,  children  are  occasionally 
born  of  a  size  and  weight  greatly  exceeding  the  average.     Thus  a  nine 
months'  child  has   been  born  weighing  eighteen  pounds  and  measuring 
thirty-two  inches,  whereas  the  usual  weight  is  from  six  to  seven  pounds, 
and  the  length  eighteen  inches.     In  such   an   exceptional  case   there  is 
reason  to  believe  that,  had  the  child  come  into  the  world  at  the  seventh 
month,  it  would  have  appeared  to  the  accoucheur  to  have  reached  the  full 
term.     As  it  is  impossilole  to  say  when  such  an  exception  is  likely  to  occur, 
and  a  lawyer  is  always  entitled  to  take  advantage  of  either  extreme,  it 
follows  that,  in  any  case  in  which  this  question  arises,  a  witness  will  be 
bound  to  admit  that  a  seven  months'  child  may  be  born  of  the  average 
size  and  weight  of  a  nine  months'  child,  or  to  give  some  valid  reason  for 
the  fact  that  great  variations  in  size  and  weight  may  occur  at  the  ninth, 
but  never  at  or  about  the  seventh  or  eighth  month  of  gestation.     He  must 
also  be  prepared  to  affirm  from  facts  within  his  knoAvledge  that,  in  these 
extreme  cases,  the  doubling  of  the  weight  and  length  of  the  child  is  not 
progressive,  but  that  it  suddenly  takes  place  at  or  near  tbe  ninth  month. 
If  the  child  is  a  male,  and  the  testicles  are  found  in  the  scrotum,  there  is 
every  reason  to  believe  that  it  has  passed  the  seventh  and  even  the  eighth 
month  of  uterine  life.     (See  Infanticide,  p.  531,a?i^e.)     The  differences 
of  opinion  among  obstetric  experts  in  reference  to  this  question  appear  to 
admit  of  explanation.     All  will  agree   that,   as  a  general  rule,   a  seven 
mouths'  child  might  be  distinguished  from  a  nine  months'  child,  unless  the 
latter  was  a  twin  ;  but  at  the  same   time,  it  must  be  admitted  that,  if 
variations  in  development  take  place  at  the  full  term,  there  is  nothing  to 
prevent  such  variations  from  occurring  at  the  seventh  and  eighth  months 
of  gestation.     Rigby  said  that  he  had  often  met  with  instances  of  well- 
developed  children  born  within  seven  months  of  marriage,  but  only  with 
the  first  child.     The  date  of  marriage  must  not,  however,  always  be  taken 
as  the  date  of  conception.     (Obst.  Trans.,  1875,  p.  227.)     Hicks  has  seen 
a  child  born  seven  months  after  marriasi'e  as  large  as  at  the  full  term  ;  but, 
as  he  suggests,  this  child  might  really  have  been  begotten  so  as  to  be  born 
at  the  full  term.     In  order  to  determine  this  point  by  unexceptional  facts, 
it  would  be  necessary  to  collect  a  series  of  cases  of  impregnation  from  one 
intercourse  in  which  the  children  were  born  seven  months  after  such  inter- 
course, and  were  proved  to  have  had  the  average  size  and  weight  of  mature 
children. 

Earliest  Period  at  which  a   Child  may  be  born  h'ving.      Viability. — 

The  fact  that  a  child  has  had  the  strength  to  survive  its  birth  for  a  certain 

period  has  been  supposed  to  furnish  additional  evidence  of  maturity;  for 

it  is  well  known  that,  under  a  certain  age,  children  are  not  born  living,  or 

39 


610  EARLIEST    PERIOD    A    CHILD    MAY    BE    BORN    ALIVE. 

if  living  thev  speedily  die.  Therefore  it  has  been  argued,  if  a  child  born 
at  the  tifth  or  sixth  month  after  the  first  cohabitation  be  born  living  or 
survive,  this  should,  ipso  facto,  be  taken  as  a  proof  of  its  illegitimacv. 
According  to  the  English  law,  it  is  not  necessary  tbat  a  child,  when  born, 
should  be  capable  of  living,  or  viable,  in  order  that  it  should  take  its  civil 
rights.  Thus  it  nia}^  be  born  at  an  early  period  of  gestation, — it  may  be 
immature,  and  not  likely  to  survive;  or,  again,  it  may  be  born  at  the  full 
period  of  gestation,  but  it  may  be  obviously  laboring  under  some  defective 
organization,  or  some  mortal  disease,  which  must  necessarih^  cause  its 
death  within  a  short  time  after  its  birth.  Fortunately,  these  points  are 
of  no  importance  in  relation  to  the  right  of  inheritance;  an  English 
medical  jurist  has  only  to  prove  that  there  was  some  well-marked  phv- 
siological  sign  of  life  after  birth.  Whether  the  child  was  mature  or  im- 
mature, diseased  or  healthy,  is  a  matter  which  does  not  at  all  enter  into 
the  investigation.  In  this  respect  our  law  appears  to  be  more  simple  and 
just  than  that  which  prevails  in  France.  B}^  Art.  T25  of  the  Code  Xapo- 
Mon,  no  child  that  is  born  alive  can  inherit  unless  it  is  born,  as  the  law 
terms  it,  viable.  The  meaning  of  this  word  is  not  defined  by  the  law 
itself,  and  there  are  probably  no  two  lawyers  or  physicians  in  that  country 
who  place  upon  it  the  same  interpretation.  The  French  law  seems  to 
intend  by  viability  in  a  newborn  child,  that  it  should  have  breathed  and 
be  capable  of  living  out  of  the  womb  of  its  mother  and  independently  of 
her ;  also  that  it  should  be  capable  of  living  for  a  longer  or  shorter  period 
after  its  birth. 

[The  Parliament  of  Paris  decided  in  the  case  of  Cardinal  Richelieu  that 
an  infant  at  five  months  was  capable  of  inheriting  under  the  law  of 
France:  Case  89.  The  Code  Napoleon  fixed  180  days,  or  six  calendar 
months,  as  the  earliest  period  when  a  child  may  be  live  born.  The  Scotch 
law  allows  an  infant  to  be  viable  in  six  lunar  months  or  168  days.] 

The  question,  therefore,  to  be  considered  is — What  is  the  earliest  period 
of  uterine  life  at  which  a  healthily  formed  child  can  be  born  living  and 
with  a  capacity  to  live  after  its  birth  and  to  attain  maturity  ?  It  is  uni- 
versally admitted  that  children  born  at  the  seventh  month  of  gestation 
are  capable  of  living,  although  they  are  more  delicate,  and  in  general 
require  greater  care  and  attention  to  preserve  them  than  children  born  at 
the  ninth  month  ;  the  chances  are,  however,  very  much  against  their  sur- 
viving. It  was  the  opinion  of  W.  Hunter,  and  it  is  one  in  which  most 
modern  authorities  concur,  that  few  children  born  before  seven  calendar 
months  (or  210  daj^s)  are  capable  of  living  to  manhood.  They  may  be  born 
alive  at  any  period  between  the  sixth  and  seventh  months;  or  even,  in 
some  instances,  earlier  than  the  sixth  ;  but  this  is  rare,  and,  if  born  living, 
they  commonly  die  soon  after  birth.  There  is  one  case  on  record  of  a 
child  having  been  born  living  so  early  as  the  fourth  month  of  gestation 
(Brit,  and  For.  Med.  Eev.,  vol.  ii.  p.  236) ;  and  another  in  which  a  woman 
aborted  at  the  fourth  month  and  a  half  of  pregnancy.  Maisonneuve  saw 
the  woman  two  hours  after  delivery  :  he  then  found  the  foetus  in  its  mem- 
branes, and,  on  laying  these  open,  to  his  surprise  it  was  still  moving. 
He  applied  w^armth,  and  succeeded  in  partially  restoring  it ;  for  a  few 
minutes  the  respiratory  movements  were  performed  with  regularity,  but 
in  spite  of  the  establishment  of  respiration,  the  child  died  about  sixth 
hours  after  its  birth.  (Lond.  Med.  Gaz.,  vol.  xxxix.  p.  97.)  Edis 
brought  before  the  01)stetrical  Society  a  foetus  born  five  months  and  ten 
days  dating  from  the  last  menstrual  period  (5i  months'  gestation). 
Immediately  the  child  was  born,  it  cried  so  loudl}^  that  it  was  heard  down- 
stairs, and  continued  at  intervals  to  cry  as  loudly  as  a  full-grown  infant. 


PREMATURE    BIRTHS.  611 

It  could  not  be  made  warm.  It  papsed  meconium,  but  no  urine.  It 
swallowed  without  trouble.  The  eyelids  were  closed.  Its  weight  was 
one  pound  and  a  quarter,  its  length  was  eleven  inches.  It  lived  forty- 
four  hours.  Other  eases  of  a  similar  kind  have  been  elsewhere  described 
(p.  594).  It  was  said  that  this  child  was  not  viable,  though  it  had  poten- 
tial life.  (Brit.  Med.  Jour.,  187-i,  i.  p.  541.)  In  two  instances  of  abortion 
about  ih^  fifth  month,  Davies  noticed  that  the  foetus  showed  signs  of  life 
after  its  birth,  by  moving  its  limbs  (Lond.  Med.  Gaz.,  vol.  xl.  p.  1022); 
and  in  the  following  case  a  child  born  at  the  fifth  month  survived 
upwards  of  twelve  hours.  A  woman  in  her  second  pregnancy,  and  in 
the  147 th  day  of  gestation,  had  severe  flooding  with  rupture  of  the  mem- 
branes. Labor  occurred  on  the  following  night,  when  a  small  but  well- 
formed  foetus  was  expelled,  giving  no  other  indication  of  life  than  a 
feeble  action  of  the  heart  and  a  strong  pulsation  in  the  cord.  It  was 
resuscitated,  and  cried  as  strongly  as  a  child  born  at  the  full  period  of 
pregnancy.  It  weighed  less  than  two  pounds,  and  was  twelve  inches  in 
length.  It  swallowed  some  nourishment,  but  died  about  twelve  hours 
after  birth.  The  membranse  pupillares  were  entire,  the  testicles  had  not 
descended,  the  head  was  well  covered  with  hair.  The  leilgth  and  weight 
as  well  as  the  presence  of  hair  indicated  a  foetus  between  the  sixth  and 
seventh  months ;  but,  as  it  is  asserted  that  the  period  of  gestation  is 
accurately  given,  this  must  be  regarded  as  an  extraordinary  instance  of 
premature  development.  There  was  clearly  nothing  in  the  organization 
of  this  child  to  have  prevented  its  growing  to  the  age  of  maturity  ;  in 
other  words,  it  was  viable.  (Med.-Chir.  Rev.,  1844,  p.  266.)  [Vid.  table 
of  cases  of  early  viability,  No.  84,  page  86,  Tidy's  Legal  Medicine,  Phil. 
Edition,  48  cases.]  In  1865,  Carter  communicated  to  the  author  the 
particulars  of  a  case  in  which  a  child  was  born  living  at  the  fifth  month 
of  gestation.  It  cried  slightly  when  it  was  born,  and  during  the  half  hour 
that  it  was  unsevered  from  its  mother  it  made  frequent  efforts  to  breathe. 
It  was  perfectly  formed,  was  about  one  foot  in  length,  and  its  weight  was 
fully  one  pound  and  a  quarter.  It  died  soon  after  it  was  born.  Moore 
reported  a  case  of  a  child  born  living  at  the  fifth  month.  (Lancet,  1865, 
ii.  p.  535.)  A  case  is  reported  in  which  a  child  born  at  five  months  and 
a  half  survived  its  birth  between  three  and  four  hours.  (Lond.  Med. 
Gaz.,  vol.  xix.  p.  165)  ;  and  on  a  trial  for  child-murder  (Reg.  v.  West, 
Nottingham  Lent  Ass.,  1848),  a  midwife  was  indicted  for  causing  the  death 
of  a  child  by  bringing  about  the  premature  delivery  of  the  mother  when 
she  was  between  the  fifth  and  sixth  months  of  her  pregnancy.  The  child 
in  this  instance  lived  five  hours  after  its  birth.  Capuron  mentions  a  case 
in  which  a  child  was  born  at  the  sixth  month  and  a  half  of  pregnancy, 
and  at  the  date  of  the  report  it  was  two  years  old  and  enjoyed  excellent 
health.  In  another  instance  a  child  was  born  at  the  same  period,  and 
lived  to  the  age  of  ten  years.  (Med.  Leg.  des  Ace,  pp.  162,  208.) 
Capuron  considers  that  a  child  born  at  the  180th  day,  or  at  the  sixth 
month  after  conception,  may  be  sufficiently  mature  to  live,  i.  e.  that  there 
would  be  no  reason  to  presume  it  was  illegitimate  merely  because  it  sur- 
vived its  premature  birth.  On  the  other  hand,  if  born  before  the  sixth 
month  with  sufficient  maturity  to  live,  this  fact,  although  by  no  means  a 
proof,  affords,  in  his  opinion,  a  strong  presumption  of  its  illegitimacy. 
Of  eight  cases  of  children  born  living  (by  abortion)  at  the  sixth  month. 
Whitehead  states  that  seven  perished  within  six  hours  after  birth,  and 
only  one  attained  to  the  age  often  days.     (On  Abortion,  p.  249  ) 

Rfittel,  who  has  examined  this  subject  with  great  care,  states,  as  the 
result  of  his  experience,  that  he  attended  a  married  woman,    who  was 


612  PREMATURE    BIRTHS. 

afterwards  delivered  of  a  living  child  in  the  fiflh  viontJi  of  her  pregnancy  ; 
the  child  survived  its  birth  for  twenty-four  hours.  He  delivered  another 
wonjan  of  twins  in  the  cnxth  month  of  her  pregnancy  ;  one  was  dead,  and 
the  other  continued  alive  for  three  hours,  its  life  being  indicated  only  by 
the  visible  pulsation  of  the  heart,  but  there  was  no  perceptible  breathing. 
This  fact  strongly  corroborates  the  remarks  made  elsewhere,  as  to  life 
without  active  respiration  (Infanticide,  p.  544,  ante)  ;  it  has  also  an  im- 
mediate bearing  on  the  proof  of  life  in  reference  to^  tenancy  by  curtesy 
(p.  593,  ante).  In  another  instance  of  the  birth  of  male  twins  at  the 
siirth  month,  each  weighed  three  pounds,  Riittel  saw  them  a  year  after 
their  birth,  and  they  were  then  two  healthy  strong  children.  (Henke's 
Zeitschrift  der  S,  A.,  1844,  p.  241.)  Barker  met  with  a  case  in  which  a 
female  child  was  born  on  the  158th  day  of  gestation,  or  twenty-two  weeks 
and  four  days  after  intercourse.  The  size  and  weight  of  the  child  corre- 
sponded with  the  period  at  which  it  Avas  born  :  it  weighed  one  pound, 
and  was  eleven  inches  in  length.  It  had  only  rudimentary  nails,  and 
very  little  hair  on  the  back  of  the  head  ;  the  eyelids  were  closed  and  re- 
mained closed  until  the  second  day  ;  the  nails  were  hardly  visible ;  the 
skin  was  shrivelled.  The  child  did  not  suck  properly  until  after  the  lapse 
of  a  month,  and  did  not  walk  until  she  was  nineteen  months  old.  When 
born,  the  child  was  wrapped  up  and  placed  in  a  box  before  the  fire.  Three 
years  and  a  half  afterwards  the  child  was  in  a  thriving  state  and  healthy, 
but  of  small  make,  weighing  twenty-nine  pounds  and  a  half.  (Med. 
Times,  1850,  ii.  pp.  250,  392.)  In  a  case  which  occurred  to  Outrepont 
(Henke's  Zeitschrift,  vol.  vi.),  there  was  the  strongest  reason  to  believe 
that  gestation  could  not  have  exceeded  twenty-seven  weeks.  A  male 
child  weighed,  when  born,  one  pound  and  a  half,  and  measured  thirteen 
inches  and  a  half  The  skin  was  covered  with  down  and  much  wrinkled, 
the  limbs  were  small,  the  nails  appeared  like  white  folds  of  skin,  and  the 
testicles  had  not  descended.  It  breathed  as  soon  as  it  was  born  ;  and  by 
great  care  its  life  was  preserved.  It  is  singular  that  its  development  was 
very  slow  until  it  had  reached  a  period  which  would  have  corresponded 
to  the  forty-second  week  of  gestation.  Outrepont  saw  the  child  when  he 
had  attained  the  age  of  eleven  years,  and  then  he  appeared  to  be  of  the  size 
of  a  bo}'  of  eight  years.  The  only  remarkable  point  about  this  case  is  the 
length  of  time  which  the  child  lived.  In  a  case  quoted  in  the  Lancet 
(1851,  ii.  p.  nt),  a  child  born  at  six  months  and  ten  da^^s  was  thriving 
satisfactorily  when  four  months  old.   (See  also  Med.  Times,  1850,  i.  p.  129.) 

Hence  it  may  be  considered  as  established  that  children  born  at  the 
seventh  and  even  at  or  about  the  sixth  month  may  be  reared,  and  that 
the  fact  of  their  surviving  for  months  or  years  cannot  be  taken  as  a  proof 
of  illegitimacy.  In  forming  our  judgment  on  these  occasions  we  are  bound 
to  look  less  at  the  period  at  which  a  child  is  born  than  at  the  marks  of  de- 
velopment about  the  body.  Bonnar  has  pulilished  a  tabulated  view  of  112 
cases  of  premature  births  of  living  children — the  dates  of  gestation  ex- 
tending from  the  120th  to  the  210th  day.  Among  these  cases  35  children 
died  within  the  first  twenty-four  hours;  13  more  before  the  completion  of 
one  week;  1  in  six  weeks;  4  in  four  months.  The  following  lived  or 
were  living  at  the  date  of  the  report:  1,  seven  months  and  a  half;  8, 
from  one  to  two  years;  1,  three  years  and  a  half;  5,  from  ten  to  fifteen 
years;  6,  to  adult'age;  5  lived,  but  it  is  not  stated  how  long.  (Critical 
Inquiry  regarding  Superfoetation,  1865,  p.    13.) 

Froirarted  Births.  Long  Periods  of  Gestation. — The  questions  con- 
nected with  retarded  gestation  have  given  rise  to  considerable  discussion 
in  legal  medicine.     That  gestation  may  be  retarded  or  protracted  beyond 


PROTRACTED    BIRTUS.  613 

the  fortieth  week  is  now  not  disputed  by  any  obstetric  writer  of  reputa- 
tion. Some  accoucheurs  have  denied  it,  because  they  have  not  met  with 
such  cases ;  but  the  medico-legal  relations  of  such  questions  as  these  do 
not  depend  upon  the  solitary  experience  of  practitioners.  It  is  only  by 
the  accumulation  of  well-ascertained  facts  from  all  authentic  sources  that 
medical  knowledge  caa  be  made  available  for  the  purposes  of  the  law  ; 
otherwise,  owing-  to  the  mere  accident  of  a  witness  not  having  met  with 
any  exceptional  instance,  a  court  may  be  entirely  misled  in  its  judgment  by 
trusting  to  his  opinion.  It  is  the  more  important  to  attend  to  this  because 
most  of  the  cases  involving  questions  either  of  contested  legitimacy  or 
of  the  chastity  of  women  turn  upon  protracted  rather  than  upon  premature 
delivery. 

In  standard  works  on  Midwifery  will  be  found  authentic  reports  of 
cases  in  which  gestation  continued  to  the  forty-first,  forty -second,  forty- 
third,  and  even  to  the  forty -fourth  week.  Murphy  regarded  301  days  or 
forty-three  weeks  as  the  average  limit  of  gestation.  (Obst.  Rep.  p.  4.) 
Lee  met  with  a  case  in  which  he  had  no  doubt  that  the  pregnancy  lasted 
287  days ;  the  labor  did  not  take  place  until  iorty-one  weeks  after  the  de- 
parture of  the  husband  of  the  lady  for  the  West  Indies.  (Lend.  Med.  Gaz., 
vol.  xxxi.  p.  917.)  W.  Hunter  met  with  two  instances  in  which  gestation 
was  protracted  until  the  forty-second  week.  Montgomery  met  with  a 
case  in  which  delivery  did  not  ensue  until  between  the  forty-second  and 
forty-fourth  weeks.  (Lond.  Med.  Gaz.,  vol.  xix.  p.  646.)  Merriman  has 
published  a  table  on  the  subject  of  protracted  gestation,  on  which  the  most 
experienced  accoucheurs  have  been  in  the  habit  of  relying.  Of  114  preg- 
nancies calculated  by  him  from  the  last  day  at  which  the  women  men- 
struated and  in  which  the  children  appeared  to  be  mature,  the  following 
were  the  periods  : — 


In  the  37th  week 
38th      " 
"       39th      " 
"      40th      " 


2 

In  the  41st  week 

13 

42nd    " 

14 

"       43rd     " 

33 

"       44th     " 

22 

15 

10 

4 


Another  well-marked  case  occurring  precisely  forty-four  weeks  after  the 
cessation  of  the  menses  was  communicated  to  the  author  by  Merriman. 

From  these  results  Merriman  considers  that  in  the  greater  number  of 
women  gestation  is  completed  in  the  fortieth  week  from  the  cessation  of 
the  menses,  and  next  to  this  period  in  the  forty-first.  In  the  evidence 
given  by  him  in  the  Gardner  Peerage  case  before  the  House  of  Lords  in 
1825,  the  case  of  longest  protraction  on  which  he  was  able  to  rely  was 
that  of  a  married  woman  who  was  in  the  habit  of  calculating  from  the 
last  day  on  which  her  monthly  period  ceased.  This  lady  was  delivered 
309  days,  or  forty-four  weeks  and  one  day,  from  the  time  at  which  she 
supposed  that  she  had  conceived.  In  another  case  mentioned  by  the  wit- 
ness the  period  was  303  days,  or  forty-three  weeks  and  two  days  from  the 
termination  of  the  last  monthly  period.  It  was  objected  to  ttiis  evidence 
that  it  was  impossible  to  fix  the  exact  date  of  conception,  and,  as  the 
female  might  have  really  conceived  only  a  day  or  two  before  the  expected 
return  of  menstruation,  twenty-eight  days  (or  four  weeks)  should  be  de- 
ducted from  the  periods  assigned  by  the  witness.  Admitting  the  validity 
of  this  objection — and  the  fact  upon  which  it  is  based  is  indisputable — it 
followed  that  the  longest  protracted  case  observed  by  Merriman  might 
have  really  been  only  a  case  of  ordinary  gestation  extending  to  forty 
weeks  and  one  day.  An  objection  of  this  kind  may,  of  course,  be  suc- 
cessfully urged  in  law  to  any  inference  from  a  calculation  so  made,  and  it 


614  CASES    OF    PEOTRACTED    GESTATION. 

was  thus  that  in  the  Gardner  Peerage  case  the  medical  evidence  failed  to 
render  it  certain  that  gestation  might  be  so  protracted  as  to  support  the 
legitimacy  of  the  claimant ;  namely,  311  days  or  forty-four  weeks  and  three 
days.  Hence  in  considering  this  question  it  is  necessary  to  make  full 
allowance  for  such  a  cause  of  error ;  and  in  calculating  the  pregnancy 
from  the  last  day  of  the  last  menstrual  period  we  should  deduct  the  in- 
terval of  menstruation  if  known,  and  at  least  twenty-eight  days  if  un- 
known. In  these  cases  of  contested  legitimacy  the  offspring  is  commonly 
the  result  of  a  single  intercourse,  hence  the  date  of  conception  is  fixed 
within  limits  already  described  (p.  603) ;  and  a  comparison  can  be  insti- 
tuted only  between  the  period  of  gestation  thence  deduced  and  the  periods 
taken  in  other  cases  which  are  equally  free  from  error. 

A  well-marked  case  of  gestation  passing  beyond  what  is  commonly  set 
down  as  the  average  period  was  communicated  to  the  author  by  Howell. 
This  occurred  in  a  healthy  woman,  aged  30,  who  had  borne  three  children, 
the  youngest  being  4  years  old.  She  had  menstruated  with  regularity  up 
to  the  third  week  in  June  ;  the  menses  then  stopped  without  any  apparent 
cause.  Her  delivery  took  place  323  days  after  their  last  appearance. 
Allowing  that  impregnation  occurred  at  the  intermenstrual  period,  this 
would  make  the  gestation  309  days ;  or  assuming  that  impregnation  did 
not  occur  until  twenty-eight  days  from  the  date  of  the  last  menstruation, 
this  would  make  the  period  295  days,  or  forty-two  weeks  and  one  day. 

A  case  is  reported  by  Power  (Human  Pregnancy),  in  which  gestation 
is  said  to  have  extended  to  325  days.  Chattaway  communicated  to  the 
author  the  following  instance  of  protracted  gestation.  A  healthy  woman, 
set.  36,  applied  to  him  to  attend  her  in  her  confinement,  which  she  expected 
to  take  place  in  Sept.  1856.  The  menses  appeared  for  the  last  time  in 
Dec.  1855,  and  she  quickened  in  the  beginning  of  April,  1856.  About  the 
middle  of  September  {i.  e.  on  the  283d  day,  dating  from  the  last  men- 
struation) Chattawa}^  was  summoned  to  attend  her  and  found  her  laboring 
under  severe  false  pains  ;  there  was  also  a  discharge  of  mucus  tinged  with 
blood.  The  case  went  on  until  Nov.  19,  1856,  when  the  patient  was 
delivered  of  a  female  child  of  the  average  size.  It  would  thus  appear, 
according  to  the  ordinary  mode  of  calculation,  that,  deducting  twenty- 
eight  days  from  the  last  appearance  of  the  menses,  gestation  was  pro- 
tracted in  this  instance  to  330  days,  or  forty-seven  weeks  and  one  day. 
This,  of  course,  is  open  to  the  suggestion  that  the  menses  had  ceased 
from  some  accidental  cause,  and  that  pregnancy  had  taken  place  some 
weeks  subsequently.  It  is  known,  in  fact,  that  a  woman  may,  ex- 
ceptionalh%  menstruate  even  more  than  once  after  conception.  In 
reference  to  this  objection,  it  may  be  observed  that  few  women  have  such 
unusually  protracted  pregnancies.  Then,  again,  all  practitioners  may  not 
have  met  with  protracted  cases;  but  the  fact  being  clearly  ascertained  in 
one  case,  it  is  unnecessary  to  search  for  more,  unless  we  doubt  the  credi- 
bility of  reporters  Avell  qualified  to  observe  and  who  could  have  had  no 
conceivable  motive  to  misrepresent  the  facts  v\-hich  came  before  them. 
The  advocates  of  a  fixed  and  limitable  period  differ  from  each  other  by  a 
space  of  at  least  ten  or  twelve  days  and  each  must  either  take  his  own 
experience  for  the  final  decision  of  this  question,  or  must  allow  that  men 
of  equal  powers  of  observation  with  themselves  have  met  with  exceptional 
in.-tance.s. 

Protracted  cases  of  gestation  are  always  open  to  the  olijection  that  the 
menstrual  function  may  have  been  suspended  from  some  hidden  morbid 
cause,  one  or  two  months  before  the  actual  date  of  conception,  and  that 
there  may  have  been  some  error  in  the  calculation  by  which  the  period 


CASES  OF  PROTRACTED  GESTATION.  615 

has  been  determined.  If,  however,  the  objection  is  admitted  under  these 
circumstances,  it  would  be  only  ecjually  just  to  admit  that  in  any  given 
case  the  ordinary  and  so-called  fixed  period,  also  calculated  from  the  ces- 
sation of  menstruation,  is  based  on  a  fallacy.  The  menstrual  function 
may  have  accidentally  ceased,  or  continued  for  several  intervals  after  con- 
ception and  thus  a  corresponding  change  should  be  made  in  fixing  the 
ordinary  period  of  gestation.  This  view  of  the  question  implies  that  no 
reliance  can  be  placed  on  the  date  of  the  cessation  of  the  menses  as  evi- 
dence of  the  actual  duration  of  pregnancy,  whether  natural,  premature, 
or  protracted.  But  Hicks  met  with  a  case  in  which  the  pregnancy 
of  a  woman  appeared  to  be  protracted  to  between  twelve  and  thirteen 
mouths.  There  was  every  reason  to  believe  that  this  woman  became 
pregnant  during  the  absence  of  the  menses  and  that  these  had  been, 
suspended  for  some  time  before  intercourse  took  place.  This  is  no 
doubt  the  explanation  of  a  large  number  of  cases  of  alleged  protracted 
gestation.  We  have  no  right,  in  alleged  protracted  cases,  to  refer  the 
suppression  to  disease,  for  the  sake  of  shortening  the  period,  when 
in  ordinary  cases  we  do  not  refer  its  continuance  to  disease,  because 
this  would  tend  to  lengthen  it;  if  rejected,  it  would  be  in  the  highest 
degree  unjust  not  to  give  to  a  claimant  the  beneficial  presumption  of  his 
having  been  born  legitimately,  when  the  cases  adduced  in  evidence  against 
his  claim  are  actually  based  upon  a  precisely  similar  mode  of  calculation. 
It  is,  however,  difficult  to  admit  that  all  the  protracted  cases  recorded  by 
different  observers  have  depended  upon  mistakes  being  made  in  the  calcu- 
lation of  the  period,  since  this  calculation  is  based  on  the  same  principles 
as  those  adopted  in  cases  of  ordinary  pregnancy.  Hence,  if  there  is  a 
mistake  in  the  one  case,  there  would  be  in  the  other  ;  if  an  error  in  the 
exception,  there  would  be  an  error  in  the  rule.  Either  the  average  term  of 
pregnancy  is  wrongly  calculated  by  most  accoucheurs  at  the  thirty-eighth 
or  fortieth  week,  or  it  is  rightly  calculated  to  extend  occasionally  to  the 
forty-fourth,  or,  admitting  these  protracted  cases,  to  the  forty-sixth  week. 
But,  even  setting  aside  the  obvious  answer  to  an  objection  of  this  nature, 
some  of  the  protracted  cases  observed  were  instances  of  impregnation 
fi'om  a  single  intercourse;  and,  making  due  allowance  for  the  interval  for 
conception,  the  general  inference  would  not  be  affected  and  no  fallacy 
could  have  arisen  in  these  cases  of  protraction  from  mistakes  dependent 
on  the  cessation  of  menstruation. 

Reid's  conclusions,  derived  from  numerous  facts  and  cases,  represent  the 
views  of  an  experienced  observer  on  this  much-disputed  question.  They 
are — "  1.  The  duration  of  pregnancy  is  not  altogether  a  fixed  period  ;  it 
varies  somewhat  in  the  human  female  as  it  does  in  the  lower  orders  of 
animals.  2.  This  deviation,  however,  is  not  to  any  great  extent ;  the 
only  certain  data  of  calculation  are  those  dependent  on  the  known  time  of 
conception  (of  intercourse'?).  3.  The  average  duration  of  the  pregnant 
state,  when  calculated  from  this  event,  is  about  275  days,  or  it  may  have 
a  range  of  from  270  to  280  days.  4.  There  is  no  full  or  satisfactory  evi- 
dence of  gestation  having  been  prolonged  beyond  293  da3's.  5.  The  Code 
Napoleon,  which  allows  300  days,  may  be  regarded  as  liberal.  6.  The 
menstrual  period  must  generally  serve  as  our  guide  in  default  of  some 
exact  knowledge  ;  it  is,  however,  often  fallacious  and  is  only  a  means  of 
approximation  to  the  probable  time  of  parturition.  7.  The  fortieth  week 
after  the  last  appearance  of  the  menses  is  the  most  likely  period  and  the 
forty-first  week  the  next."  Strathy  (Brit.  Med.  Jour.,  1876,  i.  p.  505), 
after  giving  a  case  of  his  own  which  reached  to  298  days  after  the  last 
intercourse  in  the  married   state,  refers   to   reported   cases  by  different 


616  CASES  OF  PROTRACTED  GESTATION. 

authoi'ities  in  which  the  periods  were  as  follows  :  Bently,  291  days ;  Skey, 
293  ;  Macilwain,  293  ;  Reid,  287  to  293 ;  and  Ashwell,  300. 

Duncan  (Edin,  Month.  Jour.,  1854,  vol.  ix.  p.  230)  draws  the  followini^: 
conclusions  regarding  the  duration  of-  pregnancy  :  1.  That  the  interval 
between  conception  and  parturition  (the  real  duration  of  pregnancy)  has 
not  been  exactly  ascertained  in  any  case.  2.  That  the  average  interval 
between  insemination  (intercourse)  and  parturition  (commonly  called  the 
duration  of  pregnancy)  is  275  days.  3.  That  the  average  intervals  be- 
tween the  end  of  menstruation  and  parturition  have  no  standard  length, 
but  vary  within  certain  limits.  4.  That  while  absolute  proof  of  the  pro- 
longation of  real  pregnancy  beyond  its  usual  limits  is  still  deficient,  there 
is  evidence  to  establish  the  probability  that  it  may  be  protracted  beyond, 
such  limits  to  the  extent  of  three  or  even  four  weeks. 

Duncan,  of  Shetland,  has  fully  reported  the  case  of  a  woman  who,  in 
her  first  pregnancy,  was  not  delivered  until  300  days  after  the  last  men- 
strual period.  The  second  and  third  pregnancies  lasted  for  about  285  days. 
In  the  fourth,  to  which  he  especially  refers,  she  carried  her  child  325  clear 
days  from  the  last  menstruation,  excepting  one  other  case,  the  longest 
period  recorded.     (Med.  Times  and  Gaz.,  1877,  ii.  p.  712.) 

It  will  be  perceived  from  the  conclusions  of  Reid,  that  he  admits  a 
variation  of  23  days,  i.  e.  from  270  days  (the  shortest  period)  to  293  days, 
the  longest  known  to  himselr  from  a  single  intercourse.  There  appears  to 
be  no  valid  reason  why  the  variation  should  not  be  even  greater  than  that 
which  is  here  assigned,  and  why  the  duration  of  pregnancy  might  not  ex- 
tend occasionally  to  296  and  even  to  301  days.  It  is  merely  a  question 
of  individual  experience.  An  accoucheur  who  admitted  a  variation  of  23 
days,  and  who  had  known  gestation  to  be  protracted  to  the  293d  day 
after  intercourse,  would  hesitate  to  pronounce  a  child  illegitimate  merely 
because  it  has  been  born  on  the  296th  or  the  300th  day  after  possible  access 
of  the  husband.  There  is,  no  doubt,  a  limit  to  gestation,  but  it  is  not  in 
our  power  to  fix  it ;  hence  we  find  obstetric  writers  of  repute  adopting 
periods  which  have  no  point  of  agreement  among  themselves.  Some  stop 
short  at  280  days  ;  others,  like  Reid,  fix  the  maximum  yet  known  at  293 
days;  Murphy  allows  from  his  experience  at  least  324  days;  and  Meigs 
considered  that  gestation  may  be  continued  to  twelve  months,  or  365  days. 
(Obstetrics,  the  Science  and  the  Art,  1849,  p.  194  )  The  fact  is,  the  term 
has  not  yet  been  fixed  even  approximately  by  medical  science ;  hence,  in  a 
disputed  case,  other  circumstances  must  be  looked  to  in  order  to  lead  a 
court  of  law  to  a  safe  decision.  It  is  at  present  hopeless  to  reconcile  the 
conflicting  medical  opinions  which  exist  on  the  subject  of  the  duration  of 
pregnancy  in  the  human  female.  There  is,  indeed,  only  one  point  on 
which  all  modern  observers  agree — namely,  that  the  period  cannot  be  lim- 
ited to  a  fixed  and  invariable  number  of  days  or  weeks,  but  that  it  is  liable 
to  variation  according  to  circumstances  not  fully  understood. 

In  Renouf  t>.  Eden  (Q.  B.,  March,  1870),  an  action  for  seduction,  the 
defendant  denied  his  liability  on  the  ground  that  the  plaintiff,  jet.  19,  was  not 
delivered  until  301  days  after  their  last  interview.  Medical  evidence  was 
given  for  the  plaintiff  that  protraction  to  this  extent  was  possible,  one  of  the 
witnesses  (Tanner)  having  seen  a  case  beyond  293  days.  Barnes  and  Tyler 
Smith,  on  the  part  of  the  defendant,  would  not  say  it  was  impossible,  but 
thought  it  highly  improbable  that  gestation  could  have  been  thus  pro- 
tracted. The  Lord  Chief  Justice,  after  referring  to  several  cases  of  pro- 
tracted gestation  recorded  in  this  work,  assumed  that  it  was  possible  the 
defendant  might  have  been  the  father  of  the  child,  and  summed  up  on  the 
question  of  seduction.     The  jury  gave  a  verdict  for  damages,  thus  aflSrm- 


PERIODS    OF    GESTATION    NOT    FIXED    BY    LAW.  617 

in.f^  that  the  defendant  was  the  father  of  the  child.    (Med.  Times  and  Gaz., 
1870,  i.  p.  290.) 

It  has  been  elsewhere  observed  that  the  date  of  intercourse  does  not 
furnish  us  with  the  date  of  conception  (pp.  604,  605),  and,  according  to 
some  authorities,  all  evidence  connected  with  the  function  of  menstruation 
is  untrustworthy.  In  spite  of  these  objections,  the  menstrual  period  must 
-generally  serve  as  a  guide  in  default  of  more  certain  criteria.  It  is,  how- 
ever, curious  that  the  date  of  the  cessation  of  the  menses  is  taken  by  some 
physicians  as  a  guide  (in  married  life  with  constant  intercourse)  so  long 
as  gestation  does  not  extend  beyond  280  days ;  while,  supposing  it  to  ex- 
tend to  300  days,"  they  will  assume  that  some  other  cause  than  pregnancy 
.must  have  led  to  an  earlier  suppression  and  thus  to  an  error  in  the  calcu- 
lation. There  may  be  no  more  evidence  of  suppression  from  a  morbid - 
cause  in  the  one  case  than  in  the  other,  and  the  period  of  280  days  may 
be  as  much  based  on  error  as  the  period  of  300  days.  It  is  strange  that 
those  who  adopt  this  mode  of  making  facts  square  with  a  foregone  con- 
clusion do  not  perceive  that  they  must,  in  fairness,  either  reject  altogether 
the  evidence  derivab'e  from  a  cessation  of  the  menses,  or  admit  it  ad- 
versely to  their  own  views  in  cases  in  which  the  facts  connected  with  the 
cessation  have  been  as  carefully  observed  and  recorded  by  others  as  by 
themselves.  No  evidence  on  this  subject  can  be  drawn  from  an  examina- 
tion of  the  body  of  the  child.  There  is  no  increase  of  size  or  development 
after  the  ninth  month  has  passed.  Children  born  at  the  full  period  of 
nine  months  have  been  larger  and  heavier  than  many  children  born,  as  it 
was  believed,  at  a  later  period  ;  but  in  cases  of  alleged  protracted  gesta- 
tion it  may  be  considered  that  the  child  should  always  have  attained  its 
full  growth  and  perfect  development. 

Stolz,  after  stating  that  the  ordinary  period  of  gestation  is  from  270  to 
280  days,  admits  that  it  may  extend  to  a  fortnight  beyond  the  latter 
period,  but  not  longer,  whatever  may  be  the  circumstances  to  cause  pro- 
traction. Protracted  labor,  expending  over  five  or  six  days,  must  not  be 
included  in  this  term.  The  death  of  a  child  may  favor  its  retention  in 
utero,  and  thus  add  to  the  apparent  length  of  gestation.  [See  table  of  38 
cases  of  protracted  utero-gestation  compiled  by  Dr.  C.  Meymott  Tidy: 
Tidv's  Legal  Medicine,  vol.  ii.  p.  93,  No.  109,  Phil,  edition. J 

Period  of  Gestation  not  fixed  by  Laio. — In  all  cases  of  contested  legiti- 
macy the  question  respecting  the  duration  of  gestation,  when  it  arises,  is 
left  entirely  open  by  the  English  law.  No  period  of  time  has  been  fixed 
by  English  jurists  within  which,  or  beyond  which,  a  child,  if  born  in  wed- 
lock, will  be  presumed  to  be  illegitimate.  The  decisions  of  our  courts 
would  be  founded,  quoad  the  duration  of  pregnancy,  on  the  opinions  of 
experts  selected  for  the  occasion,  and  each  case  would  be  decided  on  its 
own  merits.  Precedents  can  have  but  little  influence  on  these  occasions, 
because  a  court  may  think  fit  to  pronounce  illegitimate,  on  non-medical 
grounds,  a  child  born  in  the  thirty-eighth  week  of  gestation,  while  it  may 
decide  that  another  was  legitimate  that  had  been  born  in  the  forty-third 
week.  By  some  law  authorities ybr^y  weeks  (or  280  days),  and  by  others 
forty-three  weeks  (or  301  days),  have  been  taken  as  the  vltiminn  tempus 
pariendi ;  but  it  is  not  the  custom  of  courts  to  act  upon  any  definite  rule. 
Nevertheless,  it  is  clear  in  some  extreme  cases  that  the  law  may  fairly  in- 
terpose and  pronounce  for  a  reasonable  limit.  In  the  case  of  Cotterall  v. 
Cotterall  (Consist.  Ct.,  .luly,  1847),.  a  child  was  born  during  the  mar- 
riage, and  the  husband  proceeded  against  the  wife  for  a  divorce  on  the 
ground  of  adultery.  The  main  proof  was  based  on  the  fact  that,  in  order 
to  have  been  the  child  of  the  husband,  it  must  have  been  born  after  iivelce 


618  PERIODS    OF    GESTATION    NOT    FIXED    BY    LAW. 

months''  gestation.  Lnshington,  without  entering  into  the  question  of 
protracted  gestation,  upon  proof  of  this  allegation  at  once  pronounced  for 
the  divorce.  Such  a  duration  of  pregnancy  is  not  supported  by  any  known 
facts  and  is  altogether  opposed  to  medical  probability.  In  suits  of  con- 
tested legitimacy  the  general  practice  consists  in  establishing  possibility 
of  access  on  the  part  of  the  husband;  when  this  is  proved,  the  medical 
question  arises  whether  the  term  of  gestation  falls  within  the  limits 
assigned  by  the  best  medical  experience.  In  two  instances  children  have 
been  pronounced  legitimate  which  were  born,  the  one  in  forty-one  weeks 
and  three  days,  and  the  other  in  forty-one  weeks  and  four  days,  after  the 
death  of  the  husband.  Legitimacy  has  been  allovi'ed  where  gestation  was 
probably  protracted  to  ih^i  forty -third  week.  (Anderton  v.  Gibbs,  1854.) 
In  the  United  States,  a  decision  in  favor  of  paternity  has  been  made  in  a 
case  in  which  gestation  extended  to  forty -five  weeks  and  two  days.  (Com- 
monwealth V.  Porter.)  Legitimacy  has  been  disallowed  in  the  English 
courts,  although  probably  on  non-medical  grounds,  where  it  was  pro- 
tracted to  forty -four  weeks  and  three  days  (Gardner  Peerage  case,  1825)  ; 
in  one  case  paternity  was  denied  (judicially)  because  gestation  had  ex- 
tended to  forty-two  weeks  and  ^ve  days  (Luscombe  v.  Prettyjohn),  and 
in  another  (Dyson)  because  it  had  extended  to  forty-eight  loeeks. 

The  French  Code  cuts  short  all  difficulties  respecting  the  period  of 
gestation,  in  cases  of  contested  legitimacy,  by  fixing  upon  the  term  of  180 
days  after  marriage,  and  300  days  after  dissolution  of  marriage  or  non- 
access,  between  which  periods  children  born  may  be  regarded  as  legitimate. 
In  Germany,  it  is  laid  down  that  gestation  may  be  protracted  to  301  or 
308  days,  but  not  beyond.  The  general  law  of  Germany  places  the  period 
for  ordinary  gestation  among  women  not  married,  at  285  days,  but  for  a 
married  woman  divorced,  or  whose  husband  has  died,  it  allows  302  days. 
Hohl,  who  records  these  facts,  thinks  that  there  is  injustice  in  this  fixed 
rule  regarding  time,  and  that  in  exceptional  cases  a  period  of  from  322  to 
336  days  might  be  admitted.  (Ann.  d'Hyg.,  1873,  t.  2,  p.  153.)  It  is 
more  reasonable  and  just  to  leave  the  question  of  duration  open,  than  to 
fix  it  by  assigning  arbitrary  periods,  to  which  there  must  necessarily  be 
numerous  exceptions. 


DISPUTED    PATERNITY.  619 


PATERNITY. 


CHAPTER    LVII. 

DISPUTED     PATERNITY. PARENTAL     LIKENESS.  —  AFFILIATION. POSTHOIOUS      CHILDREN. 

SL-PERFCETATION      IN     RELATION     TO     LEGITIMACY. SUPPOSITITIOUS     CHILDREN. SEXUAL 

MALFORMATION. 

Disputed  Pateiniity .  Parental  Likeness. — It  has  been  stated  that  the 
law  does  not  pretend  to  determine  who  begat  a  child  when  it  has  been 
born  during  wedlock,  and  from  circumstances  it  might  be  the  child  either 
of  the  husband  or  of  an  adulterer.  But  medical  jurists  have  recommended 
that  family  likeness  should  be  looked  to  on  these  occasions — not  merely  a 
likeness  in  feature  and  figure,  but  in  gesture  and  other  personal  peculi- 
arities which  may  have  characterized  the  alleged  parent.  These  are  called 
questions  of  paternity :  they  seldom  occur  except  in  reference  to  cases  of 
bastardy,  and,  when  they  do  present  themselves  the  evidence  thus  pro- 
duced, even  if  affirmative,  is  properly  regarded  as  only  corroborative.  In 
the  Townshend  Peerage  case  (House  of  Lords,  May,  1843)  a  presumption 
based  on  family  likeness  was  admitted.  The  person  whose  legitimacy 
was  in  question  was  sworn  by  one  of  the  witnesses  to  bear  so  strong  a 
likeness  as  a  child  to  the  alleged  adulterer,  that  he  should  have  known  him 
among  five  hundred  children. 

The  proceedings  in  the  Douglas  Peerage  case  (176Y-9)  show  that  evi- 
dence of  this  kind  is  occasionally  of  some  importance.  The  peerage  was 
claimed  by  Archibald  Douglas — the  survivor  of  two  brothers  after  the 
death  of  the  alleged  parents,  Sir  John  and  Lady  Douglas.  The  claim  was 
disputed,  on  the  ground  that  the  appellant  and  his  deceased  brother  were 
supposititious  children.  Evidence  for  and  against  the  legitimacy  of  the 
claimant  had  been  collected  from  every  quarter,  and,  after  it  had  been 
most  minutely  sifted  and  criticised,  the  case  came  on  for  judgment  in  the 
Court  of  Sessions  in  Scotland,  on  July  7,  1T67.  So  important  was  the 
cause  deemed,  that  the  fifteen  judges  took  eight  days  to  deliver  their 
opinions.  The  result  was  that  seven  of  the  judges  voted  in  favor  of  the 
identity  or  legitimacy  of  Mr.  Stewart,  and  seven  against  it  ;  the  Lord 
President,  who  had  the  casting  vote,  agreed  with  the  latter,  by  which 
Archilmld  Douglas,  alias  Stewart,  was  cast  on  the  world  without  either 
name  or  estate.  An  appeal  from  the  decision  was  taken  to  the  House  of 
Lords,  by  which  the  judgment  of  the  Court  of  Session  was  reversed  in 
1769,  and  Archibald  Stewart  (or  Douglas)  declared  to  be  the  undoubted 
son  of  Lady  Jane,  the  sister  of  the  previous  holder  of  the  title.  Much 
stress  was  laid,  in  favor  of  the  legitimacy  of  these  children,  on  the  fact  that 
they  closely  resembled — the  one  Sir  John,  and  the  other  Lady  Douglas. 
The  resemlDlance  was  said  to  be  general ;  it  was  evident  in  their  features, 
gestures,  and  habits.  Lord  Mansfield,  in  delivering  judgment,  made  the 
following  remarks,  which  comprise  all  that  can  be  said  on  this  subject: 


620  EVIDENCE    FROM    PARENTAL    LIKENESS. 

"  I  have  always  considered  likeness  as  an  arg-nment  of  a  child  being  the 
son  of  a  parent,  and  the  rather  as  a  distinction  between  individuals  in  the 
human  species  is  more  discernible  than  among  animals.  A  man  may  sur- 
vey ten  thousand  people  before  he  sees  two  faces  exactly  alike  ;  and  in  an 
army  of  a  hundred  thousand  men,  every  man  may  be  known  from  another. 
If  there  should  be  a  likeness  of  feature,  there  may  be  a  difference  in  the 
voice,  gesture,  or  other  characters,  whereas  a  family  likeness  runs  generally 
through  all  of  these  ;  for  in  everything  there  is  a  resemblance,  as  of  feature, 
voice,  attitude,  and  action."  This  kind  of  evidence  has  been  objected  to 
from  its  uncertainty  ;  and  it  was  in  this  instance  much  disputed  whether 
one  of  the  children  did  resemble  Lady  Douglas,  but  it  seems  to  have  been 
generally  admitted  that  the  other  child  resembled  the  husband.  Sir  John. 
From  this  account  it  will  be  seen  that  evidence  from  family  likeness  is  not 
strictly  medico-legal ;  it  can  be  furnished  only  by  friends  and  relatives 
who  have  known  the  parties  well,  and  are  competent  to  speak  of  the  facts 
from  personal  acquaintance  with  them.  It  will  also  be  apparent  that  the 
affirmative  evidence  in  such  cases  will  be  stronger  than  that  which  is 
negative,  for  it  could  hardly  be  inferred  that  a  person  was  illegitimate  be- 
cause he  did  not  resemble  his  parent.  The  view  taken  by  Lord  Mansfield 
is  based  on  physiological  truth.  The  resemblance  is  not  in  features  only, 
but  in  gesture — in  the  mode  of  walking,  sitting,  or  running,  and  in  certain 
habits  which  are  really  inherited,  for  they  appear  in  the  child  when  it  has 
reached  manhood,  although  the  child  may  have  had  no  knowledge  of  its 
parent. 

One  of  the  witnesses  in  the  Tichborne  case  (Reg.  v.  Castro  or  Orton, 
May,  1873),  speaking  to  the  identity  of  the  claimant  with  Arthur  Orton, 
chiefly  relied  on  these  grounds.  He  had  known  the  Orton  family  for 
many  years,  and  knew  the  claimant  from  his  infancy  up  to  the  time  of 
his  leaving  England  in  1852.  In  1870  he  saw  the  claimant,  then  repre- 
senting himself  as  Roger  Tichborne  ;  but  the  witness  at  once  recognized 
him  as  the  Arthur  Orton  whom  he  had  known  as  a  child,  a  boy,  and  a 
young  man.  When  cross-examined  on  his  reasons  for  this  strong  opinion 
after  the  lapse  of  many  years,  he  said  he  had  formed  his  opinion,  "  not 
from  likeness  of  features  alone,  but  from  the  whole  appearance  of  the  man 
— his  figure,  his  tone  of  voice,  his  features,  all  confirmed  it,  and,  in  fact, 
he  could  see  no  i-eal  difference."  Other  witnesses  deposed  that  he  had  the 
features,  voice,  and  figure  of  the  father  of  Arthur  Orton. 

Parental  likeness  may  be  occasionally  indicated  by  color  or  peculiari- 
ties belonging  to  the  varieties  of  mankind,  as  of  the  intermixture  of  the 
negro  or  Mongolian  with  one  of  the  Caucasian  variety.  In  such  a  case  the 
evidence  afforded  becomes  much  stronger;  and,  supposing  that  two  men 
of  different  varieties  have  had  intercourse  about  the  same  time  with  the 
same  woman,  the  color  of  the  skin  of  the  offspring  might  enable  a  court 
to  determine  the  question  of  paternity.  It  is  stated  to  have  happened,  on 
more  than  one  occasion,  that  a  black  woman  has  given  birth  at  the  same 
time  to  a  black  child  and  a  mulatto;  Cunningham  refers  to  a  case  in 
which  a  negress  gave  birth  to  twins — one  a  black  and  the  other  a  white 
child.  (Lancet,  1846,  i.  p.  52.5.)  This  was  probably  a  case  of  supercon- 
ception.  In  Stothard  v.  Aldridge  (Bail  Ct.,  Jan.  1856),  the  plaintiff  sued 
the  defendant  for  damages  for  the  seduction  of  his  wife.  The  defendant 
was  a  man  of  color,  and  the  child  born  of  the  alleged  adulterous  inter- 
course was  proved  by  the  medical  witness  to  have  been  born  colored  and 
with  woolly  hair.  The  husband  and  wife  were  both  light.  This  pecu- 
liarity fixed  the  paternity  of  the  child  on  the  black  defendant. 

Personal  deformities  are  not  necessarily  transmitted  from   parent  to 


AFFILIATION.  621 

child ;  yet  it  would  appear  from  the  subjoined  ease  that  a  disputed  ques- 
tion of  affiliation  has  been  settled  on  this  pi-inci})le.  A  woman  alleged 
that  a  gentleman  in  whose  service  she  had  lived  was  the  father  of  a  child 
of  which  she  had  been  recently  delivered.  The  solicitor  who  appeared  to 
support  the  affiliation  rested  his  case  chiefly  on  the  fact  that  the  child  had 
been  born  with  five  fing-ers  and  a  thumb  on  the  right  hand,  the  defendant 
himself  having-  been  born  with  a  similar  malformation  on  both  of  his 
hands.  It  was  argued,  on  the  other  side,  that  the  deformity  might  have 
arisen  from  the  mother's  imagination,  as,  while  pregnant,  she  was  con- 
stantly in  the  habit  of  seeing-  the  defendant.  The  magistrates  decided 
that  he  was  the  father  of  the  child.  (Med.  Times,  1847,  i.  p.  47.)  It  is' 
very  likely  that  the  decision  was  here  influenced  by  moral  circumstances, 
for  otherwise  the  defendant  might  have  been  the  victim  of  a  coincidence. 
Six-fingered  children  are,  it  is  well  know^n,  born  occasionally  of  five- 
fiagered  parents;  and  as  the  deformity  existed  only  on  one  hand  in  the 
child,  while  it  was  on  both  hands  in  the  parent,  the  medical  proof  that  it 
was  actually  transmitted  by  generation  was  certainly  not  clearly  made 
out  In  some  instances  attempts  have  been  made  to  fix  the  paternity  of 
a  child  by  the  color  of  the  hair,  but  this  evidence  is  far  less  conclusive 
than  that  afforded  by  the  color  of  the  skin  In  the  case  of  Frazier  v. 
Bagley  (Feb.  1844),  it  was  alleged  that  the  wife  of  the  plaintiff  had  had 
criminal  intercourse  with  the  defendant,  and  the  last  two  children  were 
stated  to  be  the  offspring  of  the  latter.  The  plaintiff  and  his  wife  had 
dark  hair,  as  well  as  all  the  children  with  the  exception  of  the  last  two  : 
these  had  red  hair,  and  it  was  further  proved  that  the  defendant  had  red 
whiskers  and  sandy  hair.  No  particular  stress  was  laid  upon  this  evidence, 
but  it  was  received  as  a  kind  of  indirect  proof.  Not  much  confidence  can 
be  placed  in  facts  of  this  description,  since  red-haired  children  are  often 
born  to  parents  who  have  dark  hair  ;  and  in  one  case  the  children  born  in 
w^edlock  were  observed  to  have  dark  and  red  hair  alternately. 

Affiliation. — Questions  of  paternity  are  involved  in  those  relating  to 
'affiliation.  A  man  may  allege  that  he  is  not  the  father  of  a  particular 
child,  by  reason  of  certain  circumstances  upon  which  a  medical  opinion 
may  be  required.  The  necessary  transmission  of  gonorrhoea  or  syphilis 
by  intercourse  may  thus  become  a  medical  question.  A  man  was  required, 
under  the  law  of  bastardy,  to  support  two  children  alleged  bv  a  woman 
to  be  his,  the  time  of  gestation  being  within  nine  months.  The  accused 
denied  that  he  had  had  intercourse  with  the  woman,  or  that  he  could  have 
been  the  father,  since  he  was  at  the  time  under  medical  treatment  for  the 
venereal  disease.  The  medical  questions  may,  therefore,  assume  this 
shape:  1.  Are  these  diseases  invariably  transmitted  by  intercourse?  2. 
Do  they  interfere  with  the  act  of  procreation  ?  Under  common  circum- 
stances, they  must  both  be  answered  in  the  negative. 

Two  men,  A.  and  B.,  had  intercourse,  unknown  to  each  other,  with  a 
young  woman  of  delicate  health  ;  and  after  this  had  continued  for  some 
years,  she  was  delivered  of  a  female  child — nine  calendar  months  and  three 
days  after  sexual  intercourse  with  A.,  and  nine  calendar  months  less  five 
days  after  similar  intercourse  with  B.  ;  that  is,  a  period  of  eight  days 
elapsed  between  the  periods  of  intercourse  with  the  two  men.  The  woman 
had  no  menstrual  discharge  in  the  mean  time,  and  it  is  not  believed  that  she 
knew  any  other  man  ;  she  went  her  full  time,  had  a  good  labor,  and  produced 
a  healthy  girl ;  she  had  a  plentiful  supply  of  milk,  and  enjoyed  better  health 
during  her  pregnancy  and  suckling  than  at  any  other  time.  The  Avoman 
died,  and  the  circumstances  of  the  mixed  intercourse  having  become  known 
to  A.  and  B.,  they  both  refused  to  maintain  the  child.     A.  contended  that, 


622  POSTHUMOUS    CHILDREN. 

as  the  woman  was  not  delivered  until  nine  months  and  three  da^'s  after 
the  connection  with  him,  it  was  physically  impossible  that  the  child  could 
be  his.  B.  contended,  on  the  other  hand,  that  280  daj^s,  and  not  nine 
months,  is  the  period  of  gestation  ;  and  that  the  child  having-  been  born 
279  days  after  connection  with  A.,  and  only  271  days  after  connection  with 
B.,  it  was  therefore  probable  that  the  child  was  begotten  by  A.  There 
was  no  perceptible  likeness  to  either  of  the  men  in  the  child,  but  a  marked 
likeness  to  the  mother.  (Lancet,  1847,  i.  p.  336.)  It  is  obvious,  from  the 
remarks  elsewhere  made  {ante,  p.  611),  that  the  periods  of  271  and  279 
days  are  comprised  within  the  ordinary  range  of  gestation  :  hence  there 
would  be  no  medical  ground  for  affiliating  the  child  to  one  more  than  to  the 
other.  When  two  men  have  had  intercourse  with  the  same  woman  on 
the  same  day,  it  is  impossible  to  settle  the  paternity  except  by  the  ac- 
cident of  likeness.  In,  cases  of  affiliation  under  the  law  of  bastardy,  the 
evidence  of  the  mother,  if  corroborated,  is  received  in  support  of  a  ques- 
tion of  disputed  paternit}^ ;  but  sometimes  these  cases  are  decided  by  the 
length  of  the  period  of  gestation.  A  man  may  prove,  or  a  woman  may 
state,  that  the  intercourse  took  plate  at  such  a  remote  period  as  to  be  in- 
consistent with  the  ordinary  duration  of  pregnancy.  On  this  point  some 
remarks  have  been  made  alread}^  {ante,  p.  618).  In  this  country,  the  ten- 
dency is  to  reject  medical  evidence  altogether  in  bastardy  cases.  In  one 
case,  the  date  of  intercourse  was  proved  to  have  been  319  days  before  the 
birth  of  the  child.  The  medical  evidence,  on  the  whole,  was  in  favor  of 
this  protraction — one  of  the  witnesses  having  met  with  two  cases  in 
which  gestation  was  protracted,  as  he  believed,  to  310  days  from  inter- 
course— but  the  case  was  summarily  dismissed. 

These  questions  of  affiliation,  when  the  interval  is  less  than  six  or  eight 
weeks,  can  rarely  be  determined  by  medical  evidence.  In  a  case  of  affilia- 
tion, an  attempt  was  made  to  set  aside  the  order  of  a  magistrate  fixing  the 
paternity  on  the  putative  father,  on  the  ground  that,  as  the  intercourse 
was  had,  and  the  child  conceived  in  France,  although  born  in  England,  it 
was  removed  from  the  jurisdiction  of  an  English  magistrate,  and  should* 
be  left  to  the  French  courts.  The  objection  was  overruled,  and  the  alleged 
father  was  ordered  to  pay  the  usual  sum  for  maintenance.  The  place  of 
birth  should  properly  fix  the  liability,  as  any  other  rule  would  be  too 
vague.  From  what  has  been  elsewhere  stated,  it  will  be  perceived  that 
intercourse  might  take  place  in  Scotland,  followed  by  conception  in  Eng- 
land, and  birth  in  Ireland.  So  that  there  is  a  due  relation  between  the 
date  of  intercourse  and  the  date  of  birth,  no  other  proof  is  required. 

Posthumous  Children. — It  has  been  supposed  that  a  case  involving  a 
question  of  paternity  might  present  itself  on  the  marriage  of  a  widow  soon 
after  the  death  of  her  first  husband.  If  a  child  were  born  after  the  lapse 
often  months,  it  might  be  a  question  Avhether  it  was  a  child  of  the  first  or 
second  marriage — of  the  dead  or  the  living  husband;  and  although  there 
might  be  no  dispute  concerning  its  legitimacy,  yet  it  would  be  difficult  to 
settle  its  fjaternity.  Such  a  case  appears  hypothetical.  In  order  that  any 
doubt  should  exist,  a  woman  must  marry  within,  at  the  furthest,  six  weeks 
after  the  death  of  her  first  husband,  or  the  birth  of  the  child  would  fall 
beyond  the  furthest  limit  of  gestation  so  far  as  he  was  concerned.  The 
customs  of  society  are,  however,  a  bar  to  such  marriages ;  and  admitting 
that  a  child  was  so  born,  and  that  it  might  be  the  off"spring  of  either  bus- 
band,  then  the  fact  of  its  having  been  born  during  the  marriage  of  the 
second  husband  would  presumptively  fix  the  offspring  upon  him,  unless  it 
could  be  shown  that  there  was  no  possibility  of  access  on  his  part.  If 
there  was  a  supposed  greater  likeness  to  the  first  than  to  the  second  bus- 


SUPERFCETATION    IN    RELATION    TO    LEGITIMACY.  623 

band,  still  this  would  not  be  allowed  to  defeat  the  leg-al  presumption  of  the 
real  parentage  of  the  child.  It  appears  that  evidence  much  stronger  than 
thi.-5  would  be  required  for  such  a  purpose.  (See  Henke's  Zeitschrift,  1838, 
Bd.  2,  p.  432  ) 

Svperfoetation  in  Relation  to  Legitimacy. — By  "  superfoetation  "  we 
understand  that  a  second  conception  may  at  any  time  follow  the  first,  and 
that  a  gestation  may  go  on  to  its  full  period  in  each  instance  independently 
of  the  other ;  so  that  if  a  woman  were  impregnated  when  in  the  third 
month  of  gestation,  she  would  bear  the  first  child  mature  in  nine  months, 
and  the  second  child,  also  mature,  at  the  end  of  twelve  months  after  the 
first  conception.  Its  importance  to  a  medical  jurist  appears  to  have  been 
considerably  exaggerated.  Not  only  is  there  no  legal  case  involving  this 
question  to  be  met  with  in  the  judicial  records  of  this  country,  but  none 
in  reference  to  this  state  is  ever  likely  to  occur  that  would  create  the  least 
practical  difficulty.  If  we  admit  that  a  woman  may  during  marriage 
present  such  a  deviation  from  the  common  course  of  nature  as  to  produce 
two  perfectly  mature  and  fully  developed  children,  the  one  three  or  four 
months  after  the  other,  how  can  such  an  event  be  any  imputation  on  her 
fidelity  ?  Superfoetation,  if  it  occur  at  all,  may  occur  as  readily  in  married 
life  during  connubial  intercourse,  as  among  unmarried  women.  The  fol- 
lowing appears  to  be  the  only  possible  case  wherein  a  medical  opinion 
might  be  required  respecting  this  alleged  phenomenon.  A  married  woman, 
six  months  after  the  absence  or  death  of  her  first  husband,  gives  birth  to 
an  apparently  mature  child,  which  dies;  three  months  afterwards,  and 
nine  months  after  the  absence  or  death  of  her  husband,  she  may  allege 
that  she  has  given  birth  to  another  child,  also  mature.  A  medical  ques- 
tion may  arise  whether  two  mature  children  could  be  so  born  that  the  birth 
of  one  should  follow  three  months  after  the  birth  of  the  other  ;  or  whether 
this  might  not  be  a  case,  by  no  means  uncommon,  of  twin  children — the 
one  being  born  prematurely,  and  the  other  at  the  full  period.  (For  a  case 
of  this  kind,  at  two  months'  interval,  see  Lond.  Med.  Gaz.,  vol.  xxxvii.  p. 
27  ;  and  for  another,  at  eight  days'  interval,  see  the  same  journal,  vol. 
xlvii.  p.  227  ;  for  a  third,  at  thirty-two  days'  interval,  Amer.  Jour.  Med. 
Sci.,  1845,  p.  503.)  In  one  case  the  abortion  of  one  fetus  occurred  at 
the  third  month,  while  the  other  attained  the  full  period.  (Assoc.  Med. 
Jour.,  1853,  ii.  p.  997.) 

Admitting  that  each  child  when  born  was  mature  and  fully  developed, 
and  therefore  that  the  second  child  presented  a  case  of  superfoetation,  the 
first  delivery  must  have  taken  place  in  the  presence  of  witnesses,  and  it 
would  then  have  been  known  whether  another  child  remained  in  the  womb 
or  not.  If  the  two  children  were  born  within  the  usual  period  of  gestation 
after  the  absence  or  death  of  the  husband,  then  their  legitimacy  would  be 
presumed  until  the  fact  of  non-access  had  been  clearly  established.  The 
mere  circumstance  of  their  being  apparently  mature  and  born  at  different 
periods  would  per  se  furnish  no  evidence  of  their  illegitimacy.  On 
the  other  hand,  if  one  or  both  of  them  were  born  out  of  the  ordinary 
period,  then,  according  to  the  evidence  given,  they  might  or  might  not  be 
pronounced  illegitimate.  The  law,  therefore,  appears  to  haveno  sort  of 
cognizance  of  the  subject  of  superfoetation  as  such  ;  it  is  generally  merged 
in  the  question  of  protracted  gestation,  which  has  already  been  fully 
considered  (p.  611). 

Bonnar  has  examined  the  subject  of  superfoetation  in  another  aspect, 
and  some  of  the  facts  which  he  has  brought  forward  are  not  consistent 
with  the  theory  of  the  births  of  twins  at  different  intervals.  (A  Critical 
Inquiry  regarding  Superfoetation,  with  Cases,  1865.)     The  first  question 


624  SUPPOSITITIOUS    CHILDREN. 

to  which  his  researches  were  directed  w^as :  "At  what  period  after  parturi- 
tion are  the  female  procreative  organs  capable  of  again  exercising  their 
functions  ?  It  has  been  supposed  that  a  period  of  thirty  days  must  elapse 
in  order  to  enable  the  organs  to  reacquire  procreative  power  ;  but,  accord- 
ing to  Bonnar,  the  earliest  period  may  be  taken  at  the  fourteenth  day 
after  delivery.  Impregnation  is  not  likely  to  take  place  until  the  organs 
have  resumed  their  natural  condition,  and  this  will  depend  on  the  disap- 
pearance of  the  signs  of  recent  delivery — snch  as  the  tender  and  swollen 
state  of  the  vagina,  the  enlargement  of  the  womb  with  its  relaxed  mouth, 
and  the  lochia!  discharge.  The  persistence  of  the  lochial  discharge,  the 
average  duration  of  which  after  delivery  Bonnar  considers  to  be  from  one 
to  three  or  four  weeks,  is  of  the  greatest  importance,  as  it  is  most  likely 
to  interfere  with  impregnation.  The  time  for  the  restoration  of  the  sexual 
organs  to  their  natural  state  varies  in  different  women,  so  that  the  date 
for  reimpregnation  must  be  more  or  less  conjectural. 

It  has  been  usually  considered  that  after  the  second  or  third  month  of 
pregnancy  the  cavity  of  the  womb  is  so  sealed  up  in  the  development  of 
theembryo  as  a  result  of  impregnation  that  it  is  impossible  that  any 
fruitful  intercourse  can  take  place.  In  two  instances,  however,  according 
to  Bonnar,  viable  children  were  born  of  the  same  woman  at  five  and  a 
half  and  four  months  respectively  after  the  first  delivery.  On  the  theory 
of  superconception  the  uterine  organs  must  have  been  susceptible  of  a 
second  impregnation  up  to  the  fourth  month  of  gestation.  But  if  the 
children  were'' not  born  mature  the  power  of  reimpregnation  must  have 
existed  for  one  or  two  months  longer  than  the  period  usually  assigned — 
i.  e.  up  to  the  fifth  or  sixth  month  of  a  pregnancy  already  existing.  These 
researches  may  help  to  explain  some  legal  difficulties  which  have  occurred 
in  reference  to  gestation.  They  furnish  a  curious  comment  upon  the 
suggestion  made  by  some  medical  jurists,  that  superfoetation  involves  the 
conjuq-al  fidelity  of  a  wife,  for  no  suspicion  of  illegitimacy  could  be  for  a 
moment  entertained  simply  on  account  of  the  shortness  of  the  interval 
between  the  two  deliveries  of  the  same  married  woman. 

Supjjosititious  Children. — Another  medico-legal  case  in  relation  to 
legitimacy  occurs  when  a  woman  feigns  delivery  and  represents  the  child 
of"^ another  person  to  be  her  offspring.  She  may  substitute  the  living 
child  of  another  woman  for  a  dead  child  of  which  she  herself  has  been 
delivered  or  for  a  mole  which  may  have  passed  from  her.  So,  again,  a 
male  may  be  substituted  for  a  female  child,  and  vice  versa.  The  prac- 
tising of  a  fraud  of  this  nature  may  seriously  aff'ect  the  rights  of  inheri- 
tance of  parties;  but  it  cannot  be  accomplished  without  great  dexterity 
and  cunning,  or  without  the  cooperation  of  one  or  more  accomplices. 
Frauds  of  this  kind  have,  in  general,  been  committed  by  the  aid  of  a 
low  class  of  midwives.  One  instance  occurred  at  Chelsea,  in  July,  1842, 
where  the  fraud  was  brought  to  light  by  the  death  of  the  supposititious 
child.  The  calling  in  of  a  professional  man  would  lead  to  discovery  when 
the  question  was  simply  whether  delivery  had  or  had  not  taken  place;  but 
if  it  be  alleged  that  one  living  child  has  been  substituted  for  another,  the 
proof  of  this  can  depend  on  "medical  evidence  only  when  the  age  of  the 
suppostitious  child  docs  not  happen  to  correspond  to  the  date  of  the  pre- 
tended delivery.  (Ann.  d'Hyg.,  1829,  t.  2,  p.  227.)  The  legitimacy  of 
the  claimant  of  the  Douglas  Peerage  was  disputed  on  this  ground,  but 
apparently  without  foundation.  A  remarkable  case  of  this  description 
will  be  found  in  Henke's  Zeitschrift.  der  S.  A.  (1845,  Bd.  2,  p.  172) ;  and 
a  trial  took  place  some  years  since  in  England  involving  the  alleged  sub- 
stitution of  a  child,  but  requiring  no  medical  evidence  for  its  elucidation. 


SUPPOSITITIOUS    CHILDREN.  625. 

(Day  V.  Day,  Leicester  Lent  Ass.,  1845.)  lu  another  case  it  was  proved 
that  a  woman  had  substituted  a  doll  for  the  dead  body  of  a  child  of  which 
she  pretended  she  had  been  delivered.  In  a  case  mentioned  by  Chevers, 
one  Mussaniat  Janoo,  a  midwife  of  Hissar,  being-  employed  to  attend  a 
Avoman  in  her  confinement,  persuaded  her  that  the  child  of  which  she  had 
been  delivered  was  a  monster  with  two  heads,  not  fit  to  be  looked  at ;  she 
afterwards  said  that  it  was  dead,  and  that  she  would  take  it  away  and 
bury  it.  She  accordingly  went  away.  Next  morning  the  midwife's  ser- 
vices being  required  she  was  sent  for.  She  excused  herself  from  going 
under  the  pretence  that  she  (the  midwife)  had  just  been  delivered  of  a 
child.  This  improbaljle  story  excited  suspicion,  and  the  police  were 
called  in :  she  declared  that  the  child  was  her  own.  This  she  also  main- 
tained at  the  trial.  It  appeared,  however,  from  the  evidence  of  midwives 
who  examined  her  shortly  after  the  discovery  of  the  child  in  her  house, 
and  also  b}^  the  deposition  of  the  civil  surgeon,  that  she  exhibited  no 
signs  of  recent  delivery.  Several  of  the  neighbors  who  were  constantly 
in  the  habit  of  seeing  her  deposed  that  she  had  not  exhibited  any  outward 
signs  of  pregnancy.  She  did  not  attempt  to  prove  how  she  had  disposed 
of  the  body  of  the  child  which  she  alleged  had  died  immediately  after  its 
birth.  She  was  convicted.  (Aied.  Jurispr.  for  India,  p.  512,  from  the 
Nizamut  Adawlut  Rep.,  26th  April,  1853.) 

Cases  involving  a  question  of  substitution  are  not  very  common.  One 
of  these  (Hutchins  v.  Hutchins)  was  heard  in  the  Vice-Chancellor's  Court 
in  May,  1851 ;  and  in  this  the  amount  of  ingenuity  required  to  perpetrate 
the  fraud  was  only  equalled  by  the  skill  with  which  the  facts  were  ex- 
posed, and  justice  ultimately  done  to  the  rightful  claimant.  In  another 
(G-edney  v.  Smith,  Rolls  Court,  Xov.  1864)  the  fraud  was  nearly  success- 
ful, and,  but  for  the  dying  declaration  of  the  woman  herself,  would  prob- 
ably have  escaped  detection  and  exposui-e.  In  the  more  recent  case  of 
Lady  Grooch  (1878),  who  was  charged  with  fraudulently  attempting  to 
pass  off  a  child  as  that  of  her  husband,  the  facts  were  clear.  She  endeavored 
to  persuade  a  medical  man  to  give  a  false  certificate  that  she  had  borne  a 
child,  and  she  induced  a  nurse  to  procure  a  child  and  to  give  the  appear- 
ance of  a  delivery  while  she  was  staying  at  a  London  hotel.  A  medical 
man  who  was  called  in,  examined  her,  and  found  that  she  had  not  been 
delivered  of  a  child,  and  that  the  child  produced  as  recently  born  was 
about  two  weeks  old.  To  carry  off  her  fictitious  pregnancy,  she  had  worn 
pads  to  her  abdomen.  These  proceedings  had  been  carried  on  in  spite  of 
the  remonstrances  of  a  female  attendant  and  her  usual  medical  advisers, 
as  well  as  the  refusal  of  her  husband  to  admit  that  she  was  pregnant.  She 
was  committed  for  trial,  but  the  grand  jury  ignored  the  bill. 

The  cases  that  have  hitherto  been  tried  illustrate  the  importance  of 
accurate  observation  on.  the  part  of  medical  men  in  their  practice  as 
accoucheurs.  Notes  of  all  cases  should  be  made  and  preserved,  including 
dates  of  attendance,  etc. — daily  symptoms  and  treatment.  This  should  be 
an  invariable  rule  when  a  medical  man  is  suddenly  called  upon  to  attend, 
in  her  confinement,  a  woman  who  has  not  previously  consulted  him.  If 
be  has  had  no  previous  knowledge  of  the  pregnancy  of  a  woman,  and  if, 
when  he  arrives,  the  child  is  said  to  have  been  born  and  is  in  the  hands  of 
a  nurse,  he  should  most  distinctly  satisfy  himself,  by  a  personal  examina- 
tion, that  the  woman  has  been  actually  delivered.  He  should  also  observe 
whether  the  child  presents  the  appearance  of  the  newborn  child  in  reference 
to  the  state  of  the  skin,  the  appearance  of  the  cut  navel-string,  and  other 
circumstances.  It  is  an  awkward  exposure  for  a  medical  man  to  hear  at  a 
40 


.626  DISTINCTION    OF    SEX. 

trial,  many  years  afterwards,  that  he  has  been  cleverly  made  to  give  sup- 
port to  a  fraud. 

Sexual  3[alformatio7i. — The  legitimacy  of  a  child  is  open  to  be  con- 
tested under  other  circumstances  than  those  connected  with  the  duration 
of  gestation.  The  alleged  parent  ma}^  have  labored  under  physical  in- 
capacity :  if  a  male,  he  may  have  been  affected  with  impotency — if  a  female, 
she  may  have  labored  under  sterility  ;  and  if  either  of  these  conditions  be 
proved,  the  illegitimacy  of  a  child  will  be  established,  although  the 
alleged  period  of  gestation  may  be  comprised  within  the  ordinary  limits, 
The  sexual  conditions  now  about  to  be  considered  have  also  important 
bearina:s  in  relation  to  divorce,  and  occasionally  to  the  civil  rights  of  a 
child  that  may  be  the  subject  of  the  malformation.  One  of  the  most  com- 
mon and  obvious  causes  of  impotency  or  sterility  is  malformation  of  the 
sexual  organs,  to  which  species  of  monstrosity  the  term  Hermaphroditism 
is  commonly  applied. 

Owing  to  arrested  development  during  the  growth  of  the  foetus,  the 
sexual  organs,  which  can  scarcely  be  distinguished  at  the  fourth  month, 
occasionally  assume  an  abnormal  arrangement.  These  organs  appear  to  be 
at  that  time  more  or  less  mixed ;  and  sometimes  the  male  and  at  other 
the  female  characters  predominate.  With  this  defective  sexual  develop- 
ment, the  other  peculiarities  of  the  sexes,  are  either  wanting,  or  more  or 
less  blended.  When  the  being  has  the  general  characters  of  a  male  with 
malformation  of  the  generative  organs,  it  is  called  androgynus :  when  the 
characters  are  those  of  a  female  with  a  like  malformation,  androgy'na. 
There  can  be  no  difficulty  in  identifying  such  cases,  and,  according  to 
the  degree  of  malformation,  a  medical  jurist  can  have  no  hesitation  in  pro- 
nouncing these  persons  to  be  physically  iaipotent.  The  organs  are  com- 
monly so  defective  as  to  be  wholly  unfitted  for  the  functions  of  either  sex. 
It  is  not  intended  to  be  said  that  it  is  in  all  cases  easy  to  assign  the  sex 
but  this  is  of  minor  importance  ;  the  main  question  is,  whether  the  mal- 
formation is  or  is  not  such  as  to  justify  divorce,  or  to  throw  the  imputa- 
tion of  illegitimacy  upon  children  claiming  to  be  the  offspring  of  these 
beings. 

Distinction  of  Sex. — The  determination  of  sex  in  the  cases  of  deformity 
has  been  considered  to  be  necessary  under  certain  circumstances ;  as  when, 
for  instance,  a  title  or  entailed  inheritance  of  lands  is  in  question.  Lord 
Coke  has  stated  that,  according  to  the  law  of  England,  an  hermaphrodite 
may  be  either  male  or  female,  and  it  shall  succeed  according  to  the  kind  of 
sex  which  doth  prevail.  Thus  it  is  obvious  that  the  law  will  decide  each, 
case  according  to  the  special  circumstances  proved,  but  it  must  not  be 
supposed  that  the  decision  is  so  easy  as  Lord  Coke's  dictum  would  imply. 
There  are  many  cases  in  which  neither  sex  can  be  obviously  said  to  pre- 
vail. The  chief  character  of  the  male  consists  in  the  presence  of  testicles, 
and  of  the  female  in  the  presence  of  a  womb  and  ovaries,  but  in  one  in- 
stance both  the  testicles  and  the  ovaries  were  wanting ;  there  were  no 
essential  characters  of  either  sex,  and  during  life  it  would  have  been  im- 
possible to  say  whether  this  being  w^as  male  or  female.  (Cormack's  Month. 
Jour.,  1845,  p.  492.)  In  the  same  journal  (p.  531)  is  reported  another 
case,  in  which,  notwithstanding  the  external  resemblance  to  a  female,  the 
presence  of  one  testicle  in  a  scrotum  showed  that  the  being  was  of  the 
male  sex;  yet  this  person  yjassed  for  a  woman  until  he  had  reached  his 
26th  year.  It  is  rare  that  there  is  external  malformation  without  internal 
defect,  but  even  when  the  female  character  preponderates,  it  is  not  im- 
probable that  the  womb  or  the  ovaries  may  be  absent,  or  the  former  may 
be  malformed.     Such  beings  are  not  known  to  menstruate,  and,  even  if 


LEGAL    RELATIONS    OF    HERMAPHRODITES.  627 

there  should  be  capacity  for  intercourse,  they  are  permanently  sterile. 
Sexual  desires  are,  however,  commonly  absent.  When  the  person  is 
youn^,  mistalies  respecting  the  sex  are  more  common  than  at  an  advanced 
period  of  life.  So  soon  as  the  a.i;-e  of  puberty  is  past,  certain  changes  take 
place  in  the  configuration  of  the  body  which  may  aid  a  medical  practi- 
tioner in  forming  an  opinion.  Thus  a  grave  tone  of  voice,  the  presence  of 
a  beard,  the  width  of  the  shoulders  and  narrowness  of  the  pelvis,  will  in- 
dicate, caeteris  paribus,  the  male  sex ;  while,  when  these  conditions  are 
absent,  and  there  is  a  rotundity  of  the  members,  with  want  of  prominence 
in  the  muscles,  and  a  great  development  of  the  breasts  and  pelvis,  the 
female  sex  predominates.  Although  no  testicles  are  apparent,  still  the 
being  may  be  of  the  male  sex,  since  it  is  well  known  that  in  persons  other- 
wise well  formed  these  organs  are  not  always  found  in  the  scrotum.  As- 
a  rule,  the  female  sex,  whatever  may  be  the  sexual  malformation,  is  clearly 
indicated  by  the  performance  of  the  function  of  menstruation.  In  the  case 
of  a  girl,  set.  8,  the  pubes  was  found  covered  with  black  hair.  There  was 
a  well-formed  member  like  a  penis,  two  inches  long,  capable  of  erection, 
but  without  any  urethra.  Below  the  penis  there  was  a  large  urethra  or 
meatus,  and  pendulous  vulva,  with  labia  resembling  testicles.  The  parents 
always  had  doubts  about  the  sex,  but,  as  the  child  menstruated- regularly, 
it  was  a  female  malformed.     (Brit.  Med.  Jour.,  1875,  ii.  p.  514.) 

An  external  examination  will  sometimes  entirely  fail  to  indicate  the 
sex,  and  even  the  opportunity  of  an  examination  of  the  dead  body  may 
leave  the  case  in  doubt.  (For  a  report  of  a  case  in  which  a  body  re- 
sembling the  prostate  gland  and  a  womb  coexisted  in  the  same  being,  see 
Med.  Times  and  Gaz.,  1860,  i.  p.  17T.)  A  case  has  been  already  mentioned 
in  which  neither  testicles  nor  ovaries  were  found  after  death,  and  more 
than  one  instance  is  said  to  have  occurred  in  which  both  have  been  found. 
This  last  condition  is  a  case  of  intermixture  of  the  sexes,  or,  ph^^sically 
speaking,  real  hermaphroditism,  but,  of  course,  without  the  functional 
power  of  self-impregnation. 

Medico-legal  Relatione. — Persons  in  whom  the  sexual  organs  are  defec- 
tive or  imperfectly  developed,  are  impotent  and  sterile.  Questions  con- 
nected with  the  legitimacy  of  offspring,  divorce,  and  affiliation  may,  there- 
fore, be  raised  with  respect  to  them.  Sexual  monstrosity  is  not  a  ground 
for  depriving  a  being  of  the  rights  of  inheritance,  except  under  peculiar 
legal  conditions.  Thus  a  right  of  succession  or  inheritance  to  landed 
estate  may  depend  upon  the  sex  of  the  offspring;  as  where,  for  instance, 
two  children  are  born,  the  first  an  hermaphrodite,  the  second  a  well-formed 
male  child.  The  parents  die,  and  a  title  of  nobility  or  lands  may  fall  to 
the  firstborn  male.  Here  the  sex  of  the  firstborn  must  l^e  determined 
before  possession  can  be  had.  In  a  case  of  this  kind,  if  medical  evidence 
should  establish 'that  male  peculiarities  predominate  in  the  firstborn,  the 
second  child  would  be  cut  off.  Again,  if  an  estate  were  limited  by  entail- 
ment, as  where  it  is  settled  upon  heirs  (male  or  female)  of  a  particular 
family,  the  birth  of  an.  hermaphrodite,  an  only  child,  would  create  a  legal 
necessity  for  a  positive  determination  of  the  predominance  of  sex.  So,  if 
an  hermaphrodite  lives  but  a  few  minutes  after  its  birth  and  then  dies,  the 
rights  of  persons  may  be  sul)sequently  much  affected  by  the  opinion  of 
the  medical  attendant  respecting  its  sex.  Since  we  cannot  determine 
under  what  circumstances  litigation  may  ensue,  it  is  always  right  in  a 
doubtful  case  to  observe  the  sex,  and  make  notes  on  the  spot  when  a  child 
thus  malformed  survives  its  birth  but  for  a  short  period.  The  question  of 
tenancy  by  curtesy,  or  the  right  of  the  husband  to  landed  estate  of  which 


628  LEGAL    RELATIONS    OF    HERMAPHRODITES. 

the   wife   was   seised,    will   depend  entirely  upon   the  attention  of  the 
accoucheur  to  this  point. 

When  these  beings  have  reached  adult  age,  other  questions  may  arise 
with  respect  to  them.  The  English  law  does  not  allow  them  to  select 
their  sex,  but  determines  it  for  them  by  medical  evidence.  Hermaphrodites, 
or  sexual  monsters,  were  formerly  ranked  with  infamous  persons;  and  it 
has  been  a  grave  question  in  our  courts,  whether  the  calling  a  man  an 
hermaphrodite  was  not  such  a  libel  or  slander  upon  him  as  to  render  it  a 
ground  for  civil  action.  In  a  case  reported  by  Chitty  (Med.  Jur.,  p.  374), 
the  use  of  this  term  was  held  not  to  be  actionable  unless  it  was  proved 
that  it  had  been  attended  with  special  damage.  A  dancing-master  brought 
an  action  against  a  person  for  calling  him  an  hermaphrodite,  and  it  was 
decided  that  it  was  not  sustainable  :  1.  Because  such  a  union  of  the  sexes 
cannot  exist  in  fact,  and  every  one  must  be  supposed  to  know  it;  con- 
.sequently  the  assertion  could  not  be  supposed  to  prejudice.  2.  Because, 
admitting  the  possibility  of  such  a  double  function,  the  party  would  be 
just  as  good,  and,  perhaps,  even  a  safer  dancing-master  than  if  only  one 
perfect  sex  had  been  discoverabl-e  ;  consequently,  the  words  would  not,  in 
legal  presumption,  injure  him  in  his  [profession  or  occupation. 

It  would  appear  that  in  the  United  States  the  rights  of  citizenship  and 
the  privilege  of  voting  for  members  of  Congress  have  depended  on  the 
determination  of  sex.  In  1843,  Barry  was  requested  to  examine  a  person 
named  Levy  Suydam,  aged  23  3"ears.  At  the  warmly  contested  election  of 
that  year  almost  everything  bearing  the  semblance  of  the  human  form  and 
of  the  male  sex  is  stated  to  have  been  brought  to  the  ballot-box.  It  was  at 
this  time,  and  under  these  circumstances,  that  the  above-mentioned  person 
was  presented  by  the  Whigs  to  be  made  2,  freeman  ;  he  was  challenged 
by  the  opposite  party  on  the  ground  that  he  was  more  a  female  than  a 
male,  and  that  in  his  physical  organization  he  partook  of  boih  sexes. 
Without  going  into  the  details  of  his  physical  organization  it  may  be 
stated  that  as  he  was  found  to  have  a  penis  and  one  testicle  the  privilege 
of  a  vote  as  a  male  citizen  was  conceded  to  him.  It  Avas,  however,  sub- 
sequently proved  that  this  being  regularly  menstruated,  and  that  it  had 
other  female  peculiarities.  This  was  certainly  an  embarrassing  ease — 
one  to  which  Lord  Coke's  rule  for  a  decision,  i.  e.  the  prevalence  of  either 
sex,  is  hardh^  applicable.  The  presence  of  a  penis  and  one  testicle  referred 
the  being  to  the  male  sex ;  while  the  bodily  configuration,  and  still  more 
strongly  a  periodical  menstrual  discharge,  referred  it  to  the  female  sex. 
The  right  of  voting  might  have  been  fairly  ol)jected  to,  because,  while  ■ 
the  female  characters  were  decided,  the  organs  indicative  of  the  male  sex 
are  described  as  having  been  imperfectly  developed.  It  is  possible  that 
the  question  of  sex  may  be  mooted  under  similar  conditions  in  this  country. 


IMPOTENCY.  629 


IMPOTENCY.    STERILITY. 


CHAPTER    LVIII. 

IMPOTENCY. CAUSES. PROCREATIVE  POWER  IN  THE  MALE- PUBERTY. AGE  FOR  VIRILITY." 

—  VIRILITY  OF  CRYPSORCHIDES  AND    MOXORCHIDES. STERILITY. PROCREATIVE  POWER  IN 

THE    FEMALE. EARLIEST    AND    LATEST  PERIODS    FOR    CHILDBEARING. LEGAL    RELATIONS. 

Definition. — Impotency  is  defind  to  be  a  [permanent]  incapacity  for 
sexual  intei'course.  It  may  depend,  first,  upon  physical,  second,  upon 
moral,  causes.  With  regard  to  the  moral  causes  of  impotency  they  do 
not  concern  a  medical  jurist.  Such  causes  are  not  recognized  by  law,  and 
he  has  no  duty  to  perform  beyond  the  application  of  the  principles  of 
medicine  to  the  purposes  of  the  law. 

Causes. — Impotency  may  arise  from  age  ;  from  certain  physical  causes, 
e.  g.  disease  ;  or  from  congenital  malformation  or  defect.  With  regard 
to  phjjsical  causes  a  distinction  must  be  made  between  those  which  are 
remediable  and  those  which  are  not.  The  presence  of  a  disease  of  the 
testicle,  such  as  atrophy  or  tumor,  may  give  rise  to  incapacity;  but  this 
incapacity  may  be  sometimes  removed  by  an  operation  or  by  medical  treat- 
ment, and  therefore  the  physical  cause  may  be  removed — in  other  words, 
it  is  remediable.  To  such  cases  as  these  the  law  does  not  extend;  but  it 
is  always  expected  in  alleged  incapacity  that  the  practitioner  examined  on 
the  subject  should  be  able  to  say  whether  there  is  or  is  not  a  prospect  of 
cure.  In  forming  a  judgment  upon  this  point  a  good  knowledge  of  his 
profession  can  alone  assist  him  ;  no  rules  can  be  laid  down  for  his  guid- 
ance, for  there  may  not  be  two  cases  that  will  precisely  resemble  each 
other  in  their  features;  hence  it  will  be  necessary  in  this  place  to  point 
out  the  chief  causes  of  impotency  which  are  of  an  irremediable  nature  or 
those  in  which  the  incapacity  is  absolute  and  permanent — a  point  upon 
which  medical  opinion  is  chiefly  required. 

In  strictness  of  language,  the  definition  of  impotency  as  above  given 
may  be  applied  to  2l  female  as  well  as  a  male  ;  and,  undoubtedly,  a  physi- 
cal incapacity  for  sexual  intercourse  may  exist  in  either  sex.  As  an  in- 
stance of  this  incapacity  in  the  female  may  be  mentioned  occlusion  of  the 
vagina — a  condition  not  necessarily  indicative  of  sterility.  The  mere 
occlusion  of  the  vagina  may  be  a  remediable  form  of  the  malady  ;  but 
its  entire  obliteration  would  be  an  absolute  and  irremediable  defect.  This 
latter  condition,  however,  is  the  only  instance  of  complete  impotency  in 
a  female.  A  protrusion  of  the  womb  or  of  the  bladder  into  the  vagina 
is  mentioned  by  some  writers  as  a  cause  of  physical  incapacity  for  inter- 
course ;  but  these  forms  of  disease  may  commonly  be  remedied  by  art, 
and  therefore  require  no  further  notice  in  this  place.  The  editor  was  once 
consulted  by  a  gentleman  who  alleged  that  anch^'^losis  of  the  hip-joint  of 
his  wife — the  broken  limb  being  flexed  across  the  entrance  to  the  vagina — 
was  a  bar  to  sexual  intercourse.     It  is  unlikely  that  intercourse  was  abso- 


6S0  rROCREATIVE    POWER    I>;    THE    MALE.  • 

lute'ly  impossible  under  the  circumstauces:  and  it  is  known  that  even  double 
aueliylosiri  of  the  jjip-joiiits  is  not  an  iusuperaljje  bar  to  coitus. 

In  i)rutessioual  lau<iua^_e  the  term  '"  impotency"  has  been  hitherto  applied 
exclu.-ively  to  a  defect  in  the  male  sex  ;  and  the  term  "  sterility"  is  U;-ually 
confined  to  all  those  conditions  in  the  female  which  not  only  render  inter- 
course impossible,  but  which  render  it  unfruitful.  A  male  may,  however, 
be  sterile  without  beina-  impotent — a  condition  observed  in  some  crypsor.- 
ehides;  or  he  may  be  impotent  without  bein^i-  sterile,  as  where  proper  in- 
tercourse is  prevented  by  reason  of  physical  defect  in  the  virile  member, 
although  the  testicles  may  be  in  a  normal  condition.  (See  on  this  sub- 
ject, Curling,  On  Sterility  in  Man.)  This  author  points  out  that  sterility 
in  the  male  apart  from  impotency  may  depend  on  three  causes  :  first, 
malposition  of  the  testicles;  second,  obstructions  in  the  excretory  ducts; 
and  third,  impediments  to  the  escape  of  the  seminal  fluid.  A  man  may 
not  be  impotent,  i.  e.  incapable  of  intercourse,  but  by  reason  of  one  of 
the  conditions  above  mentioned,  such  intercourse  would  be  unfruitful.  In 
reference  to  the  male,  the  English  law  does  not  appear  to  go  beyond  the 
establishu)ent  of  impotency  from  some  clear  and  demonstrable  cause,  and 
unless  the  alleged  sterility  were  accompanied  by  impotency  it  would  take 
no  cognizance  of  that  condition.  Further,  sterility  from  such  causes  could 
hardly  be  demonstrated  during  the  life  of  a  person,  and  it  would  rest  chiefly 
on  presumption  or  probability.  [A  better  definition  of  sterility  applied  to 
either  sex  would  be,  inability  to  conceive  in  the  fenjale  and  to  procreate 
their  kind  in  the  male.] 

Procreatice  Power  in  the  IlaJe.  Puberty. — Until  the  period  of  puberty 
the  testicles  are  small  and  they  increase  very  little  in  size  in  proportion  to 
other  part.s.  Curling  fonnd  that  the  size  of  the  seminal  tubes  differed  but 
little  at  the  ages  of  18  months  and  8  years.  The  sexual  function  in  the 
male  depends  entirely  on  the  development  of  the  testicles;  but  the  age  at 
which  it  appears  differs  in  different  persons.  The  a<ie  of  puberty  in  a 
healthy  male  in  this  country  varies  from  14  to  17  years;  its  appearance 
is,  however,  affected  by  climate,  constitution,  and  the  moral  circumstances 
under  which  the  individual  is  placed:  in  some  cases  it  is  not  fully  devel- 
oped until  the  age  of  21. 

The  access  of  puberty  in  the  male  is  indirectly  connected  with  the  sub- 
ject of  rape.  A  boy  under  the  age  oi  fourlfen  yearn  is  presumed  in  law 
to  be  incapable  of  committing-  a  rape.  (1  Hale,  p.  631  ;  and  Matthew's 
Digest,  p.  57.)  The  statute  law  merely  requires  proof  of  penetration,  so 
that  rape  might  be  physically  perpetrated  by  a  boy  at  or  even  under  14 
years  of  age.  In  several  cases,  bovs  at  14  have  been  convicted  of  rape. 
In  a  case  elsewhere  related  (see  Rape),  a  boy,  aged  19,  communicated 
syphilis  to  a  girl  of  6  years  of  age.  It  appears  that  in  India  puberty 
shows  itself  much  earlier  in  the  male.  Chevers,  quoting  from  the  Niza- 
mut  Adawlut  Reports,  states  that  a  boy  13  or  14  years  of  age  was  found 
guilty  of  rape.  A  lad  of  14  was  convicted  of  rape  on  a  girl  of  the  same 
age;  and  in  another  case  a  boy  only  ten  years  old  was  convicted  of  rape 
on  a  '/w\  3  years  of  age.     (Med.  Jurispr.  for  India,  p.  463.) 

The  seminal  secretion  in  the  male  is  not  considered  to  be  prolific  until  it 
contains  those  peculiar  filiform  bodies  which  are  known  under  the  name  of 
spermatozoa,  or  zoosperms.  All  agree  that  they  are  nornial  and  essential 
constituents  of  the  healthy  and  prolific  seminal  fluid.  They  are  peculiar 
to  the  s])ermatic  secretion,  and  in  healthy  males  are  always  present  in  it 
after  the  age  of  puberty.  They  disappear  in  certain  states  of  disease  and 
sometimes  in  advanced  age:  they  have  not  been  found  in  the  undeveloped 
testicles  of  crypsorchides.     In  cases  'n  which  they  are  absent,  from  what- 


IMPOTENCY    FROM    AGE..  681 

ever  cause,  it  is  a  fair  inference  that  the  person  is  impotent,  or  that  he  has 
lost  the  power  of  procreation.  (See  on  this  subject,  Curlinfj-,  On  Sterility 
in  Man.)  In  this  pamphlet,  one  case  is  related  in  which  a  man,  jet.  42, 
who  was  married  and  whose  wife  had  borne  a  son  then  eight  years  of 
ag-e,  had  died  after  four  days'  illness  from  strangulated  hernia.  The 
testicles,  from  the  fact  of  their  being  found  in  the  inguinal  canal,  were 
examined  separately  by  Gosselin  and  Goddard  and  no  spermatozoa  were 
discovered  in  the  fluid  contained  in  either  of  them  ;  but  these  may  have 
been  merely  absent  at  the  time  of  examination,  as  the  child  begotten  was 
then  eight  years  of  age.  During  this  long  interval,  the  secretion  may 
have  undergone  a  change  and  have  become  unprolific. 

Impotency  from  Age. — It  may  be  fairly  assumed  that  a  male  is  in- 
capable of  procreation  until  spermatozoa  have  appeared  in  the  seminal 
secretion  and  that  he  loses  this  power  when  they  disappear.  The  age  at 
which  they  are  formed  varies  with  all  the  causes  that  affect  puberty.  In 
one  instance  they  were  found  by  Casper  in  the  seminal  fluid  of  a  crypsor- 
chid  boy  only  14^  years  old,  and  Curling  found  them  in  the  secretion  of  a 
boy  aged  18.  This  observer  found  spermatozoa  in  the  liquid  taken  from 
the  testicles  of  a  man  upwards  of  70  years  of  age,  and  on  one  occasion  in 
the  testicles  of  a  person  aged  87.  Wagner  states  that  they  are  to  be  found 
in  the  secretions  of  men  between  70  and  80  years  of  age.  Rayer  found 
them  in  the  secretion  of  a  man  aged  82  years.  (Gaz.  Mdd.,  June  2,  1849.) 
Other  cases  of  a  similar  kind  are  recorded  by  Debrou.  (Gaz.  Hebd.,  1861, 
p.  6.)  Dien  examined  the  bodies  of  106  men  between  the  ages  of  64  and 
97.  la  64  cases  out  of  the  106  there  were  no  spermatozoa,  i.  e.  in  61  per 
cent,  of  the  cases.  Four  of  Dlen's  observations  were  on  nonogenarians: 
of  these  none  had  spermatozoa.  (Med.-Chir.  Rev.,  1868,  p.  279.)  Facts 
tend  to  render  it  highly  probable  that  a  fecundating  power  may  be  retained 
by  the  male  up  to  the  age  of  100-  According  to  Duplay,  the  seminal  fluid 
of  old  men  contains  spermatozoa  even  when  they  are  beyond  the  age  of 
fecundation;  but  he  does  not  state  the  circumstances  which  enabled  him 
to  arrive  at  this  conclusion  (Med.  Times  and  Gaz.,  1853,  i.  p.  581). 
Sexual  propensities  are  often  strongly  developed  in  children  and  thus  they 
may  be  prolific  at  an  early  age.  Riittel  met  with  a  case  in  which  a  female, 
at  the  age  of  14,  became  pregnant  by  a  boy  of  the  same  age.  (Henke's 
Zeitschrift  der  S.  A.,  1844,  p.  249.)  This  is  the  earliest  age  at  which,  so 
far  as  we  can  ascertain,  the  procreative  power  has  appeared  in  the  male. 
Hartshorne  refers  to  an  instance  of  extraordinary  development  of  the 
male  sexual  organs  in  a  child  4  years  old.  (Amer.  Jour.  Med.  Sci.,  Oct. 
1852,  p  561.)  in  a  case  of  contested  legitimacy  or  affiliation,  this  question 
regarding  the  age  at  which  a  procreative  power  appears  in  the  male  may 
have  an  important  bearing  on  the  issue.  Thus  the  person  may  be  so 
young  as  to  render  it  impossible  that  he  should  be  the  father  of  a  child 
imputed  to  him.  Cases  involving  questions  of  legitimacy  on  this  ground 
are  not  heard  of  in  the  present  day. 

The  following  case  in  reference  to  the  affiliation  of  children  occurred  in 
1840.  A  woman  wished  to  affiliate  a  child  on  a  youth  who  was  in  his 
sixteenth  yeai'.  The  boy  denied  that  he  was  the  father  of  the  child ;  and 
there  was  reason  to  suspect  that  the  imputation  had  been  wrongly  thrown 
upon  him  in  order  to  divert  suspicion  from  the  real  offender.  There  was 
some  difficulty  in  this  case  ;  but  the  rule  for  a  medical  man  to  follow  on 
these  occasions  is  this:  not  to  regard  the  mere  age  of  the  youth,  whether 
he  is  above  or  below  the  average  age  of  puberty,  but  to  observe  whether 
the  sexual  organs  are  fully  developed  and  whether  there  are  about  him 
any  of  the  marks  of  precocious  virility,  indicated  by  muscular  develop- 


632  IMPOTENCy    FROM    DISEASE    OR    ACCIDENT. 

ment,  the  growth  of  a  beard,  and  a  manly  voice.  If  these  signs  are 
present,  whatever  may  be  his  age,  there  is  strong  reason  to  suppose  that 
the  sexual  functions  are  developed.  We  occasionally  hear  of  instances  of 
extraordinary  precocity,  but  the  development  of  sexual  power  is  generally 
accompanied  by  other  well-marked  changes  in  the  person.  Sometimes 
these  changes  do  not  make  their  appearance  until  after  the  age  of  twenty- 
one. 

On  ,the  other  hand,  it  may  be  a  question  at  what  time  the  procreative 
power  disappears  in  a  male.  That  impotency  is  one  of  the  natural  conse- 
quences of  advanced  age  is  undoubted,  but  this,  as  we  know,  forms  no 
legal  impediment  to  the  marriage  of  parties,  however  old.  The  legal  pre- 
sumption is  that  the  generative  faculty  does  not  disappear  through  age  ; 
and  if  this  be  alleged,  and  legitimacy  disputed  on  this  ground,  it  must  be 
satisfactorily  proved  by  those  who  would  benefit  by  the  allegation.  This 
amounts  almost  to  an  impossibility,  because  it  is  well  known  that  there  is 
no  fixed  age  at  which  the  sexual  functions  cease  either  in  the  male  or 
female ;  and  individuals  at  least  of  the  male  sex,  who  have  passed  the 
ages  of  60,  TO,  and  even  80  years,  have  been  known  to  be  capable  of 
fruitful  intercourse.  Duplay  believes,  from  his  anatomical  observations 
on  the  bodies  of  aged  persons,  that  the  causes  of  impotency  (sterility)  in 
advanced  age  are  to  be  found  rather  in  the  excretory  than  in  the  secretory 
apparatus.  Thus  he  has  met  with  obliterations  in  the  canal  of  the 
epididymis,  the  vas  deferens,  and  the  vesiculas,  the  effect  of  which  is  to 
prevent  the  accumulation  and  passage  of  the  seminal  fluid.  (Med.  Times 
and  Gaz.,  1856,  i.  p.  650.)  Lord  Erskine,  in  the  Bambury  Peerage  claim, 
quoted  the  case  of  Sir  Stephen  Fox,  who  was  married  at  Tl,  and  had  had 
four  children,  the  last  when  he  was  81.  Schneider  met  with  a  case  in 
which  a  man  of  11  had  a  child  by  his  wife,  who  was  only  17.  (Henke's 
Zeitschrift,  1842,  Bd.  2,  p.  165.)  Riittel  mentions  the  case  of  a  man  who, 
at  the  age  of  92  years,  married  and  had  two  children  by  his  wife.  When 
the  procreative  power  even  appears  to  be  lost  at  advanced  age,  the  stimulus 
for  intercourse  is  often  very  great.  The  same  authority  mentions  cases 
in  which  these  erotic  feelings  were  remarked  by  him  in  reference  to  men 
between  15  and  86  years  of  age.  (Henke's  Zeitschrift,  1844,  p.  252.)  In 
all  cases  of  prolonged  virility,  it  is  observed  that  the  bodily  and  mental 
powers  are  also  retained  in  an  extraordinary  degree,  showing  the  close 
relation  which  exists  between  the  sexual  functions  and  corporeal  and 
mental  development,  even  to  the  latest  period  of  life.  Romilly  remarked, 
in  reference  to  the  I'etention  of  procreative  power  in  advanced  age,  that 
the  liberality  of  the  English  law  on  this  subject  was  excessive ;  for  there 
was  no  age,  from  aeven  upwards,  at  which  a  man  had  been  denied  the 
power  of  procreating  children.  (See  in  reference  to  this  subject,  Henke's 
Zeitschrift  der  S.  a!,  1842,  p.  332.)  Males  at  the  age  of  14,  and  -females 
at  the  age  of  12,  are  legally  competent  to  contract  marriage.  [In  the 
American  States  this  is  regulated  by  the  statutes  of  each  State.] 

Impotency  from  Local  Disease  or  Accident. — The  loss  or  destruction 
of  the  penis  or  testicles,  either  by  disease,  accident,  or  from  necessary 
operations,  would  be  sufficient  to  render  a  man  irremediably  impotent. 
The  loss  of  one  or  both  testicles,  from  any  of  these  causes,  would  be  indi- 
cated by  the  presence  of  distinct  cicatrices  in  the  scrotum.  When  both 
have  been  removed  by  operation,  the  person  is  incurably  impotent ;  but 
if  the  organs  are  healthy,  a  sufficiency  of  the  spermatic  fluid  to  confer 
procreative  powers  may  remain  in  the  ducts  for  two  or  three  weeks  after 
the  operation.  Thus  it  is  that  animals  have  been  known  to  be  prolific  for 
some  time  after  castration ;  and  one  case  is  on  record,  in  which  a  man, 


IMPOTENCY    FROM    DISEASE    OR    ACCIDENT.  633 

both  of  whose  testicles  had  been  carried  off  by  a  irunshot,  is  said  to  have 
retained  the  power  of  impregnating  his  wife  after  the  healing  of  the 
wound.  (See  a  paper  by  Kriigelstein,  Henke's  Zeitsehrift,  1842,  i,  pp. 
348  and  352.)  The  loss  of  one  testicle  only,  by  accident  or  operation, 
does  not  render  a  man  impotent.  Monorchides,  as  they  are  called,  have 
been  known  to  be  prolific.  Cases  of  this  kind  must  not  be  confounded 
with  those  in  which  one  or  both  testicles  have  not  descended  into  the 
scrotum. 

In  some  rare  instances  the  testicles  do  not  descend  into  the  scrotum  at 
the  usual  period  ;  but  one  or  both  may  remain  either  in  the  alxlomen  or 
in  the  inguinal  canals,  and  only  descend  some  time  after  birth  ;  or  one 
may  be  found  in  the  scrotum,  and  the  other  remain  during  life  in  the 
abdomen.  In  some  cases  of  partial  descent  the  organs  have  been  mis- 
taken for  and  treated  as  ruptures  by  the  application  of  a  truss.  (Henke's 
Zeitsehrift  der  S.  A.,  1844,  1,  p.  24  9;  Curling,  On  Disease  of  the  Testis, 
2d  ed.,  p.  31.)  In  one  instance,  the  attempt  to  reduce  the  tumor,  mistaken 
for  hernia,  and  the  application  of  a  truss,  caused  the  death  of  the  person. 
(Med.  Times  and  Gaz.,  1861,  i.  p.  240.)  When  one  testicle  only  has  de- 
scended, there  is  no  ground,  casteris  paribus,  to  impute  impotency  ;  the 
descended  organ  has  been  found  healthy  and  to  contain  spermatozoa. 
Curling  has  collected  six  cases  in  which  the  retained  testicle  and  its  ducts 
did  not  contain  spermatozoa  ;  four  of  these  fell  under  his  own  observation. 
(On  Sterility  in  Man,  1864,  p.  6;  and  Med.  Times  and  Gaz.,  1861.  i.  p. 
213.)  When  neither  testicle  has  descended,  the  scrotum  will  be  found 
empty,  without  any  scar  indicative  of  a  removal  by  operation,  but  the 
other  marks  of  virility  may  still  be  present.  These  persons  have  been 
called  Crijpsorchides.  It  has  been  stated  that  in  such  cases  the  testicles 
are  to  be  regarded  as  congenitally  defective,  and  further,  that  the  indi- 
vidual, although  capable  of  sexual  intercourse,  is  incurably  sterile. 

The  non-descent  of  the  testicles  is  a  state  rarely  seen.  Marshall  met 
Avith  only  one  case  of  non-descent  of  one  testicle  in  lOCO  recruits,  and  with 
one  case  of  non-descent  of  both  testicles  in  10,000  recruits.  There  are  three 
preparations,  showing  the  non-descent  of  these  organs  in  the  Museum  of 
Guy's  Hospital ;  one  of  them  was  taken  from  a  man  who  shot  himself 
from  despondency  at  his  supposed  defective  condition.  Hunter  thought 
that  the  undescended  testicles  were  always  imperfect,  both  in  their  struc- 
ture and  functions,  and  that  crypsorchides  were  invariably  impotent 
(sterile).  Other  observations  have  tended  to  support  the  views  of  Hunter. 
In  1860,  Partridg'e  communicated  to  the  Pathological  Society  the  case  of 
a  man.  a3t.  25,  in  whom  both  testicles  were  found  in  the  abdomen.  Sev- 
eral specimens  of  the  secretion  from  these  organs  were  examined,  and  no 
spermatozoa  were  detected.  Another  case  was  examined  with  a  like  result 
(Lancet,  1860,  i.  p.  66),  and  a  third  by  Curling  (Med.  Times  and  Gaz., 
1861,  i.  p.  213).  The  conclusion  to  which  these  observations  have  led  is 
that,  although  in  cases  of  non-descent  there  may  be  a  capacityof  sexual 
intercourse,  it  will  not  be  prolific — the  person  will  be  sterile.  According 
to  this  view,  malposition  of  the  organs  must  be  taken  as  synonymous 
with  defective  condition  ;  as  a  result  of  this  malposition,  they  are  not 
capable  of  secreting  prolific  spermatic  fluid,  and  the  person  is  as  sterile  as 
if  he  had  no  testicles.  The  cases  of  monorchides  reported  by  Curling  to 
some  extent  support  this  theory,  since  spermatozoa  were  found  only  in 
the  fluid  of  that  testicle  which  occupied  its  usual  position  in  the  scrotum. 
He  has  also  collected  from  various  sources  seven  cases  of  crypsorchides, 
Ik  which  both  testicles  were  either  in  the  abdomen  or  in  the  inguinal 
canals :  the  fluid  contained  in  them  was  destitute  of  spermatozoa,  and, 


634  VIRILITY    OF    CRYPSORCniDES    AND    MONORCIIIDES. 

although  impotency  did  not  exist,  these  persons  either  were,  or  were 
presumed  to  be,  unprolific.  Goddard  has  noticed  that  horses  whose 
testicles  are  retained  in  the  abdomen,  although  capable  of  intercourse,  are 
sterile. 

On  the  other  side  of  the  question  there  are,  however,  facts  which  are 
wholly  inconsistent  with  this  theory.  The  author  published  the  account 
of  two  cases  of  crj'psorchides  communicated  to  him  by  Cock.  The  testi- 
cles in  these  men  had  not  descended,  but  their  virile  functions  were  un- 
disputed. One  of  them,  before  he  had  reached  the  age  of  30  years,  had 
been  twice  married,  and  had  had  children  by  each  wife,  besides  illegitimate 
children  which  were  affiliated  on  him.  In  a  report  of  cases  of  hernia  by 
Poland  (Guy's  Hosp.  Rep.,  1843,  vol.  i.  p.  163),  there  is  the  case  of  a 
man,  ast.  29,  whose  testicles  had  not  descended.  Poland  states  there  was 
not  the  slightest  trace  of  scrotum  ;  the  penis  was  well  developed,  and  there 
were  all  the  other  signs  of  virility.  This  man  had  married  when  he  was 
20  ;  he  had  had  two  children  by  his  first  wife,  and  at  the  time  of  his 
sdmission  into  the  hospital  had  been  married  two  years  to  a  second  wife. 
In  1862  there  was  in  Guy's  Hospital  a  patient  under  Durham  ;  the  testi- 
cles of  this  man  had  not  descended — they  were  lodged  in  the 'inguinal 
canals.  The  man  was  32  years  of  age,  well  developed,  with  every  appear- 
ance of  virility  about  him,  and  with  the  same  masculine  development 
which  is  seen  in  other  men  of  the  same  age.  This  man  was  married,  and 
had  had  two  children  by  his  wife.  Since  puberty  he  had  always  been 
competent,  and  he  ridiculed  the  idea  that  his  testicles  were  ineflBcient. 
Another  case  is  referred  to  by  Curling,  which  occurred  to  Debrou.  The 
testicles  were  in  the  inguinal  canals ;  and  there  was  no  scrotum.  The 
man  had  been  married,  and  had  one  son  by  his  wife.  These  facts  prove 
that  crypsorchides,  in  some  cases,  have  a  power  of  procreation  like  nor- 
mally constituted  men.  Casper  relates  a  case  in  which  a  crypsorchid  was 
charged  with  an  unnatural  off'ence.  He  was  a  boy  between  14  and  15 
years  of  age,  and  it  appeared  that  he  had  been  guilty  of  unnatural  conduct 
towards  another  boy  8  years  of  age.  Spermatozoa  were  detected  by 
Casper  on  his  shirt  sixteen  days  after  the  act.  On  examining  the  boy 
both  testicles  were  found  in  the  inguinal  canals.     (Gerichtl.  Med.) 

By  these  facts,  therefore,  it  is  satisfactorily  established  that  crypsor- 
chides are  not  necessarily  sterile,  and  that  no  absolute  rule  can  be  laid 
down  respecting  the  existence  or  non-existence  of  prolific  power  under 
such  circumstances.  It  has  been  objected  that,  in  the  above  instances  of 
prolific  power,  spermatozoa  had  not  been  demonstrated  to  exist  in  the 
spermatic  secretions  of  the  individuals,  and  that  the  evidence  was  there- 
fore incomplete.  But  these  bodies  were  not  proved  to  be  absent,  and 
most  persons  will  agree  tbat  there  is  no  better  evidence  of  prolific  power 
than  the  procreation  of  children,  whether  spermatozoa  are  or  are  not  de- 
tected— a  matter  which  will  sometimes  depend  on  the  accuracy  of  obser- 
vation or  experience  of  the  examiners,  or,  it  may  be,  on  a  morbid  state  of 
the  secretion.  One  affirmative  instance  is  sufficient  for  all  the  purposes  of 
law  ;  and,  as  a  physiological  fact,  it  is  obvious  that  the  organs  which  have 
not  descended  are  not  always  defective  in  structure  or  function.  The 
cases  hitherto  observed  are  so  nearly  balanced  that  it  is  difficult  to  say 
whether  it  is  the  rule  or  the  exception  that  crypsorchides  should  be  found 
])rolific;  the  facts  above  mentioned  clearly  prove  that  there  is  no  reason- 
alile  ground  for  pronouncing  them  to  be  absolutely  sterile  or  unprolific 
merely  because  their  testicles  are  not  in  the  scrotum.  If  with  a  non- 
descent  of  these  organs  there  should  be  a  non-development  of  the  other 
external  organs,  and  this  is  accompanied  by  a  total  want  of  the  characters 


CAUSES    OF    IMPOTENCY.  635 

of  virility,  then  the  person  may  be  regarded  as  impotent  or  sterile.  The 
testicle.^  may,  in  such  a  case,  be  either  conjicnitally  absent  or  physically 
imperfect — a  fact  only  ascertainable  by  an  examination  of  the  body  after 
death.  On  the  other  hand,  in  cases  in  which  there  are  no  external  mario 
of  elfeminaey,  or  other  j^rounds  for  suspecting- a  want  of  procrentive  power, 
and  the  person  is  capable  of  sexual  intercourse,  this  imperfection  does  not 
offer  any  bar  to  niarriag-e,  nor  is  it  a  sufficient  ground  for  divorce.  It 
■would  not  justify  a  medical  man  in  denying  the  paternit}^  of  a  child  on 
a  question  of  affiliation,  bastardy,  or  inheritance;  and  so  long  as  a  power 
of  sexual  intercourse  existed,  it  would  not  justify  him  in  pronouncing  a 
person  to  be  incurably  sterile.  The  capacity  for  sexual  intercourse  is  the 
fact  to  which  the  En.ulish  law  commonly  looks  on  these  occasions.  If 
this  exist,  then  it  will  hardly  entertain  the  question — surrounded  as  it 
may  be  with  conflicting  medical  opinions — whether,  from  the  mere  reten- 
tion of  the  organs  in  the  abdomen,  the  fluid  secreted  is  or  is  not  of  a  pro- 
lific nature.  "Women  may  be  sterile  from  a  variety  of  causes  affecting  the 
internal  organs,  only  ascertainable  after  death.  The  ovaries  may  be  so 
diseased  that  no  prolific  intercourse  can  take  place,  although  there  may  be 
no  physical  incapacity.  In  a  case  related  elsewhere,  the  incapability  of  con- 
ception on  the  part  of  a  woman  was  held  hy  Lushington  not  to  be  a  suffi- 
cient ground  for  pronouncing  a  sentence  of  nullity  of  marriage  (p.  644, 
pod) ;  and  doubtless  a  want  of  power  on  the  part  of  a  man  to  effect  impreg- 
nation, unless  it  depend  on  some  visible  physical  defect,  would  be  viewed 
in  a  similar  lisyht.  Such  persons  are  not  impotent,  but  sterile,  and  sterility 
in  an  irremediable  form  is  rather  assumed  than  demonstrated  to  exist. 

The  presence  of  what  have  been  called  supernumerary  testicles  does  not 
affect  the  virile  powers  of  a  person.  These  have  in  general  been  found, 
by  dissection,  to  be  tumors  connected  with  the  healthy  glands,  and  not  at 
ail  adding  to  or  interfering  with  their  functions.  Even  the  presence  of 
two  or  three  penes,  according  to  Mende,  is  no  bar  to  the  exercise  of  sexual 
power,  provided  only  one  possesses  the  normal  characters  of  the  male 
organ.  (Ausfuhrl.  Handb.  d.  Gerichtl.  Med.,  Bd.  4,  p.  337.)  In  18S5  a 
Portuguese  youth,  aged  19,  I.  B.  dos  Santos,  was  seen  by  many  medical 
men  in  London.  He  was  well  formed,  except  in  reference  to  the  sexual 
organs.  He  had  two  complete  and  well-formed  penes,  placed  side  by  side, 
the  right  somewhat  smaller  than  the  left,  and  both  subject  to  erection  at 
the  same  time.  He  stated  that  he  used  the  left  in  sexual  intercourse.  On 
.the  outside  of  each  penis  was  a  scrotum  with  one  testicle  fully  developed. 
Between  them  was  a  sunken  scrotum,  which  contained  two  testicles  until 
he  was  10  years  old,  when  they  ascended  into  the  abdomen.  When  the 
bladder  acted  urine  issued  from  both  penes.  An  engraving  of  this  re- 
markable malformation  is  given  with  the  history  of  the  case  in  the  Lan- 
cet, 1865,  ii.  p.  124. 

In  some  instances  there  is  an  arrest  of  development  in  the  external 
organs  ;  and  with  this  there  is  generally  an  absence  of  sexual  desire.  Cer- 
tain diseases  of  the  appendages  of  the  testicles  may,  however,  render  a 
person  sterile.  The  spermatic  secretion  is  commonly  suspended  in  most 
severe  diseases  which  affect  the  body.  A  frequent  cause  of  impotency 
(sterility)  in  the  adult,  when  the  organs  are  apparently  sound,  is  sper- 
matorrhoea, arising  from  abuse  or  excess.  This,  however,  is  remediable 
to  a  greater  or  less  extent  by  treatment.  (See  Curling  on  Disea.'^es  of  the 
Testis,  2d  edit.,  p.  386  ;  also  Med.  Times  and  Gaz.,  1858,  i.  p.  95.)  The 
incapacity  for  intercourse  in  either  sex  may  arise  from  extev^ive  disease 
affecting  parts  in  and  around  the  organs  of  generation.  The  medical  opinion 
here  must  be  regulated  entirely  by  the  circumstances  attending  each  case. 


636  VIRILE    POWERS    IN    H YPOSPADI ANS. 

On  the  absence  of  the  penis,  as  well  as  on  its  defective  organization, 
as  causes  of  incapacity,  sou)e  remarks  have  been  already  made.  Some- 
times the  defect  is  merely  connected  with  the  urethra.  Thus  the  oritice 
may  be  on  the  dorsum  penis,  and  in  other  cases  underneath  the  organ,  so 
that  the  urethra  may  terminate  at  a  variable  distance  from  the  glans  penis. 
Those  laboring  under  the  former  defect  are  said  to  have  Epispadia,  and 
under  the  latter,  Hy.pospadia.  Rose  describes  a  case  of  hypospadia  in  a 
child  who  had  been  baptized,  brought  up  and  educated  as  a  female  at  a 
girls'  school.  The  androgynous  child  was  ten  years  old,  diminutive  in 
size,  and  possessing  girlish  features.  A  testicle  was  recognized  on  each 
side,  but  no  distinct  penis.  (Obst.  Trans.,  1876,  vol.  xviii.  p.  256.)  These 
beings  a.re  often  mistaken  for  girls,  but  the  absence  of  the  function  of  men- 
struation is  sufficient  to  remove  doubt. 

The  power  to  have  fruitful  intercourse  will  in  either  case  depend  on  the 
situation  of  the  urethral  aperture.  Some  doubt  has  existed  respecting  the 
virile  powers  of  those  who  are  affected  with  hj^pospadia  ;  but  Riittel  knew 
an  instance  of  an  hvpospadian  having  several  children.  (Henke's  Zeit- 
schrift,  1844,  p.  258.)  In  1850  a  lad,  get.  IT,  was  summoned  before  the 
magistrates  of  Kidderminster  on  a  charge  of  affiliation  in  reference  to  the 
pregnancy  of  a  girl,  st.  18.  The  defence  was  that  he  could  not  be  the 
father  of  a  child,  because  there  was  such  a  malformation  of  the  penis  as  to 
prevent  prolific  intercourse.  On  examination,  the  urethra  was  found  to 
terminate  on  the  under  surface  of  the  penis,  about  an  inch  and  a  half  from 
the  glans,  by  a  small  elliptical  orifice,  which  allowed  the  urine  to  pass,  but 
with  some  difficulty.  One  medical  witness  gave  it  as  his  opinion  that  it 
was  not  impossible,  but  highly  improbable,  that  the  defendant  should  pos- 
sess procreative  power ;  another  freely  admitted  the  boy's  capacity,  and 
the  case  was  decided  against  him.  (Med.  Times,  1850,  ii.  p.  321.)  This 
decision  was  physiologically  correct.  When  the  urine  can  pass,  the  sem- 
inal fluid  can  pass ;  and  the  only  question  is,  whether  the  intromission 
can  be  such  as  that  the  misplaced  orifice  should  come  in  contact  with  any 
part  of  the  vagina  or  even  the  vulva.  This  must  depend  on  the  situation 
of  the  orifice.  (Cases  illustrative  of  the  prolific  powers  of  hypospadians 
will  be  found  in  the  Med.  Times,  1850,  ii.  pp.  292,  392.  An' instance  of 
the  virility  of  an  hypospadia n  has  also  been  published  in  the  Assoc.  Med. 
Jour.,  1853,  i.  p.  236.)  Similar  remarks  apply  to  epispadians.  These 
malformations  are  sometimes  remediable  ;  but,  whether  remediable  or 
not,  they  are  not,  under  any  circumstances,  to  be  regarded  as  absolute  • 
causes  of  impotency. 

Impotencr/  from  General  Disease. — The  influence  of  local  disease  in 
affecting  virility  has  been  already  considered.  But  there  is  a  class  of  cases 
which  may  came  before  a  practitioner,  in  which,  with  well-formed  and 
healthy  organs  in  the  male,  there  will  be  a  state  of  impotency  or  inca- 
pacity for  intercourse.  Sometimes  this  may  depend  on  weakness,  or  on 
a  want  of  proper  development  of  the  muscular  and  nervous  systems;  at 
other  times  it  may  be  due  to  disease  of  a  temporar}^  nature — persisting 
while  the  body  is  still  suffering  from  the  disease,  and  disappearing  on  re- 
covery. As  a  converse  fact,  there  are  some  diseases  which  appear  to 
Itring  out  the  dormant  virile  powers  of  persons,  or  to  excite  to  a  higher 
degree  of  intensity  those  which  already  exist.  Thus  it  is  said  that  in  con- 
valescence from  fever  there  is,  occasionally,  extraordinary  salaciousness ; 
but  this  statement  requires  confirmation.  Again,  there  are  diseases  which 
neither  interupt  nor  affect  the  exercise  of  the  sexual  functions.  As  a  gen- 
eral rule,  diseases  which  neither  affect  the  brain  nor  spinal  marrow,  and 
which  are  not  attended  with  great  bodily  debility,  do  not  prevent  fruitful 


IMPOTENCY    FROM    GENERAL    DISEASE.  637 

intercourse.  On  the  other  hand,  diseases  which  are  attended  or  followed 
by  great  debility  or  cerebral  exhaustion  suspend  or  destroy  sexual  power. 
Among-  these  may  be  mentioned  water  in  the  chest;  general  dropsy, 
especially  if  attended  with  effusion  in  the  sexual  organs;  nervous  and 
malignant  fever.s  which  affect  the  brain  ;  apoplexy,  palsy,  and  other  dis- 
eases which  directly  attack  the  brain  or  spinal  marrow.  These  last-men- 
tioned diseases  probably  act  by  suspending  the  secretion  or  altering  the 
nature  of  the  prolific  fluid,  as  well  as  by  preventing  the  erection  of  the 
male  organ,  without  which  intercourse  cannot  take  place.  The  sexual 
function  is  so  intimately  allied  to  bodily  vigor  and  nervous  energy  that 
the  integrity  of  the  one  may  be  pronounced  to  be  essential  to  the  integ- 
rity of  the  other.  Habits  of  drunkenness  and  the  abuse  of  alcoholic  liquids, 
tobacco,  or  opium  may  give  rise  to  impotency  by  the  injury  done  to  the 
brain  and  nervous  system.  (The  reader  will  find  this  suloject  fully  dis- 
cussed Ijy  Mende,  Ausftihrl.  Handb.  der  Gerichtl.  Med.,  Bd.  4,  p.  349.) 

In  Wood  I'.  Hotham  (186J),  a  surgeon  was  sued  for  a  sum  of  money 
for  his  wife's  maintenance.  He  alleged,  in  defence,  that  his  wife  had  Ijeen 
guilty  of  adultery,  and  that  one  of  two  children  born  during  the  marriage 
Avas  not  his.  He  assigned  as  a  reason  for  this,  that  he  was  so  ill  at  the 
time  that  it  was  impossible  he  could  have  had  connection  with  his  wife. 
It  appeared,  however,  that  he  was  in  the  habit  of  sleeping  with  her,  and 
he  was  sufficiently  strong  to  go  his  round  of  daily  visits.  The  judge,  in 
remarking  upon  this  point,  said  if  such  evidence  were  to  be  held  suffi- 
cient proof  of  illegitimacy,  the  whole  of  the  law  relating  to  the  access  and 
non-access  of  a  husband  must  be  set  aside.  The  jury  returned  a  verdict 
for  the  plaintiff. 

Diseases  and  injuries  of  the  spinal  cord  producing  paraplegia  have  no 
direct  effect  on  the  testicles,  but  destroy  the  power  to  copulate.  (Curling, 
op.  cit.,  p.  371.)  When  there  is  a  wasting  of  the  testicles,  as  a  result  of 
general  paralysis  of  long  standing,  there  can  be  no  doubt  of  impotency  ; 
but  Curling  quotes  a  case  from  a  foreign  writer  in  which,  under  pavalvsis 
(paraplegia)  of  some  years'  duration,  a  man  retained  sufficient  sexual 
power  to  have  prolific  intercourse.  When  the  paralytic  person  is  advanced 
in  age,  it  is  highly  probable  that  he  is  impotent.  In  1857  a  case  was 
referred  to  the  author,  in  a  question  of  bastardy,  for  his  opinion  on  a 
capacity  for  intercourse  under  the  following  circumstances.  A  wonian 
required  an  order  of  affiliation  on  the  putative  father  of  her  bastard  child. 
She  was  a  widow,  and  the  illicit  connection  took  place  about  two  months 
before  her  husband's  death.  The  husband  was  at  the  time  84  years  of 
age;  he  was  bedridden,  and  for  many  weeks  before  his  death  he  could  not 
move  in  his  bed,  and  was  unable  to  pass  his  urine  without  assistance. 
The  medical  opinion  of  those  who  examined  him  Avas  that  he  was  im- 
potent from  physical  infirmity,  and  in  this  opinion  the  author  concurred, 
stating,  however,  that,  unless  the  male  organs  were  diseased  or  destroyed, 
it  could  not  be  said  that  intercourse  Avas  impossible.  It  was,  however, 
Avholly  improbable  that  the  husband  could  have  been  the  father  of  the 
child. 

Blows  on  the  head  or  spine*,  by  affecting  the  brain  and  spinal  marroAv, 
may  produce  impotency.  Several  cases  of  impotency  from  this  cause  are 
related  by  Curling.  (Op.  cit,  p.  362.)  It  has  been  noticed  that  blows 
on  the  under  and  back  part  of  the  head,  in  the  region  of  the  cerebellum, 
have  been  folloAved  by  loss  of  sexual  poAA'er  on  recovery.  Sometimes  this 
is  temporary  ;  but  at  other  times,  Avhen  there  is  wasting  of  the  testicles,  it 
is  permanent  and  irremediable. 

Of  moral  causes  it  is  unnecessary  to  speak.     The  sexual  desire,  like 


638  PROCREATIVE  POWER  IN  THE  FEMALE. 

Other  animal  passions,  is  subject  to  great  variation  ;  and  there  are  instances 
on  record  in  which  men,  otherwise  healthy-looking  and  healthily  formed, 
have  experienced  no  desires  of  this  kind.  They  are  in  a  state  of  natural 
impotenc}^ — a  condition  which  the  Canon  Law  designates  as  frigidity  of 
constitution.  This  is  not  to  be  discovered  by  external  examination,  but 
rather  fi'om  their  own  admission.  Under  this  head  we  may  class  some 
hy[)uchondriacal  affections. 

Sterility.  Definition. — Sterility  is  usually  defined  to  be  "  the  inability 
to  procreate,  or  a  want  of  aptitude  in  the  female  for  impregnation."  It  is 
nut  unusual  to  speak  of  sterility  in  the  male,  although  there  may  be  pro- 
creative  incapacity  ;  Ijecause  the  defective  condition  in  this  sex,  from  what- 
ever cause,  is  in  a  legal  point  of  view,  included  under  the  term  "  im- 
l»otency"  (see  p.  629,  ante).  In  the  strictness  of  language,  a  male  who 
has  been  castrated  is  sterile ;  but  it  is  commonl}^  said  that  he  is  impotent. 
Man}^  apparently  well-formed  males  may  be  sterile  without  being  im- 
])Otent ;  i.  e.  they  may  have  intercourse  without  procreating,  for  the 
power  of  copulating  must  not  be  confounded  with  that  of  procreation. 
Curling  has  pointed  out  that  various  causes  may  render  a  male  sterile, 
although  he  may  retain  a  power  of  sexual  intercourse,  and  thus  cannot 
be  regarded  as  impotent  in  a  legal  sense.  (Dis.  of  the  Testis,  2  ed, 
p.  216.)  Some  crypsorchides  ma}^  be  sterile  or  deficient  in  procreating 
power,  while  at  the  same  time  impotency  or  incapacity  for  intercourse 
may  not  exist.  In  reference  to  women,  sterility  implies  that  condition  in 
which  there  is  an  "  inability  to  conceive."  This  appears  to  be  the  true 
meaning  of  the  term,  and  the  sense  in  which  it  is  used  not  only  by  the 
best  writers  but  in  common  phraseolog}". 

Procreative  Power  in  the  Female.  Puberty. — In  the  female,  the  pro- 
creative  power  is  supposed  not  to  exist  until  after  the  commencement  of 
menstruation,  and  to  cease  upon  the  cessation  of  this  periodical  secretion. 
The  menstrual  function  is  commonly  established  in  females  in  this  climate 
between  the  ages  oi fovrteen  and  sixteen  ;  but  it  may  occur  much  earlier 
— indeed,  in  some  rare  instances,  a  discharge,  resembling  the  menstrual, 
has  been  known  to  occur  in  mere  infants.  (Lancet,  18T1,  i.  p.  366.)  In 
other  cases,  its  appearance  has  been  protracted  to  a  much  later  period. 
Cohnstein  states  that  the  average  duration  of  this  function  among  Avomen, 
in  400  observed  cases,  was  31  years.  (Brit.  Med.  Jour.,  1873,  i.  p.  615.) 
According  to  Riittel,  the  menstrual  function  appears  in  the  smallest 
nuniljer  of  females  at  12,  13,  and  14,  and  in  the  largest  number  at  16,  17, 
and  18  years.  In  some  it  is  only  first  established  at  from  19  to  21  years; 
and  he  states  that  at  this  age  he  has  often  found  the  womb  small  and  quite 
undeveloped.  The  earliest  and  latest  periods  in  a  large  number  of  cases 
were  respective!}^  9  and  23  years.  (Lancet,  1844,  ii.  p.  283.)  Perhaps  in 
this  country,  the  most  frequent  age  for  the  commencement  of  menstrua- 
tion may  be  taken  at  15  years.  It  is  liable  to  be  accelerated  in  its  appear- 
ance by  certain  moral  and  physical  conditions  under  which  a  girl  may  be 
placed.  The  most  common  intervals  for  its  appearance  are  twentv-eight 
and  twent3'-one  days.  It  sometimes  does'  not  appear  till  late  in  life. 
Camps  found  that  it  had  not  appeared  in  a  married  woman,  get.  30, 
who  had  borne  no  children.  (Lond.  Med.  Gaz.,  vol.  xxxii.  p.  409.) 
Another  case  is  mentioned  in  the  same  volume,  where  it  appeared  for  the 
first  time  at  the  age  of  47.  So  soon  as  this  function  commences,  a  woman 
may  be  considered  to  have  acquired  procreative  power  ;  but  a  female  may 
conceive  before  the  function  has  commenced,  during  the  time  of  its  occur- 
rence, or  even  after  it  has  ceased.     From  facts  elsewhere  stated,  there  is 


PREGNANCY    BEFORE    MENSTRUATION.  639 

some  reason  to  believe  that  the  period  which  immediately  precedes  or  follows 
the  discharge  is  most  favorable  to  conception;  although  the  experience  of 
many  accoucheurs  has  shown  that  impreg-nation  may  take  place  at  any 
time  between  one  menstruation  and  another  (p.  605,  ante).  In  India  it 
is  commonly  asserted  that  puljerty  occurs  very  early,  but  t-he  recent  ex- 
perience of  European  female  doctors  in  India  shows,  however,  that  ma- 
turity of  women  l)y  no  means  occurs  so  early  as  has  been  hitherto  supposed 
among  Eastern  women. 

It  is  important  to  remember  that  these  changes  in  the  womb  may  pro- 
duce remarkal)le  effects  by  sympathy  with  the  brain  and  nervous  system. 
At  or  about  the  time  of  puberty,  especially  if  any  cause  of  obstruction 
exists,  some  girls  are  observed  to  become  irritable,  easily  excited,  and  they 
have  been  known  to  perpetrate,  without  motive,  crimes  of  great  enormity, - 
such  as  murder  and  arson.  A  propensity  to  steal  is  also  stated  to  mani- 
fest itself  in  some  cases.  (See  pfM,  Kleptomania  )  It  has  been  remarked 
that  acts  of  arson  and  murder  have  been  frequently  committed  by  girls  at 
this  period  of  life  without  any  apparent  motive  or  for  the  most  trivial 
reasons,  and  the  crime  has  spread  by  imitation.  The  case  of  Brixey, 
tried  for  the  murder  of  an  infant,  and  acquitted  on  the  ground  of  insanity,, 
will  serve  as  an  illustration  of  the  morbid  effect  produced  on  the  brain  by 
disordered  menstruation.  (See  2:)ost,  Insanity.)  Other  cases  have  been 
ali'eady  referred  to  in  this  w^ork  in  which  crimes  of  the  greatest  magnitude 
have  been  traced  to  girls  of  this  age,  but  without  any  apparent  ground 
for  imputing  actual  insanity.  'The  only  suggestion  that  could  be  ad- 
vanced in  favor  of  insanity  was  the  atrocity  of  the  act  without  any  of  the 
ordinary  motives  which  actuate  criminals,  and  the  fact  that  the  acts  of 
niurder  had  been  perpetrated  on  helpless  children  incapable  of  giving 
offence.  In  the  case  of  Yamplew  (Lincoln  Aut.  Ass.,  1862),  it  was 
proved  that  the  prisoner,  a  girl  under  18  years  of  age,  acting  as  nurse  in 
a  family,  had  destroyed  with  strychnine  an  infant  entrusted  to  her  care. 
It  transpired  that  in  two  other  families  she  had  previously  destroyed,  with 
poison,  infants  placed  under  her  charge.  The  case  of  Constance  Kent,  a 
girl  between  15  and  16  years  of  age,  furnishes  another  illustration.  She 
was  convicted  on  her  own  confession,  of  the  murder  of  her  infant  step- 
brother, under  circumstances  showing  great  atrocity  and  cunning,  and  for 
which  no  motive  could  at  the  time  be  suggested.  Lastly,  there  is  the  case 
of  the  girl  Norman  (see  ante),  aged  15  years,  convicted  of  an  attempt 
to  murder,  by  suffocation,  a  child  placed  under  her  care  as  nurse.  It  came 
out  that  three  other  children  to  whom  she  had  been  nurse  had  died  under 
her  hands  from  suffocation.  There  was  no  evidence  of  intellectual  insanity 
in  any  of  these  cases ;  nor  was  there  anything  to  show  that  the  uterine 
sympathy,  if  it  existed,  was  beyond  the  power  of  self-control.  These 
females  were  all  convicted  of  the  crime  of  murder.  At  this  period  of  life, 
the  state  of  the  mind  should  be  closely  watched,  and  any  causes  of  irrita- 
tion or  violent  excitement  removed.  Irregularity,  difficulty,  or  suppres- 
sion of  the  menstrual  secretion,  may  give  rise  to  temporary  insanity, 
indicated  by  taciturnity,  melancholia,  capricious  temper,  and  other  symp- 
toms. Puberty  in  the  male  may  be  attended  with  similar  morbid  pro- 
pensities, but  these  are  not  so  commonly  witnessed  as  in  the  female. 

Pregnancy  Jwfore  AlenHtruation. — The  previous  occurrence  of  menstrua- 
tion is  not  indispensable  to  pregnancy  :  many  cases  are  on  record  in  which 
Avomon  who  have  never  menstruated  have  conceived  and  born  children 
(p.  488,  ante).  One  case  is  reported  in  which  a  woman,  aet.  25,  became 
yjregnant  and  bore  a  child,  and  menstruation  was  only  regularlv  estab- 
lished afterwards.     (Lancet,  1842.)     Murphy  mentions  another  instance 


640  PREGNANCY    BEFORE    MENSTRUATION. 

of  pregnancy  previous  to  menstruation  in  a  woman,  set.  23.  (Obst.  Rep., 
1844,  p.  7.)  Numerous  cases  of  conception  witiiout  previous  menstrua- 
tion are  quoted  by  Capuron  (M^d.  L^y.  des  Ace,  p.  96)  ;  and  no  fewer 
than  nine  instances  of  pregnancy  before  menstruation  have  been  collected 
by  Whitehead.  The  women  were  all  in  excellent  health  during-  the  whole 
time,  and  one  did  not  menstruate  until  more  than  two  years  after  the 
marriag-e  had  been  consummated.  (On  Abortion,  p.  223;  see  also  Lond. 
Med.  Gaz.,  vol.  xliv.  p.  969.)  W.  Taylor  met  with  an  instance  in  which 
a  girl,  set.  13,  bore  a  child  before  menstruation  had  appeared.  (Med. 
Times  and  Gaz.,  1853,  i.  p.  277  ;  see  also  for  remarks  on  this  subject,  Edin. 
Month.  Jour.,  1850,  ii.  p.  73.)  Reid  reported  a  case  in  which  a  patient  of 
his  bore  a  child  at  the  age  of  17  without  having  previously  menstruated  ; 
and  he  collected  from  various  authorities  other  cases  of  pregnancy  occur- 
ring in  women  who  had  not  menstruated.  (Lancet,  1853,  ii.  p.  206.) 
Many  other  cases  have  been  reported  in  the  medical  journals ;  and  it  is 
not  unlikely  that  girls  not  unfrequently  anticipate  menstruation  by  becom- 
ing pregnant  shortly  before  the  advent  of  the  first  monthly  flow. 

Instances  of  premature  puberty  in  the  female  are  now  numerous:  they 
are  far  more  common  than  in  the  male  sex.  Whitmore  met  with  the  case 
of  a  female  child  who  from  a  feiv  days  after  birth  menstruated  regularly, 
at  the  periods  of  three  weeks  and  two  or  three  days,  until  she  had  attained 
the  age  of  4  years,  when  she  died.  On  inspection  after  death  she  ap- 
peared like  a  much  older  girl.  The  breasts  were  unusually  large,  and  the 
female  organs  and  lower  limbs  were  considerably  developed.  (North, 
Jour.  Med.,  1845,  ii.  p.  70.)  Another  case  is  reported  in  the  Lancet 
(1848,  i.  p.  137);  this  was  a  child  aged  3  years.  The  breasts  were  as 
healthily  developed  as  in  an  adult  of  20  years,  and  the  sexual  organs  were 
also  as  much  developed  as  in  a  girl  at  the  age  of  puberty.  It  was  observed 
that  this  child,  who  had  been  regularly  menstruating  for  twelve  months, 
had  the  appearance  of  a  little  old  woman.  (For  other  cases  of  menstrua- 
tion at  5  years,  see  Lond.  Med.  Gaz.,  vol.  xxv.  p.  548  ;  at  3  years,  vol. 
xlvii.  p.  24*4  ;  and  at  3^  years,  Med.  Times  and  Gaz.,  1858,  ii.  p.  98  ;  and 
Brit.  Med.  Jour.,  1873,  ii.  p.  666.)  A  girl,  set.  2,  in  good  health,  regu- 
larly menstruated  in  a  natural  way.  Another,  get.  8,  also  performed  the 
function  in  the  usual  way.     (Brit.  Med.  Jour.,  1875,  ii.  p.  514.) 

In  these  instances  of  early  menstruation  there  is  reason  to  believe  that 
a  procreative  power  is  also  early  developed ;  but  it  is  not  common  to  hear 
of  such  young  females  becoming  impregnated.  A  case  is  mentioned  by 
Beck  in  which  a  girl  menstruated  at  one  year;  she  became  pregnant,  and 
was  delivered  of  a  child  when  little  more  than  ten  years  old.  Walker 
met  with  a  case  in  which  the  menstrual  function  was  established  at  the 
age  of  1}^  years,  and  the  girl  was  delivered  of  a  living  child  when  only 
12  years  and  8  months  old.  (Amer.  Jour.  Med.  Sci.,  Oct.  1846,  p.  547.) 
In  another,  observed  by  Riittel,  a  girl  of  the  age  of  fourteen  became 
pregnant  by  a  boy  of  the  same  age.  He  also  quotes  three  other  cases, 
where  one  girl  at  the  age  of  nine,  and  two  at  the  age  of  thirteen,  became 
pregnant.  The  first  of  these  three  cases  represents  the  earliest  age  for 
pregnancy  yet  assigned  by  any  author.  In  a  case  of  criminal  assault  on 
a  girl  under  12,  tried  at  the  Maidstone  Winter  Assizes,  1878-9  (Reg,  v. 
Dean),  it  was  proved  in  evidence  that  at  the  age  of  12  years  and  1  month 
the  girl  had  been  delivered  of  a  full-grown  child,  which  was  then  living. 
The  prisoner,  who  was  the  girl's  stepfather,  was  convicted  of  the  felony. 
Wilson  rr.et  with  an  instance  in  which  a  girl  at  the  age  of  13  years  and 
6  months  gave  birth  to  a  full-grown  child  :  conception  must  have  taken 
place  when  she  was  12  years  and  9  months  old.     (Edin.  Month.  Jour., 


MENSTRUAL    CLIMACTERIC.  641 

1801,  ii.  p.  332.  See  also  Yierteljahrsschr.  fiir  Gorichtl.  Med.  1803,  Bd. 
1,  p.  180.)  Koberston  mentions  the  case  of  a  factory  girl  who  l)ecanie 
pregnant  in  the  eleventh  year  of  her  age.  In  another,  communicated  to 
the  author,  a  girl  menstruated  at  10  years  and  2  months,  and  became 
pregnant  when  11  years  and  8  months  old. 

Age  at  ivhich  Menstruation  ceases.  Menstrual  Climacteric. — The 
average  age  at  which  this  function  ceases  in  women  is  usually  from  40 
to  50  3'ears ;  but  as  it  may  commence  early,  so  it  may  continue  late  in 
life.  In  one  case  it  has  been  known  to  cease  at  the  age  of  23,  and  in 
other  instances  it  has  continued  up  to  the  age  of  66,  and  even  of  15 
years.  (Whitehead,  op.  cit.,  p.  145,  et  seq.)  Royle  describes  two  cases 
in  which  menstruation  continued  up  to  the  age  of  67.  Thomas  met  with 
a  case  in  which  a  woman  had  ceased  to  menstruate  at  the  age  of  45,  but 
the  discharge  suddenly  reappeared  after  an  attack  of  illness  when  she  had 
reached  the  age  of  69.  The  discharge  appeared  several  times,  but  not 
with  monthly  periodicity.  It  seems  that  her  mother  and  sister  had  also 
menstruated  at  the  ages  of  69  and  60  respectively.  (Med.  Times  and 
Gaz.,  1852,  ii.  p.  148.)  In  a  case  which  occurred  to  Capuron,  it  con- 
tinued beyond  the  age  of  60;  but  a  more  remarkable  case,  both  of  late 
menstruation  and  late  pregnancy,  is  quoted  by  Orfila  from  Bernstein.  A 
woman  in  w^hom  the  function  appeared  at  20  menstruated  until  her  ninet}^- 
ninth  year.  Her  first  child  was  born  when  she  was  47,  and  her  seventh 
and  last  when  she  was  60.  (Med.  Leg.,  4eme  edit.,  1848,  t.  1,  p.  257  ; 
see  also  Briand,  Man.  de  M^d.  Leg.,  1846,  p.  137.)  From  these  facts  it 
is  clear  that  it  is  impossible  to  fix  the  age  of  a  woman  by  the  period  at 
"which  this  "change  of  life"  occurs.  At  the  best  it  can  only  be  an  aver- 
age of  a  certain  number  of  instances. 

Other  cases  are  recorded  on  good  authority.  Whitehead  communicated 
to  the  Lancet,  1866,  the  following  facts.  He  was  called  to  a  lady,  agt.  77, 
suffering  from  uterine  hemorrhage.  Upon  inquiry  he  found  that  she  had 
menstruated  monthly  up  to  the  time  at  which  he  saw  her.  The  discharge 
lasted  from  four  to  five  days,  and  had  then  left  her ;  but  on  this  occasion 
it  had  been  very  profuse.  She  was  restored  by  the  usual  remedies. 
Other  cases  are  reported  in  the  Araer.  Jour,  of  Med.  Sci.  (July,  1845, 
p.  172).  In  one  of  these,  a  num,  the  menses  ceased  at  52;  at  the  age 
of  62  they  reappeared,  and  so  continued  regularly  until  she  was  last  seen 
at  the  age  of  73.  In  another  instance,  a  nun,  aged  90,  had  regularly 
menstruated  from  15  to  52.  The  menses  then  ceased,  but  they  reappeared 
at  the  age  of  60  without  pain,  and  had  occurred  regularly  every  month 
since  that  date.     Her  health  had  been  good  throughout. 

From  observations  made  on  400  women  by  Cohnstein  it  appears  that 
the  menstrual  function  is  of  the  longest  duration  in  women  who  men- 
struate early,  are  married,  have  more  than  three  children,  nurse  their 
children  themselves,  and  cease  childbearing  between  the  ages  of  38  and 
42.     (Brit.  Med.  Jour.,  1873,  i  p.  615.) 

Is  it  possible  for  a  ivoman  to  become  pregnamt  after  menstruation  has 
ceased'?  It  is  commonly  asserted  and  believed  that  after  the  cessation  of 
menstruation  a  woman  is  sterile.  This  is  doubtless  the  general  rule ;  but 
in  a  medico-legal  view  it  is  necessary  to  take  notice  of  the  exceptions. 
Pearson  communicated  the  case  of  a  lady,  ©t.  44,  who  up  to  Sept.  1836, 
had  given  birth  to  nine  children.  After  this  the  menses  appeared  only 
slightly  at  the  regular  periods  until  July,  1838,  when  they  entirely  ceased. 
Owing  to  this  she  supposed  that  she  was  not  liable  to  become  pregnant; 
but  on  I)ec.  31,  1839 — therefore  eighteen  months  after  the  entire  cessation 
of  the  menses — she  was  delivered  of  her  tenth  child.  Hence  conception 
41 


642 


LATEST    AGE    FOR    PREGNANCY. 


must  have  taken  place  at  from  eight  to  nine  months  after  the  final  cessation 
of  the  discharge. 

Latent  Age  for  Pregnancy.  Fecundity. — As  a  rule,  women  rarely  con- 
ceive after  the  age  of  45.  At  and  beyond  this  age  they  have  not  often 
intercourse  with  young  and  vigorous  men.  Menstruation  may  continue 
up  to  50  and  52  years.  The  age  at  which  women  commonly  cease  to  be 
impregnated  ranges  from  45  to  50.  It  has  been  observed  that  out  of 
10,000  pregnant  women  there  were  only  three  above  the  age  of  50  years. 
(Ann.  d'Hyg.,  1873,  t.  2,  p.  150.)  Many  exceptional  instances  are,  how- 
ever, recorded  of  women  advanced  in  life  bearing  children.  A  case  is 
reported  in  which  a  well-formed  woman  who  had  been  married  19  years 
did  not  bear  a  child  until  she  had  reached  the  age  of  ^/(f^/.  (Schmidt's 
Jahrb.  d.  Med.,  1838,  S.  65;  Henke's  Zeitschr., 'l844,  S.  251.)  In  this 
case  it  is  stated  that  menstruation  had  ceased  two  years  before  conception. 
Riittel  observed  in  twelve  women  that  they  bore  their  last  children  at  ages 
varying  from  45  to  50  years.  Ottinger  met  with  an  instance  of  a  woman 
bearing  a  child  at  50;  Cederschjald  with  another  where  the  woman  was 
fifty-three,  and  menstruation  still  continued.  Haller  records  two  cases 
in  which  w^omen  at  sixty-three  and  seventy  respectively  bore  children. 
(Briand,  Complet  de  Med.  Leg.,  p.  137.)  But  these  are  doubtful  in- 
stances, contrary  to  all  modern  experience.  Neuermann  drew  up  a  table 
in  reference  to  the  late  ages  of  life  at  v/hich  women  have  borne  children. 
Out  of  1000  cases  in  10,000  births  he  found  that  436  children  were  born 
by  females  at  the  ages  respectively — 


A  case  was  communicated  to  the  Lond.  Med.  Gaz.  (vol.  xxxix.  p.  950), 
in  which  a  woman  was  fifty-five  years  of  age  when  her  last  child  was 
born  ;  she  had  menstruated  up  to  that  time.  Barker,  XJ.  S.,  has  found 
that  the  retention  of  this  power  of  childbearing  depends,  not  so  much  on 
the  continuance  of  mentruation,  as  on  the  state  of  the  ovaries.  These 
organs  usually  become  atrophied  in  women  between  the  fortieth  and  the 
fiftieth  years,  but  in  exceptional  cases  this  change  may  not  take  place  until 
from  one  to  four  years  later.  When  the  ovaries  have  undergone  this 
senile  atrophy,  the  woman  is  permanently  sterile.  He  asserts  that  not  a 
single  authenticated  instance  has  been  known  of  a  woman  over  fifty-five 
years  of  age  who  has  given  birth  to  a  child.  A  woman  over  fifty-five 
years  ma)^  be  considered  as  past  the  age  of  childbearing.  (Med.  Times 
and  Gaz.,  1875,  i.  p.  186.) 

In  Lord  v.  Colvin  (Vice-Chanc.  Ct.,  July,  1859),  one  of  the  questions 
raised  was  whether  a  woman,  set.  52,  who  had  been  m.arried  30  years 
without  having  had  children,  had  then  passed  the  age  of  childbearing  ; 
her  issue,  if  any,  would  take  the  benefit  of  certain  property  under  a  will. 
It  was  decided  that  the  woman  had  not  reached  an  age  at  which  it  could 
be  said  to  be  impossible  that  she  might  bear  children.  In  a  return  of  the 
Registrar-General  for  Scotland  (Feb.  1862),  it  is  stated  in  the  Table  for 
Glasgow,  that  one  mother  who  was  only  18  had  had  four  children,  one 
who  Avas  22  had  had  seven  children,  and  of  two  who  were  only  34,  one 
had  had  thirteen  children  and  the  other  fourteen  children.     On  the  other 


Of  41  years. 

101 

Of  48  vears 

42   "     .    . 

113 

49  ■'  "   . 

43   "     .    . 

70 

50   "   . 

44   "     .    . 

58 

52   "  . 

45   "     .    . 

43 

53   "   . 

46   "     .    . 

12 

54   "   . 

47   "     .    . 

13 

MEDICO-LEGAL    RELATIONS    OF    THE    SUBJECT.  G43 

hand,  two  women  became  mothers  as  late  in  life  as  at  51,  four  at  52,  and 
one  mother  was  re,iiistered  as  having-  given  birth  to  a  child  in  the  5Tih 
year  of  her  age.  We  cannot,  therefore,  pretend  to  fix  the  age  bevoud 
which  preg-naucy  may  not  occur.  Questions  of  this  kind  have  an  impor- 
tant bearing  on  the  subject  of  legitimacy  ;  and  unless  the  law  looks  to 
something  more  than  ordinary  professional  experience  in  such  matters,  the 
decisions  of  courts  must  be  inequitable.  It  two  cases,  however,  it  appears 
to  have  been  assumed  that  a  woman  could  not  bear  a  child  after  the  age 
of  53.  These  were  the  decision  of  the  Master  of  the  Rolls  in  Price  v. 
Bousted,  and  more  recently  the  decision  was  followed  by  Kindersley, 
y.  C,  in  Haynes  v.  Haynes  (Feb.  1866).  The  petition  in  this  case  in- 
volved the  question  whether  a  single  lady,  aged  5.3  in  Dec.  1865,  could  be 
considered  as  past  childbearing,  and  it  was  decided  in  favor  of  this- 
assumption.  These  decisions  are  not  reconcilable  with  the  cases  given 
above.  Stolz  refers  to  three  cases  of  married  women  bearing  childten  at 
the  ages  of  45,  48,  and  51  respectivel}^.  In  two  of  these  cases  the  preg- 
nancy was  mistaken  for  dropsv  and  treated  as  such.  (Ann.  d'Hvg., 
1873,  t.  2,  p.  151.) 

Causes  of  Sterility. — The  causes  of  sterility  in  the  female  are  very 
numerous.  Some  of  them  depend  upon  peculiarities  of  constitution,  the 
sexual  organs  being  well  formed  and  developed  ;  others  upon  latent 
changes  or  congenital  defects  in  the  womb  and  its  appendages,  only  dis- 
coverable by  an  examination  after  death.  Sterility  rarely  becomes  a 
medical  question  in  contested  cases  of  legitimacy  ;  for  a  claim  on  the  part 
of  a  person  to  be  the  offspring  of  a  particular  woman,  unless  she  were  in 
collusion  with  the  claimant,  could  only  be  made  after  her  death  ;  and  if 
not  disproved  by  medical  evidence,  showing  that  the  woman  could  not  have 
borne  children,  it  would  in  general  be  easily  set  aside  by  circumstances. 
It  may  be  most  important  to  prove  that  a  woman  was  in  such  a  bodily 
condition  that  she  never  could  have  conceived  or  borne  a  child.  If  the 
womb,  ovaries,  or  other  parts  were  congenitally  defective  or  absent,  or  if 
there  were  external  sexual  malformation,  accompanied  by  occlusion  or 
obliteration  of  the  vagina,  a  medical  witness  could  have  no  difficulty  in 
saying  that  the  woman  must  have  been  sterile.  (Med.  Times  and  Gaz., 
1858,  i.  p.  96.)  A  mere  occlusion  of  the  vagina,  removable  by  operation, 
does  not  necessarily  indicate  sterility,  for  the  internal  parts  may  be  healthy 
and  sound. 

3Iedico-legal  Relations  of  the  Subject.  Divorce. — Sexual  malformation, 
involving  impotency  or  sterility,  constitutes  one  of  the  canonical  impedi- 
ments to  marriage,  and  if  matrimony  be  contracted  by  a  party  laboring 
under  such  malformation,  the  contract  is  voidable.  The  impediment  con- 
stituting impotency  may  arise  either  from  malformation,  from  that  which 
the  law  calls  frigidity  of  constitution,  or  any  physical  cause  of  whatever 
nature  which  may  render  intercourse  impossible.  When  the  phvsical 
defect  is  not  apparent,  or  when  it  is  alleired  to  be  irremediable,  a  continued 
cohabitation  of  three  years  is  required  before  a  suit  can  be  entertained 
(Ayliff's  "  Parergon") ;  but  according  to  Oughton — "  haec  triennalis  ex- 
pectatio  non  est  necessaria  ubi  statim  possit  constare  de  impotentia 
coeundi."  A  suit  for  a  sentence  of  nullity  may  be  promoted  by  either 
partv,  and  the  medical  proof  required  to  found  a  sentence  must  be  such  as 
to  satisfy  the  court  that  the  incapacity  pleaded  was  in  existence  at  the 
time  of  the  marriage,  and  that  it  still  remained  without  remedy.  There 
should  be  no  delay  in  instituting  the  suit,  and  there  should  be  proof  that 
the  impediment  was  not  known  to  the  complaining  party  at  the  time  of 
the  contract.     A  longer  delay  in  making  the  complaint  is  allowed  to  a 


644  CASES    OF    NULLITY. 

female,  without  prejudicing  tier  case,  than  to  a  male,  by  reason  of  the 
modesty  of  her  sex. 

In  a  suit  which  came  before  the  Ecclesiastical  Courts  in  1845  a  singular 
question  arose  whether,  when  there  was  a  capacity  for  sexual  intercourse 
on  the  part  of  a  woman,  with  a  certainty  that  from  physical  defect  it  could 
never  be  prolific,  this  was  sufficient  to  entitle  the  husband  to  a  divorce. 
On  the  part  of  the  woman  it  was  insisted  that,  in  order  to  entitle  a  party 
to  a  sentence  of  divorce,  there  must  be  an  utter  im2')0ssibility  of  sexual  in- 
tercourse. The  case,  it  was  argued,  was  one  ©f  mere  sterility,  which  was  no 
ground  for  a  sentence.  Lushington,  in  pronouncing  sentence,  said  that 
mere  incapability  of  co??cpp^^on  is  not  a  sufficient  ground  whereon  to  found 
a  decree  of  nullity.  The  only  question  is,  whether  a  female  is  or  is  not 
capable  of  sexual  intercourse  ;  or,  if  at  present  incapacitated,  whether  that 
incapacity  admits  of  removal.  A  power  of  sexual  intercourse  is  necessary 
to  constitute  legally  the  marriage-bond,  and  this  intercourse  must  be 
ordinary  and  complete,  not  partial  and  imperfect ;  yet  it  would  not  be 
proper  to  say  that  every  degree  of  imperfection  would  deprive  it  of  its 
natural  character.  If  it  be  so  imperfect  as  to  be  scarcely  natural,  it  is, 
legally  speaking,  no  intercourse  at  all.  As  to  conception,  there  is  no 
doubt  that  the  malformation  is  incurable.  If  there  was  a  reasonable  prob- 
ability that  the  female  could  be  made  capable  of  natural  coitus  the  mar- 
riage could  not  be  pronounced  void ;  if  she  could  not  be  made  capable  of 
more  than  an  incipient,  imperfect,  and  unnatural  coitus,  then  it  would  be 
void. 

It  appears  that,  in  order  to  justify  a  decree  of  divorce  on  the  ground  of 
impotency  or  sterility  the  impediment  to  intercourse  or  procreation  should 
be  established  by  good  medical  evidence,  and  it  must  be  aj^parent  and 
irremediable ;  it  must  also  have  existed  before  the  marriage  of  the  parties, 
and  have  been  entirely  unknown  to  the  person  suing  for  the  divorce ;  if  it 
has  supervened  after  the  marriage,  this  is  no  ground  for  a  suit.  (See, 
however,  p.  646,  post.)  The  nature  of  the  impediment  is  to  be  determined 
by  private  medical  opinions  or  affidavits  based  on  an  examination  of  both 
parties.  Such  an  examination  must  be  voluntary  on  the  part  of  the  man 
or  the  woman.  The  judge  of  the  court  cannot  order  it  against  the  wish 
of  the  part3^  All  that  he  can  do  is  to  decide  in  the  absence  of  evidence  of 
the  kind,  and  this  may  be  adverse  to  the  pany  refusing.  In  the  case  of 
Hewitt  V.  Perry  (Divorce  Ct.,  July,  1873),  a  suit  for  nullity,  Hannen,  J., 
gave  his  decision  in  favor  of  the  husband  and  against  the  wife.  She  re- 
fused to  submit  to  an  examination,  and  abstained  from  presenting  herself 
as  a  witness  in  the  case.  The  case  was  remarkable  in  other  respects.  The 
evidence  of  the  husband  was  to  the  effect  that  there  had  been  more  than 
three  years'  cohabitation,  but  no  consummation  of  the  marriage.  There 
was  no  structural  impediment  in  the  way  of  consummation  in  the  wife's 
person  ;  but  whenever  an  attempt  at  intercourse  Avas  made  it  brought  on 
an  attack  of  hysteria,  and  this  rendered  it  practically  impossible.  A  decree 
visi  for  annulling  the  marriage  was  granted  to  the  husband  ;  but  the  judge 
at  the  same  time  observed  that  such  a  decree  could  only  be  granted  on  the 
ground  that  there  was  a  physical  difficulty.  Thus  it  must  not  be  merely  a 
wilful  refusal  on  the  part  of  the  wife.  This  alone  would  not  justify  legal 
interference  ;  it  must  be  shown,  as  in  this  case,  that  injury  may  be  done 
to  health  by  inducing  an  attack  of  hysteria  or  other  disorder.  Oldham  has 
informed  the  author  that  several  cases  of  this  kind  have  come  before  him. 
It  may  be  regarded  as  incapacity,  not  from  structural  defect,  but  from  a 
general  disturbance  to  the  system  induced  by  the  attempts  at  intercourse. 
In  one  instance  that  came  under  the  editor's  notice  consummation  of  the 


CASES    OF    NULLITY.  645 

marriage  was  long  delayed  in  consequence  of  the  hysterical  condition  of 
the  woman.  The  difficulty  was  at  length  overcome  by  the  administration 
of  ether  vapor.  She  recovered  consciousness  during  the  act  of  coitus,  and 
there  was  no  subsequent  difficulty  in  intercourse. 

St.  Clair  Gray  pointed  out  another  condition  in  a  woman  which  may 
prevent  consummation  of  a  marriage  and  give  rise  to  a  suit  of  nuUily. 
This  has  been  called  Vaginismus.  In  this  disease  there  is  a  peculiarly 
sensitive  state  of  the  parts,  whereby,  "  from  excessive  nervous  irritability 
of  the  vagina,"  any  attempt  at  sexual  intercourse,  or  even  any  pressure 
made  in  the  vicinity,  causes  intolerable  pain  to  the  woman.  He  describes 
three  cases  which  have  fallen  under  his  notice.  In  one,  a  woman,  set.  38, 
had  been  married  thirteen  years,  but,  in  consequence  of  the  intolerable 
pain  produced,  her  husband  had  not  been  able  to  have  intercourse  with, 
her.  An  examination  showed  that  the  hymen  was  persistent,  but  the 
parts  were  so  highly  sensitive  that  a  touch  with  the  finger  only  produced 
great  suffering.  Nine  years  passed  without  any  change  in  her  condition. 
In  two  other  cases  of  married  women  there  was  a  similar  state  of  the  parts, 
the  hymen  being  also  persistent  in  both.  One  had  been  married  four,  and 
the  other  seven  years,  and  they  had  no  children.  The  hymen  was  de- 
stroyed by  operation  ;  the  sensibility  of  the  parts  disappeared ;  and  one 
gave  birth  to  four,  and  the  other  to  three,  children.  (Glasgow  Med.  Jour., 
May,  1873.)  It  is  clear,  therefore,  that  vaginismus  would  be  no  legal 
ground  for  divorce  according  to  the  law  of  England,  because  the  defect  is 
remediable — a  fact  proved  by  the  two  cases  described.  In  the  three  cases 
the  women  labored  under  no  physical  malformation.  They  were  in  every 
respect  healthy  and  well-formed. 

There  is  one  remarkable  circumstance  with  respect  to  these  suits  of 
nullity  ;  namely,  that,  in  nearly  all  of  them,  the  suit  is  by  the  woman  against 
the  man  ;  although  there  is  no  reason  whatever  to  suppose  that  impotency 
and  sexual  malformation  are  more  common  in  males  than  malformation 
and  sterility  in  females.  We  rarely  hear  of  a  husband  instituting  a  suit 
of  divorce  on  the  ground  of  sterility  (incapacity  of  procreation)  in  the 
wife  ;  it  is,  in  most  instances,  the  wife  that  promotes  the  suit  on  the  ground 
of  impotency  or  incapacity  of  intercourse  in  the  husband.  The  diffi- 
culty of  establishing  incapacity  in  the  female,  and  the  facility  of  proving 
impotency  from  physical  causes  in  the  male,  may  probably  account  for 
this  difference.  Suits  of  this  kind  are  sometimes  instituted  man}^  months 
and  years  after  the  union  of  the  persons ;  but  it  is  probable  that  the  de- 
sire for  separation  in  such  cases  often  depends  on  some  cause  which  the 
law  would  not  recognize  as  sufficient  of  itself,  while  it  would  admit  a  plea 
of  impotency.  The  French  law  applies  the  principle  of  condonation  to 
such  cases,  so  that  no  suit  for  nullity  of  marriage  can  be  entertained,  if 
cohabitation  has  continued  for  six  months  after  the  discovery  of  the 
personal  defect.  The  laws  of  England  and  France  differ  in  reference 
to  personal  defects.  Impotency  or  incapacity  of  intercourse  in  a  woman 
is,  in  England,  a  sufficient  ground  for  annulling  the  contract;  but  not  so 
in  France.  Tardieu  states  that  the  law  has  not  placed  impotency  in  the 
female  among  the  causes  for  nullity  of  marriage.  (Ann.  d'Hyg.  1872 
t.  2,  pp.  153,  155.) 

Braxton  Hicks  (Lancet,  1885,  ii.  p.  198)  gives  interesting  cases  of  suc- 
cessful suits  for  nullity  :  one  on  account  of  the  frigidity  of  the  wife ;  and 
another  on  account  of  the  incompetence  of  the  husband,  he  having  lived 
with  his  wife  for  two  years  without  once  attempting  intercourse.  JHe  also 
relates   an    unusual   case   of   post-nuptial   insanity    supervening   on   the 


646  CASES    OF    SEXUAL    IDENTITY. 

wedding  night  from   sexual  difficulties  on  both  sides.     The  woman  re- 
covered and  bore  several  children  to  her  husband. 

The  validity  of  a  marriage  cannot  be  disputed,  on  the  ground  of  physi- 
cal incapacity,  after  the  death  of  one  of  the  parties.  The  incapacity  does 
not  render  a  marriage  void,  but  only  voidable.  It  is  a  matter  purely  of 
personal  complaint  or  grievance.  Third  parties  cannot  be  admitted  to. 
institute  a  suit  of  nullity  after  the  death  of  husband  or  wife.  In  an  ad- 
ministration suit,  July,  18G8,  the  plaintifi'  clainjed  as  the  lawful  husband 
of  the  intestate.  The  defendants,  who  were  her  next  of  kin,  alleged  that 
the  plaintiff  was  not  her  lawful  husband,  on  the  ground  of  physical  inca- 
pacity, and  that  the  marriage  had  never  been  consummated.  Wilde,  J., 
delivered  judgment  against  the  defendants,  saying  that  the  suit  of  nullity 
Avas  a  personal  one,  and  as  this  had  not  been  instituted  during  the  life  of 
the  woman,  the  validity  of  the  marriage  could  not  now  be  contested. 

In  treating  of  sexual  identity,  Tardieu  remarks  that  n)arriage  implies 
the  laAvful  union  of  a  man  and  woman  ;  that  such  a  contract  cannot  be 
entered  into  except  between  persons  who  are  of  different  sexes.  When 
the  sex  is  disputed,  the  doubt  can  be  removed  only  by  an  anatomical  and 
physiological  examination  of  the  person.  The  intervention  of  a  medical 
expert  is  indispensable  in  such  a  case  and  the  object  of  such  intervention 
is  perfectly  defined.  The  problem  for  solution  may  be  stated  in  these 
simple  terms:  Is  the  person  married  as  a  woman — a  malformed  woman — 
impotent  and  incapal;]e  of  sexual  intercourse  ?  In  this  case,  according  to 
the  strict  interpretation  of  the  law  of  France,  there  is  no  ground  for  nullity 
of  marriage.  Is  the  person  a  malformed  man,  presenting  some  doubtful 
appearance  of  the  female  sex  ?  In  this  case  there  has  been  no  legal  mar- 
riage. It  is  null  ab  initio.  Assuming  that  there  are  no  beings  entire!}" 
deprived  of  sex,  there  may  be  cases,  although  rare,  in  which  a  mixture  of 
the  organs  of  the  two  sexes  ma}^  be  found  in  the  same  person.  Such  a 
being  is  incapable  of  entering  into  the  marriage  contract,  since,  whatever 
may  be  the  sex  of  the  person  with  whom  the  contract  is  made,  there  must 
be  identity  of  sex  and  therefore  nullity  of  marriage. 

Insanity,  if  existent  at  the  date  of  marriage,  is  a  ground  for  instituting 
a  suit  of  nullity.  (Hunter  v.  Hunter,  otherwise  Edney.)  When  not 
clearly  developed  on  the  day  of  marriage,  the  suit  will  fail.  (Durham  v. 
Durham,  otherwise  Milner,  Prob.  Ct.,  Fel),  1885  ;  Cannon  v.  Cannon, 
otherwise  Smalley,  Prob.  Ct.,  March,  1885.) 


RAPE SOURCES    OF    MEDICAL    EVIDENCE.  647 


RAPE. 


CHAPTER    LIX. 

SODROES  OF  MEDICAL  EVIDENCE. RAPE  OX  INFANTS  AND  CHILDREN. MARKS  OF  VIOLENCE. 

PURULENT  DISCHARGES  FROM  THE  VAGINA. EVIDENCE  FROM  GONORRHCEA  AND  SYPHILIS. 

RAPE  ON  GIRLS  AFTER  PUBERTY. DEFLORATION. SIGNS  OF  VIRGINITY. 

% 

Rape  is  defined  in  law  to  be  the  carnal  knowledge  of  a  woman  by  force 
and  against  her  will.  Medical  evidence  is  commonly  required  to  support 
a  charge  of  rape,  but  it  is  seldom  more  than  corroborative ;  the  facts  are, 
in  general,  sufficiently  apparent  from  the  statement  of  the  prosecutrix. 
There  is,  however,  one  case  in  which  medical  evidence  is  of  some  impor- 
tance— namely,  when  a  false  accusation  is  made.  In  some  instances,  as  in 
respect  to  rape  on  infants  and  children,  the  charge  may  be  founded  on 
mistake;  but  in  others  there  is  little  doubt  that  it  is  often  wilfully  and 
designedly  made  for  motives  into  Avhicli  it  is  here  unnecessary  to  inquire. 
Amos  remarked  that  for  one  real  rape  tried  on  the  circuits,  there  were  on 
the  average  twelve  pretended  cases;  and  common  experience  bears  out 
this  statement.  In  some  few  instances  these  false  charges  are  at  once 
set  aside  by  medical  evidence  ;  in  others,  medical  men  may  be  sometimes 
the  dupes  of  designing  persons;  but  in  the  majority,  the  falsehood  of  the 
charge  is  proved  by  inconsistencies  in  the  statement  of  the  prosecutrix 
herself.  In  "Scotland,  where  there  is  a  public  prosecutor,  and  a  careful 
preliminary  inquiry,  false  charges  of  rape  are  said  to  be  exceedingly  rare. 
The  consent  of  the  girl  does  not  excuse  or  alter  the  nature  of  the  crime 
when  she  is  under  thirteen  years  of  age,  since  consent  at  this  period  of 
life  is  invalid;  and  the  carnal  knowledge  of  such  a  girl  is  rape  in  law,  and 
is  a  felony  by  the  48  and  49  Vict.,  c.  69.  An  attempt  at  carnal  knowledge 
is  a  misdemeanor.  Even  the  solicitation  of  the  act  on  the  part  of  a  child 
does  not  excuse  it.  A  man  who  carnally  knows,  or  attempts  to  know,  any 
girl  above  the  age  of  thirteen  and  under  the  age  of  sixteen  years,  even  if 
she  consents,  is  guilty  of  a  misdemeanor. 

The  duty  of  a  medical  witness  on  these  occasions  is  very  simple  ;  and 
perhaps  this  will  be  best  understood  by  considering  the  subject  in  relation 
to  females  at  different  ages.  On  being  called  to  examine  a  person  on 
whom  a  rape  is  alleged  to  have  been  committed,  the  first  circumstance 
which  a  practitioner  should  notice  is  the  precise  time  and  date  at  which 
he  is  summoned,  taking  an  early  opportunity  of  comparing  his  watch  with 
some  neighboring  clock.  This  may  appear  a  trivial  matter,  and  one 
wholly  irrelevant  to  the  duties  of  a  medical  practitioner  ;  but  it  is  to  be 
observed  that  the  time  at  which  a  surgeon  is  required  to  examine  a  woman 
may  form  a  material  part  of  the  subsequent  inquiry.  It  will  be  highly 
important  to  the  defence  of  a  person  accused  if  it  can  be  proved  that  the 
female  did  not  take  the  earliest  opportunity  to  complain  ;  and  it  may  be 
also  the  means  of  defeating  an  alibi  falsely  set  up  for  the  defence.    Medical 


648  RAPE  ON  INFANTS  AND  CHILDREN. 

evidence  in  cases  of  rape  may  be  derived  from  four  sources  ;  1.  Marks  of 
violence  about  the  genitals.  2.  Marks  of  violence  on  the  person  of  the 
complainant  or  prisoner.  3.  The  presence  of  stains  of  the  spermatic  fluid 
or  of  blood  on  the  clothes  of  the  complainant  or  prisoner.  4.  The  exist- 
ence of  gonorrhoea  or  S3'philis  in  one  or  both.  This  evidence  will  vary 
according-  to  the  age  of  the  female  and  other  circumstances. 

Rape  on  Infants  and  Children. 

The  sexual  organs  should  in  these  cases  present  marks  of  injury  if  the 
crime  has  been  completed,  and  there  has  been  any  i-eaistaiice  on  the  part 
of  the  child;  for  it  is  impossible  to  conceive  that  forcible  intercourse 
should  take  place  without  the  production  of  ecchymosis,  the  effusion  of 
blood,  or  a  laceration  of  the  pudendum.  Even  without  reference  to 
manual  violence  on  the  part  of  the  adult  assailant,  the  size  of  the  male 
organ  must  generally  cause  much  local  injury  in  the  attempt  to  enter  the 
vagina  of  a  child.  If  the  violation  has  taken  place  within  two  or  three 
days,  the  appearances  presented  by  the  parts  may  be  as  follows:  1.  In- 
flammation, with  more  or  less  abrasion  of  the  lining  membrane.  2.  A 
muco-purulent  discharge  from  the  vagina  of  a  ropy  consistency,  and  of.  a 
yellowish  or  greenish-yellow  color,  staining  and  stiffening  the  linen  worn 
by  the  girl ;  the  mucous  membrane  of  the  urethra  is  inflamed,  rendering 
the  discharge  of  the  urine  painful  3.  In  recent  cases  blood  may  be  oozing 
from  the  abraded  membrane,  or  clots  of  blood  may  be  found  deposited  in 
the  vulva.  4.  The  hymen  may  be  entirely  destroyed,  or  (what  is  more 
commonly  observed)  it  may  present  on  careful  examination  one  or  more 
slight  lacerations.  Owing  to  the  inflamed  state  of  the  parts,  the  proper 
examination  of  the  hymen  is  rendered  difficult — any  attempt  to  separate 
the  thighs  for  this  purpose  causing  great  pain.  For  this  reason  also,  the 
child  walks  with  difficulty,  and  complains  of  pain  in  walking.  5.  Lastly, 
the  vagina  may  be  unnaturall}"  dilated. 

It  has  been  propounded  as  a  serious  question  whether  a  rape  can  be 
perpetrated  on  children  of  tender  age  by  an  adult  man ;  and  medical  wit- 
nesses at  trials  have  adopted  conflicting  opinions.  Some  are  inclined  to 
regard  all  such  charges  as  unfounded,  and  to  .seek  for  other  medical  expla- 
nations of  the  symptoms  above  described.  This  practice  has  been  carried 
of  late  years  to  an  undue  extent,  simply  because  many  of  these  charges 
have  been  proved  to  be  false ;  but  common  experience,  supported  as  it  is 
by  the  accurate  observations  of  Casper,  shows  that  there  is  too  frequently 
area]  foundation  for  the  charge  in  reference  to  cliildren,  and  that  a  girl 
is  not  to  be  discredited  merely  because  of  her  tender  age.  This  would  be 
conferring  impunity  on  the  acts  of  a  vile  class  of  offenders.  In  all  cases 
there  should  be  good  medical  evidence  and  a  corroboration  from  circum- 
stances. There  is  a  deplorable  vulgar  error,  causing  this  crime  to  be  a 
frequent  one.  It  is  this,  that  gonorrhoea  and  syphilis  in  the  male  are  cured 
by  coitus  with  a  female  who  is  a  virgin.  It  need  hardly  be  said  tnat  this 
supposition  has  no  medical  basis.  In  1884,  a  case  was  tried  at  Liverpool, 
in  which  Lowndes  gave  evidence  that  in  this  way  a  man  had  inoculated  a 
young  girl  with  S3'philis. 

For  the  legal  establishment  of  the  crime,  proof  of  penetration  only  is 
demanded,  and  a  sufficient  degree  of  penetration  to  constitute  rape  in  law 
may  take  place  without  necessarily  rupturing  the  hymen.  There  must  be 
medical  evidence  to  show  that,  in  a  special  case,  there  was  actual  penetra- 
tion— the  degree  of  penetration  beinir  quite  immaterial.  It  is  true  that 
there  could  not  be  a  complete  introduction  of  the  adult  male  organ  into 


MARKS    OF    VIOLENCE    ON    THE    PUDENDUM.  649 

the  vagina  of  a  child  without  a  rupture  or  laceration  of  the  soft  parts  ;  but 
the  absence  of  such  marks  of  violence  would  not  justify  a  medical  witness  in 
denying  the  perpetration  of  the  crime,  since  the  law  does  not  require  proof 
either  of  a  complete  or  of  a  violent  introduction.  It  has  been  decided  that 
penetration  to  the  vulva  alone  is  suflicient  to  constitute  this  crime.  Medi- 
cal men  have  sometimes  fallen  into  an  error  on  this  point,  considering 
that,  when  the  hymen  was  entire,  rape  could  not  have  been  committed ; 
but  the  statute  law  says  nothing  about  the  rupture  of  the  hymen  as  a 
necessary  part  of  the  medical  evidence ;  it  merely  requires  from  the  medi- 
cal witness  proof  of  vulval  penetration — this  may  occur  and  the  hymen 
remain  intact.  In  Reg.u.  Harris  (Bristol  Lent  Ass.,  18Y3),  the  prisoner, 
an  adult,  was  convicted  of  rape  on  an  infant  only  seven  months  old.  Ac- 
cording to  the  medical  evidence  there  was  no  great  amount  of  violence  to 
the  genital  organs.  The  parts  were  swollen,  and  there  was  slight  excoria- 
tion about  the  labia  minora,  with  a  small  discharge  of  blood.  The  hymen 
and  the  vagina  had  escaped  laceration.  Seminal  fluid  was  found  on  the 
person  of  the  child.  In  this  case  there  might  have  been  penetration  of 
the  male  organ  to  the  vulva.  In  so  young  a  child  there  could  have  been 
no  resistance,  and  the  act  might  therefore  have  been  perpetrated  without 
leaving  any  serious  marks  of  violence. 

In  Scotland  this  question  came  formally  before  the  judges  in  the  case  of 
Macrae  (High  Ct.  of  Just.,  1841).  It  was  insisted  by  the  prisoner's 
counsel  that  there  should  be  proof  of  full  and  complete  penetration  ;  and 
there  was  no  sufficient  evidence  to  show  that  penetration  had  taken  ))lace 
into  the  canal  of  the  vagina  beyond  the  vulva.  Lord  Meadowbank 
charged  the  jury  to  the  effect  that  the  evidence  of  the  prisoner's  guilt  was 
complete ;  that  scientific  and  anatomical  distinctions  as  to  where  the 
vagina  commenced  were  worthless  in  a  charge  of  rape ;  and  that,  by  the 
law  of  Scotland,  it  was  enough  if  the  woman's  body  was  entered.  In  a 
case  like  this,  where  there  was  no  evidence  of  emission,  and  the  girl  was 
young,  he  did  not  consider  it  necessary  to  show  to  what  extent  penetra- 
tion of  the  parts  had  taken  place,  or  to  prove  that  it  had  gone  either  past 
the  hymen,  into  what  was  anatomically  called  the  hymen,  or  even  so  far 
only  as  to  touch  the  hymen.  The  prisoner  was  convicted.  (Cormack's 
Edin.  Jour.,  1846,  p.  48.)  Up  to  the  date  of  the  case  of  Macrae,  it  had 
been  the  practice  with  the  Scotch  judges  to  require  proof  of /"wZZ  and  com- 
plete penetration.  (See  on  this  question  a  paper  by  Easton,  Glasgow 
Med.  Jour.,  1859,  p.  129.) 

Marks  of  Violence  on  the  Pudendum. — When  there  are  no  marks  of 
violence  or  physical  injury  about  the  pudendum  of  a  child,  whether  be- 
cause none  originally  existed,  or  they  existed  and  had  disappeared  in  the 
course  of  time,  a  medical  witness  must  leave  the  proof  of  rape  to  others. 
He  can  only  answer  questions  of  possibility  or  probability,  according  to 
the  special  facts  proved.  It  is,  however,  in  all  cases  his  duty  to  be  guarded 
in  giving  an  opinion  that  a  rape  has  been  perpetrated  when  there  is  a 
total  absence  of  marks  of  violence  on  the  genitals.  It  is  true  that  rape 
in  a  legal  sense  may  be  perpetrated  without  necessarily  producing  such 
marks  on  a  child  ;  but  then  the  proof  of  the  crime  will  not  depend  on 
medical  evidence  only.  The  absence  of  marks  of  violence  on  the  geni- 
tals, when  an  early  examination  has  been  made,  furnishes  a  strong  pre- 
sumption that  rape  has  vot  been  committed  on  these  young  persons.  It 
is  obvious  that  a  false  charge  might  be  easily  made  and  sustained,  if  med- 
ical opinions  were  hastily  given  on  the  statements  of  a  mother  and  child, 
when  there  was  no  physical  appearance  to  corroborate  the  accusation. 


650  MARKS    OF    VIOLENCE    ON    THE    PUDENDUM. 

(See  on  this  subject  a  paper  by  ToulmoucLe,  Ann.   d'Hvg.,   1864,  t.  2, 
p.  338.) 

Supposing  at  the  period  of  examination  no  marks  exist,  it  may  be 
necessary  to  consider  whether  there  has  been  time  for  them  to  disap- 
pear after  the  alleged  perpetration  of  the  offence ;  but  in  such  cases  it  is 
rarely  in  the  power  of  a  medical  witness  to  express  an  affirmative  opinion 
of  the  perpetration  of  the  crime  ;  he  should  leave  this  to  be  proved  by  the 
general  and  circumstantial  evidence.  Casper  met  with  a  case  in  which  a 
man,  set.  37,  committed  a  rape  on  a  girl  only  eight  years  of  age ;  he  was 
seen  in  the  act,  and  defended  himself  on  the  plea  of  drunkenness.  The 
girl  was  examined  by  a  medical  man  on  the  day  following  ;  the  labia  were 
then  reddened,  and  there  was  an  injection  of  the  membrane  at  the  en- 
trance of  the  vagina,  which  was  very  sensitive.  As  an  illustration  of  the 
rapidity  with  which  the  marks  of  rape  disappear  in  young  children,  when 
not  attended  with  great  physical  injury,  it  may  be  stated  that  this  girl 
was  carefully  examined  by  Casper  eleven  cloys  after  the  assault.  The  sex- 
xial  organs  were  then  in  their  natural  state;  there  was  not  the  least  ap- 
pearance of  local  injury,  and  no  inference  could  have  been  drawn  at  this 
date  that  the  girl  had  been  subjected  to  any  violence.  Medical  prac- 
titioners are  not  always  sufficiently  careful  in  the  inferences  which  they 
draw  from  an  examination  of  children  at  distant  periods  after  an  alleged 
rape.  They  allow  themselves  to  be  deceived  by  a  plausible  story,  ap- 
parently consistent,  and  thus  see,  or  think  they  see,  proofs  of  rape  on  ex- 
amining the  sexual  organs  of  a  girl  weeks  after  the  alleged  perpetration 
of  the  crime  ;  whereas,  had  the  girl  been  brought  before  them  as  a  casual 
patient,  and  no  suggestion  of  violent  intercourse  had  been  made,  they 
would  have  probably  ridiculed  the  idea  of  basing  a  charge  of  rape  on  so 
slender  a  foundation.  The  delay  in  having  the  examination  made,  unless 
satisfactorily  explained,  is  in  itself  always  a  suspicious  circumstance.  In 
one  case  a  medical  man  gave  evidence  that  a  rape  had  been  committed  on 
a  girl  seven  years  of  age,  although  he  did  not  examine  her  until  si;jc  iceeks 
had  elapsed  from  the  date  assigned  by  the  parents  for  the  alleged  perpe- 
tration of  the  crime. 

On  the  other  hand,  when  marks  of  violence  on  the  genitals  are  present, 
they  must  not  be  hastily  assumed  as  furnishing  proofs  of  rape  ;  for  cases' 
are  recorded  in  which  such  injuries  have  been  purposely  produced  on 
young  children  by  women  as  a  foundation  for  false  charges  against  per- 
sons with  a  view  of  extorting  money.  The  proof  or  disproof  of  facts  of 
this  kind  must  rest  more  upon  general  than  on  medical  evidence,  unless 
the  injuries  obviously  indicate  the  use  of  some  weapon  or  instrument.  It 
should  be  remembered  that  the  h3nuen  is  not  always  present  in  young 
children  ;  it  maj  be,  according  to  some,  congenitally  deficient,  or,  what  is 
more  probable,  it  may  have  been  destroyed  by  ulceration  or  suppurative 
inflammation  of  the  parts — a  disease  to  which  female  infants  of  a  scrofu- 
lous habit  are  very  subject.  The  mere  absence  of  this  membrane,  there- 
fore, can  afford  no  proof  of  the  perpetration  of  the  crime,  unless  we  find 
traces  of  its  having  been  recently  torn  by  violence.  Other  and  more  im- 
portant deductions  may,  however,  be  drawn  from  the  presence  of  severe 
injuries  on  the  genitals,  i.e.  of  rupture  or  laceration  of  the  vagina  or 
perineum.  It  is  difficult  to  obtain  accurate  medical  reports  of  these  cases 
as  they  occur  in  England  ;  but  it  is  quite  clear  that  the  male  organ  may 
produce  much  phvsical  injury,  whether  the  child  does  or  does  not  resist 
the  attempt.  ( Vierteljahrss^chr.  fur  Gerichtl.  Mod.,  1863,  p.  337.)  A 
yout-li  was  convicted  of  murder  at  Chelmsford  in  1874.  He  had  com- 
mitted rape  on  a  girl  with  so  much  violence  as  to  cau.se  her  death.    It  was 


FALSE  CHARGES  OF  RAPE.  ■  651 

found  that  the  rectum  and  part  of  the  intestines  had  been  forced  out  in 
the  act  of  intercoui-se,  which,  according  to  the  confession  of  the  prisoner, 
had  taken  place  after  death.  Chevers,  in  referring-  to  Indian  experience, 
says  that  in  a  large  j)roportion  of  rapes  on  children  it  was  very  clearly 
proved  that  rather  severe  injuries  had  been  inflicted  on  them.  In  the 
Nizamut  Adawlut  Heports  (1853-5),  there  are  several  instances  recorded 
in  which  the  vagina  was  lacerated.  Out  of  66  trials  for  rape  there  were 
25  convictions ;  and  in  one-half  of  these  the  females  were  under  the  age 
of  twelve  years.  In  one  case  of  a  girl,  set.  12,  there  was  a  rupture  of  the 
lower  part  of  the  vagina  to  the  extent  of  half  an  inch.  In  another, 
a  child  of  six,  but  apparently  much  younger,  had  suffered,  as  a  result 
of  rape,  from  rupture  of  the  hymen  and  laceration  of  the  perineum 
^nd  vagina.  In  one  instance  the  violence  proved  fatal.  (Med.  Jurispr. 
for  India,  p.  468.)  When  it  is  alleged  that  injuries  have  been  inten- 
tionally produced  on  the  genitals  of  a  child  by  mechanical  means,  with 
a  view  of  extorting  money  in  laying  a  false  charge  of  rape,  the  med- 
ical evidence  can  do  no  more  than  show  that  a  girl  Avith  such  appearances 
about  her  sexual  organs  has  suffered  from  some  violence  applied  to  the 
parts,  but  whether  by  the  human  member,  or  any  other  physical  means, 
it  w^ould  be  impossible  to  say. 

In  1840,  Brady  communicated  a  case  of  alleged  rape  on  a  female  infant 
only  eleven  months  old,  in  which  the  violence  done  to  the  genitals  proved 
fatal.     In  1858,  a  girl  seven  years  old  was  brought  'into  Guy's  Hospital, 
owing  to  injuries  resulting  from  a  perpetration  of  rape  by  a  boy  under 
seventeen  years  of  age,  about  half  hour  after  the  occurrence.     There  was 
a  complete  destruction  of  the  hymen,  with  a  laceration  of  about  one-eighth 
of  an  inch  extending  into  the  perineum.     There  had  been  profuse  bleeding. 
There  was  then  no  complaint  of  pain,  and  there  were   no   scratches  or 
marks  of  violence  on  any  part  of  the  body.     There  was  no  discharge  of  a 
purulent  kind.     The  child  was  of  a  scrofulous  habit;  but   she  was  not 
suffering  from  vaginitis,  and  appeared  in  other  respects  perfectly  healthy. 
Forty-eight  hours  after  the  occurrence  the  bleeding  had  ceased,  and  the 
extent  of  the  lacerations  was  very  perceptible.     There  was  no  discharge 
of  any  kind  from  the  vagina,  and  no  inflamed  or  swollen  condition   of 
the  parts.     The  boy  was  examined  about  an  hour  after  the  perpetration 
of  the  rape,  and,  although  he  had  been  under  strict  custody,  and  had  no 
opportunity  of  changing  his  clothes,  there  was  vo   blood  found  about  his 
l)rivate  parts  or  on  his  clothing.     It  is  probable,  as  the  boy  was  inter- 
rupted in  the  act  by  the  screaming  of  the  girl,  that  he  suddenly  withdrew 
after  having  caused  the   laceration,  and  that  the  bleeding  was  an   after 
efTect  of  oozing  from  the  ruptured  vessels.     This  is  an  important  faci, 
because,  had  not  the  circumstances  been   known,  the  absence  of  blood 
on  his  person  might  have  been  construed  into  a  strong  proof  of  inno- 
cence.    Sawyer  met  with  a  case  in  which  a  rape  was  committed  on  a 
girl,  ffit.  5.     There  was  a  bruised  and  swollen  state  of  the  genitals  ;  the 
hymen  was  not  ruptured,  and  there  was  no  laceration  of  parts.     In  spite 
of  this,  a  large  amount  of  blood  had  been    lost.     This  bleeding,   in   his 
opinion,  took  place  from  the   hymen,   which  was  in  a   highly  congested 
state.     The  man  who  had  perpetrated  the  crime  was  examined  soon  after- 
wards, but  no  appearance  of  blood  was  found  on  his  organs  ;  there  were  a 
few  stains  only  on  the  front  of  his  clothing.     (New  Orleans  Med.  Gaz., 
1858,  p.  283.)     A  case  occurred  to  Sells,  in  1863,  in  which  he  found,  on 
the  person  of  a  girl  said  to  have  been  violated,  laceration  of  the  hymen,  a 
clot  of  blood  recently  effused  lying  on  the  vulva,  and  the  thighs  of  the 
child  smeared  with  blood,  quite  fresh  ;  there  was  also  blood  on  the  sheets 


652        NOMA  PUDENDI  MISTAKEN  FOR  VIOLENCE. 

of  the  child's  bed.  The  next  morning  he  examined  the  accused,  but  he 
could  find  no  trace  of  blood  upon  him  or  on  the  clothing  which  he  wore  at 
the  time  of  the  alleged  assault.  In  this  case,  as  there  was  a  failure  of 
identit}^  the  accused  was  discharged. 

Sometimes,  owing  to  the  violence  used,  the  parts  are  much  lacerated  ; 
and  inflammation,  followed  by  sloughing  or  mortification,  may  set  in  and 
destroy  life,  et^pecially  in  children  of  an  unhealthy  habit.  Care  should  be 
taken  that  the  symptoms  of  a  malignant  form  of  disease  (noma),  to  which 
female  children  when  in  a  dirty  or  neglected  state  are  liable,  are  not  mis- 
taken for  the  results  of  criminal  violence.  Some  such  cases  are  reported, 
from  which  it  would  appear  that  men  have  narrowly  escaped  conviction 
for  a  crime  which  had  really  not  been  perpetrated.  Percival  (Med. 
Ethics,  3d  edit.,  1849,  p.  117)  relates  a  case  which  has  been  the  subject  of 
frequent  quotation  and  comment  in  reference  to  false  charges  of  rape.  A 
girl,  get.  4,  was  admitted  into  the  Manchester  Infirmary  in  1191,  on 
account  of  a  mortification  of  the  female  organs  and  general  depression  of 
strength.  She  had  been  in  bed  with  a  boy  fourteen  years  old,  and  it  was 
supposed  that  he  had  taken  criminal  liberties  with  her.  The  mortification 
increased,  and  the  child  died.  The  boy  was  tried  on  a  charge  of  rape,  but 
acquitted  on  evidence  being  adduced  that  several  instances  of  a  similar 
disease  had  appeared  among  girls  about  the  same  period  of  time,  in  which 
there  was  no  reason  to  suspect  injury  or  guilt.  In  one  of  these  cases  there 
was  typhus  fever,  with  a  mortification  of  the  genitals.  There  was  no 
cause  of  death  discoverable  on  inspection  ;  the  lumbar  glands  were  of  a 
dark  color,  but  all  the  viscera  were  sound.  This  case,  with  the  w  hole  of 
Kinder  Wood's  paper  on  the  subject,  has  been  republished  by  Kesteven. 
(Med.  Times  and  Gaz.,  1859,  i.  p.  443.)  A  case  of  this  disease  {-noma 
piidendi),  but  in  Avhich  no  charge  of  rape  was  made,  was  referred  to  the 
author  in  1865.  E.  A.  R.,  a  girl,  set.  5,  died  suddenly  under  circum- 
stances which  led  to  a  suspicion  that  poison  had  been  administered  to  her. 
There  was  congestion  of  the  lining  membrane  of  the  stomach,  but  no 
poison  was  found  in  the  body,  and  there  was  no  trace  of  the  action  of 
poison.  When  the  body  was  inspected,  the  genitals  externally  and  the 
skin  around  and  beyond  the  anus  were  intensely  inflamed,  swollen,  and 
ulcerated,  and  in  an  approaching  state  of  gangrene  or  slough.  The 
hymen  at  the  entrance  was  ruptured,  and  the  lining  membrane  of  the 
vagina  and  womb  M'as  highly  inflamed — of  a  dark  purple  color,  with 
softening  and  disorganization  of  substance.  The  inguinal  glands  w^ere 
enlarged  on  both  sides.  The  child  was  in  a  neglected  and  dirty  state,  and 
died  from  exhaustion  produced  by  the  disease  and  want  of  proper  food 
and  support.  The  deceased  was  seen  by  a  medical  man  shortly  before 
her  death,  and  the  state  of  the  genitals  was  only  discovered  by  accident, 
the  mother  having  made  no  observation  about  it.  When  questioned  on 
the  su])ject,  she  said  the  girl  had  been  blown  down  about  a  fortnight 
before,  and  had  injured  herself  by  falling  on  some  thorns.  This  was  quite 
inadequate  to  account  for  the  condition  of  the  parts.  There  was  no  doubt 
that  this  was  a  case  of  noma  rendered  fatal  by  neglect  in  an  unhealthy  child. 
Hnd  any  man  been  seen  noticing  this  child,  a  charge  of  rape  might  easily 
have  been  founded  upon  the  state  of  the  genital  organs. 

On  the  other  hand,  fatal  injury  may  be  done  to  these  organs  in  crimi- 
nal assault.  Colles  has  reported  a  case  in  which  a  rape  was  committed  by 
an  adult  on  a  child  eight  years  old  ;  it  terminated  fatally  from  peritonitis, 
as  a  result  of  the  violence,  six  days  after  the  assault.  The  child  stated 
that  the  accused  had  had  forcible  connections  with  her,  causing  much  pain 
and  loss  of  blood.     There  were  no  marks  of  violence  externally,  but  the 


VAGINITIS.  65B 

orifice  of  the  vagina  was  lacerated  in  its  entire  circumference,  and  the 
perineum  was  nearly  torn  through.  It  was  found,  on  inspection,  that 
the  orifice,  as  well  as  the  whole  of  the  vagina,  was  in  a  state  of  gangrene, 
and  its  posterior  wall  had  been  lacerated  at  its  line  of  junction  with  the 
womb  to  the  extent  of  an  inch.  There  was  no  ulceration  ;  the  labia  and 
clitoris  had  not  undergone  any  change.  (Med.  Times  and  Gaz.,  18<i0, 
i.  p.  5()0.)  The  prisoner  subsequently  confessed  his  guilt.  A  case  com- 
municated by  M'Kinlay  (Glasgow  Med.  Jour.,  1859,  p.  140)  proves  that 
extensive  injuries  may  be  produced  on  a  child  by  the  act  of  violation. 
The  girl  in  this  instance  was  aljout  six  years  of  age,  and  very  intelligent. 
From  her  description  of  the  assault,  it  appears  that  she  fainted,  probably 
owing  to  the  severity  of  the  pain.  When  examined,  it  was  found  that 
the  vagina  was  ruptured  in  various  directions.  One  laceration  extended 
from  the  lower  part  downwards,  dividing  the  recto-vaginal  septum  and 
perineum  down  to  the  verge  of  the  anus.  There  was  a  lacerated  opening 
in  the  coats  of  the  rectum  ;  the  orifice  of  the  vagina  was  lacerated  upwards 
as  well  as  laterally  ;  the  parts  were  raw,  swollen,  and  very  tender.  When 
the  child  was  first  seen,  there  was  blood  on  the  limbs  and  clothes.  She 
recovered  from  these  serious  injuries  in  about  two  months.  In  one  case 
of  alleged  rape,  it  was  a  question  raised  in  favor  of  the  prisoner,  whether 
rupture  of  the  perineum  could  or  could  not  be  produced  in  rape  on  a 
girl.  Some  eminent  members  of  the  profession  appear  to  have  doubted 
the  possibility  of  a  rupture  being  produced  under  these  circumstances 
(Dub.  Med.  Jour.,  1859,  p.  53);  but  the  facts  here  recorded  show  that 
such  a  doubt  is  erroneous. 

Purulent  Discharge  from  the  Vagina.  Vaginitis.  Infantile  Leu- 
corrhoea. — The  existence  of  a  purulent  discharge  from  the  vagina  as  a 
result  of  inflammation  of  the  vagina,  has  been  frequently  adduced  as  a 
sign  of  rape  in  girls.  The  parents,  or  other  ignorant  persons  who  examine 
the  child,  often  look  upon  this  disease  as  a  positive  proof  of  impure  inter- 
course ;  and  perhaps  lay  a  charge  against  an  innocent  person,  who  mav 
have  been  observed  to  take  particular  notice  of  the  child.  A  purulent  dis- 
charge with  aphthous  ulceration  of  the  mucous  membrane  is  occasionallv 
a  result  of  vaginitis,  or  inflammation  of  the  vagina.  It  may  arise  from 
dentition,  or  local  causes  of  irritation — as  worms  or  uncleanly  habits — and 
is  observed  especially  in  children  of  a  scrofulous  habit.  It"^  is  frequently 
met  with  in  girls  up  to  six  or  seven  years  of  age ;  and  children  thus 
affected  have  been  tutored  to  lay  imputation  against  innocent  persons  for 
the  purpose  of  extorting  money.  This  state  may  commonly  be  distin- 
guished from  the  effects  of  violence,  either  by  the  hymen  being  entire, 
or  by  the  non-dilatation  or  laceration  of  the  vagina  or  perineum,  bv  the 
red  and  inflammatory  condition  of  the  mucous  membrane,  and  the  abund- 
ance of  the  purulent  discharge,  which  is  commonly  much  greater  than  that 
which  takes  place  as  a  mere  result  of  violence.  Capuron  mentions  two 
cases  in  which  charges  of  rape  on  children  were  falsely  made  against  inno- 
cent persons,  on  account  of  the  existence  of  a  purulent  discharge,  the 
nature  of  which  had  been  mistaken.  (Med.  Leg.  des  Accouchemens,  p. 
41.)  Locock  observed  that  the  purulent  discharges  of  female  children 
were  attended  with  redness  and  swelling  of  the  sexual  organs,  and  were 
sometimes  accompanied  with  excoriation  and  sloughing  of  the  skin,  owing 
to  the  irritating  nature  of  the  matter.  They  are  so  connected  wnth  denti- 
tion that  they  not  only  appear  with  the  first  and  second  set  of  teeth,  but 
even  when  the  wisdom-teeth  are  irritating  the  system  at  a  mature  age. 
South,  commenting  on  this  statement  (Chelius's  Surgery,  vol.  i.  p.  IGl), 
justly  remarks  that  a  knowledge  of  these  facts  "  is  highl}- necessary,  and  is 


654  CASES    OF    VAGINITIS. 

very  properly  insisted  on,  as  there  is  no  doubt  that  many  men  have  suffered 
capital  punishment  from  the  i<^noranee  of  practitioners  on  this  point; 
and  even  now,  with  our  better  knowledge,  it  is  by  no  means  unlrequent 
to  hear  of  medical  men  giving  a  decided  opinion  which  is  almost  certainly 
erroneous  upon  the  gonorrhoeal  character  of  pudendal  discharges,  and  thus 
jeopardizing  the  character,  if  not  the  life,  of  an  innocent  man.  In  giving 
his  opinion  or  evidence  in  such  cases,  a  practitioner  is  bound  to  speak 
with  extreme  caution,  and  only  on  the  most  incontestable  proof  (which  by 
a  mere  examination  of  parts  it  is  almost  impossible  for  him  to  attain), 
before  he  makes  a  positive  statement  as  to  the  gonorrhceal  character  of  a 
discharge."  Although  the  facts  are  or  ought  to  be  well  known  to  medical 
men,  there  is  still  much  popular  ignorance  in  reference  to  this  disease,  and 
false  charges  of  rape  on  children  are  now  not  unfrequently  made.  Kest- 
even  met  with  a  case  in  which  a  discharge  from  the  vagina  of  a  child  nine 
years  of  age  was  supposed  by  the  parents  to  prove  that  intercourse  had 
been  had  with  her.  There  was  no  mark  of  contusion  or  violence  on  or 
about  the  pudendum  or  in  the  vagina,  and  the  case  was  very  properly 
pronounced  by  him  to  be  one  of  vaginitis.  (Lond.  Med.  Gaz.,  vol.  xlvii. 
p.  372.)  A  similar  case  was  referred  to  the  author,  in  which  a  soldier  was 
supposed  to  have  infected  a  child  ;  but  an  investigation  showed  that  it  was 
a  purulent  discharge  depending  on  inflammation  of  the  vagina.  The 
author  was  consulted  in  reference  to  a  charge  against  a  father  for  criminal 
intercourse  with  two  of  his  daughters,  one  of  them  nine  and  the  other 
fourteen  years  of  age  If  the  purulent  discharges  were  gonorrhoea!,  there 
was  a  strong  presumption  of  his  guilt ;  if  only  of  the  ordinary  kind,  aris- 
ing from  vaginitis,  he  might  be  innocent,  and  the  accusation  made  against 
him  false.  (See  also  Ann.  d'Hvg.,  1864,  t.  2,  p.  833  ;  and  1860,  t.  2,  pp. 
131,  345.) 

A  gonorrhoeal  discharge  is  generally  very  profuse — much  more  profuse 
than  that  purulent  discharge  which  is  simply  the  result  of  such  violence  as 
is  produced  in  the  commission  of  rape.  There  is  another  fact  worthy  of 
notice,  namely,  that  the  last-mentioned  discharge,  besides  being  less  pro- 
fuse, lasts  for  a  much  shorter  time.  Casper  has  recommended  that  in 
doubtful  cases  an  examination  of  the  sexual  organs  should  be  made  in  ten 
or  twelve  days.  If  the  purulent  discharge  has  then  ceased  or  is  ceasing, 
there  is  good  reason  to  believe  that  it  was  not  the  result  of  gonorrhoea, 
but  of  some  temporary  cause  of  inflammation  in  the  mucous  membrane, 
(Klin.  Novellen,  1863,  p.  10.)  Of  false  charges  of  rape  arising  from  mis- 
takes on  this  subject,  Casper  furnishes  various  instances.  The  power  of 
distinguishing  gonorrheal  or  syphilitic  discharges  from  ordinary'  purulent 
discharges  has  been  much  debated,  and  Henry  Lee  has  especially  called 
the  attention  of  the  profession  to  this  subject.  In  a  case  which  occurred 
under  his  own  observation,  a  free  purulent  discharge  from  the  vagina, 
with  a  reddened  and  inflamed  mucous  membrane,  led  him  to  believe  that 
it  was  derived  from  gonorrhoeal  infection;  but  a  week  afterwards  the  in- 
flammation had  disappeared,  the  mucous  membrane  was  of  its  usual  color, 
and  the  dischai'ge  not  more  than  natural.  This  caused  him  to  reverse  his 
opinion,  and  to  congratulate  himself  that  he  had  not  unjustly  accused  the 
patient.  (Lancet,  1873,  i.  p.  218.)  A  microscopical  examination  may 
lead  to  the  detection  of  the  specific  micrococcus  of  gonorrhoea,  and  thus 
aid  the  diagnosis ;  but  the  specific  character  of  the  micrococcus  has  been 
recently  doubted. 

Assuming  that  the  surgeon  is  satisfied  from  a  careful  examination  that 
the  purulent  discharge  must  have  existed  before  the  alleged  assault,  and 
that  it  is  of  the  ordinary  inflammatory  character  with  which  young  girls 


CASES    OF    INFANTILE    LEUCORRII  (E  A  .  655 

are  liable  to  be  attacked,  this  would  not  justily  him  in  affirming  that  no 
rape  had  been  attempted  or  perpetrated  on  the  child.  Girls  laboring 
under  this  disease  may  be  the  subjects  of  rape,  and  it  will  then  be  neces- 
sary to  seek  for  further  evidence  of  the  condition  of  the  hymen,  the  lining 
meml)rane  of  the  vagina,  and  the  vulva.  If  nothing  is  found  bevond 
what  is  consistent  with  disease,  there  is  an  absence  of  medical  evidence 
to  prove  that  any  rape  has  been  committed.  An  aphthous  state  of  the 
meml)rane  of  the  vagina  must  not,  under  these  circumstances,  be  ascribed 
to  injurv  caused  by  mechanical  violence.  (Casper's  Gerichtl.  Med.,  Bd. 
2,  p.  148.) 

Infantile  leucorrhoea  has  been  fully  investigated  by  Wilde  (Medico- 
Legal  Observations,  etc.,  1853),  and  he  has  collected  numerous  instances 
illustrating  the  great  danger  to  which  innocent  persons  are  exposed  by 
reason  of  false  charges  of  rape  on  children.  Two  of  these  are  especially 
noticed  in  his  essay.  A  charge  was  raised  against  a  respectable  man,  that 
he  had  intercourse  with  and  produced  disease  in  two  children.  The  day 
and  hour  were  circumstantially  given,  extorted  as  it  appears  from  the 
children  by  their  parent,  and  the  man  was  put  upon  his  trial.  The  ap- 
pearances were  such  as  are  usual  in  these  cases — a  purulent  discharge 
from  the  vagina  with  some  excoriation,  but  no  bruise,  laceration,  or  mark 
of  violence  on  the  pudendum.  There  had  not  been  any  penetration  of  the 
vagina.  The  charge  against  the  prisoner,  although  unsupported  by  any- 
affirmative  circumstances,  received  some  strenii-th  from  the  admission  made 
by  one  medical  witness  for  the  prosecution,  namely,  that  the  appearances 
might  have  been  the  result  of  violence,  and  that  the  discharge  might  have 
been  produced  by  friction  with  the  member  of  a  healthy  man.  (Wilde, 
op.  cit.,  p.  14.)  It  was  proved  that  the  prisoner  was  not  affected  either 
with  gonorrhcBa  or  syphilis.  Geoghegan,  Churchill,  and  other  medicTl 
witnesses  of  repute  gave  testimony  to  the  effect  that  the  child  was  really 
laboring  under  an  ordinary  form  of  disease,  and  that  there  was  no  medical 
indication  that  it  had  been  subjected  to  any  kind  of  violence.  This  testi- 
mony was  not  considered  by  the  court  to  furnish  a  complete  answer  to 
the  charge,  since  it  was  inferred  that  the  appearances  on  the  child  might 
have  been  caused  by  the  accused  without  any  marks  of  violence  being 
left  on  the  pudendum.  So  strong  was  this  feelina:  that  had  the  case  rested 
here  it  is  probable  the  accused  would  have  been  convicted  u|)on  the  unsup- 
ported statement  of  the  child.  An  alibi  was,  however,  clearly  proved, 
and  the  man  was  acquitted.  In  this  instance,  it  will  be  perceived  it  was 
alleged  that  a  man  who  labored  under  no  disease  had  caused  a  purulent 
discharge  in  a  child.  At  the  same  time  it  was  admitted  that  the  puden- 
dum had  sustained  no  violence  v.'hatever.  Medically  speaking  there  ap- 
pears to  have  been  not  the  slightest  pretence  for  charging  the  accused  with 
the  perpetration  of  rape  ;  the  appearances  might  have  or  might  not  have 
been  caused  in  the  manner  suggested. 

If  the  child  is  really  laboring  under  syphilis  or  gonorrhoea,  this  is  pre- 
sumptive evidence  of  impure  intercourse,  either  with  the  ravisher  or  some 
other  person  ;  but  we  should  be  well  assured  before  giving  an  opinion  that 
the  discharge  is  really  of  a  gonorrhoeal  and  not  simply  of  a  common  in- 
flammatory (purulent)  character.  The  party  accused  may  have  been  at 
the  time  free  from  the  disease,  or,  if  laboring  under  it,  then  we  should 
expect  to  find  that  the  discharge  had  suddenly  made  its  appearance  in  the 
child,  with  its  usual  severe  symptoms,  on  the  third  to  the  eighth  day  after 
the  alleged  intercourse.  When  these  conditions  do  not  exist  it  is  extremely 
difficult  to  form  a  medical  opinion  on  the  subject,  since  there  are  perhaps 
no  certain  means,  by  the  microscope  or  otherwise,  of  distinguishing  com- 


656  EVILEXCE    FROM    PURULENT    DISCHARGES. 

nion  purulent  discharges  from  those  which  are  gonorrhoeal  or  syphilitic. 
A  ease  occurred  to  Biessy  in  which  a  merely  mucous  discharge  in  a  girl 
was  pronounced  to  be  syphilitic,  and  the  person  who  was  falsely  accused 
of  rape  narrowlv  escaped  conviction.  (Briand,  Man.  de  Med.  Leg.,  1846, 
p.  81.) 

We  should  further  distinctly  satisfy  ourselves  that  gonorrhoea  in  a  child, 
if  it  exist,  could  not  have  arisen  from  infection  by  any  accident  irrespec- 
tive of  intercourse.  This  limitation  is  rendered  necessary  by  the  publi- 
cation of  a  report  of  two  cases  by  Ryan  (Lond.  Med.  Gaz.,  vol.  xlvii. 
p.  744),  in  which  two  sisters,  one  of  one  year  and  the  other  of  four  years 
of  age,  received  the  infection  by  reason  of  their  being  washed  in  a  vessel 
of  water  with  a  sponge  used  by  a  young  woman  affected  with  profuse 
gonorrhoeal  discharge.  Ryan  clearly  traced  the  origin  of  the  discharge 
to  this  accident.  Had  an  accusation  of  rape  been  made  against  a  man 
laboring  under  gonorrhoea  it  is  not  at  all  improbable  that  this  condition 
of  the  children,  resulting  from  an  unsuspected  accident,  would  have  been 
taken  as  a  proof  of  his  guilt.  Cases  of  this  kind  convey  an  important 
caution  to  medical  witnesses ;  i.  e.  that  they  should  not  infer  criminal  in- 
tercour.=e  merely  from  the  existence  of  a  gonorrhoeal  discharge,  in  the 
absence  of  marks  of  violence  to  the  genitals,  or  of  other  strong  corrobo- 
rative proofs.  It  is  doubtful  v.-hether  the  alleged  specific  micrococcus  of 
gonorrhcea  is  not  found  in  non-specific  discharges. 

As  a  summary  of  these  remarks  with  respect  to  purulent  discharges  we 
mav  observe  that  they  should  not  be  admitted  as  furnishing  corroborative 
evidence  of  rape,  except — first,  when  the  accused  person  is  laboring  under 
gonorrhceal  discharge ;  second,  when  the  date  of  its  appearance  in  a  child 
is  from  the  third  to  the  eight  day  after  the  alleged  intercourse ;  and  third, 
when  it  has  been  satisfactorily  established  that  the  child  had  not  suffered 
from  any  such  discharge  previously  to  the  assault.  It  may  be  said,  how- 
ever, that  all  these  conditions  may  exist,  and  yet  the  accused  be  innocent ; 
for  a  child  may,  either  through  mistake  or  design,  accuse  an  innocent  per- 
son. This,  however,  removes  the  case  entirely  from  the  hands  of  a  med- . 
ical  jurist.  (The  reader  will  find  much  useful  information  on  this  subject 
in  Ann.  d'Hyg.,  1860,  t.  2,  pp.  130,  345.) 

With  respect  to  marks  of  violence  on  the  body  of  a  child  these  are  seldom 
met  with,  because  no  resistance  is  commonly  made  by  mere  children. 
Bruises  or  contusions  may  occasionally,  however,  be  found  on  the  legs. 

If  carnal  intercourse  be  had  with  the  consent  of  a  female  between  the 
ages  of  thirteen  and  sixteen  years  the  offender  is  guilty  of  a  misdemeanor 
onlv ;  above  the  age  of  sixteen  years  the  consent  of  the  girl  does  away 
with  any  imputation  of  a  legal  offence.  Girls  who  have  pas.sed  the  age 
of  thirteen  are  considered  to  be  capable  of  offering  some  resistance  to  the 
perpetration  of  the  crime ;  and  therefore,  in  a  true  charge,  we  should  ex- 
pect to  find  not  only  marks  of  violence  about  the  pudendum,  but  also  in- 
juries of  greater  or  less  extent  upon  the  body  and  limbs.  It  is  probable 
that  in  these  cases,  if  the  charge  were  well  founded,  the  hymen  would  be 
ruptured,  and  the  intercourse  is  always  presumed  to  be  violent ;  but  there 
miirht  be  some  dejrree  of  penetration  without  this  being  a  necessary  re- 
sult, especially  if  the  membrane  were  small  or  placed  far  up.  At  any  rate, 
a  girl  at  the  age  of  thirteen  may  sustain  all  the  injury,  morally  and  phys- 
ically, which  the  perpetration  of  the  crime  can  possibly  bring  down  upon 
her,  whatever  may  have  Vieen  the  degree  of  penetration  ;  and  for  this 
reason  it  is  very  properly  laid  down  by  our  law  that  the  crime  consists  in 
the  mere  proof  of  penetration.  The  fact,  however,  is  generally  clearly 
made  out  by  the  statement  of  the  girl.     Girls  of  tender  age  are  sometimes 


RAPE    ON    GIRLS.  657 

violated  by  boys  ;  the  amount  of  physical  injury  inflicted  in  such  cases  is 
less  tiian  when  the  assailant  is  an  adult.  In  addition  to  other  cases  re- 
ported, Geoghegan  communicated  to  the  author  one  which  was  the  subject 
of  a  trial  at  the  Liverpool  Wint.  Ass.  of  1862.  A  boy  aged  seventeen 
committed  rapes  on  two  children,  one  aged  eight  years,  and  the  other  ten 
years;  he  then  attenipted  to  commit  a  rape  on  a  third  girl,  aged  eleven 
years.  These  crimes  were  perpetrated  in  about  half  an  hour,  during 
which  time  he  was  alone  with  the  children.  He  was  convicted  of  felony 
for  rape  on  the  youngest  child,  and  sentenced  to  four  years'  penal  servi- 
tude. 

Rape  on  Young  Females  after  Puberty. 

With  respect  to  marks  of  violence  on  the  person,  the  exact  form,  posi- 
tion, and  extent  of  these  should  be  noticed,  also  their  appearance,  whether 
recent  or  of  old  standing.  A  false  accusation  of  rape  may  be  sometimes 
detected  by  the  violence  being  in  a  situation  in  which  it  is  not  probable 
that  the  ravisher  could  have  produced  it.  When  bruises  are  found  the 
presence  or  absence  of  the  usual  zones  of  color  may  occasionally  throw 
light  upon  the  time  at  which  the  alleged  assault  was  committed.  As  these 
marks  of  violence  on  the  person  are  not  likely  to  have  been  produced  with 
the  concurrence  of  the  girl  they  are  considered  to  furnish  some  proof  of 
the  intercourse  having  been  against  her  \\'ill.  But  the  physical  appear- 
ances of  rape  about  the  genital  organs  may  be  found,  whether  the  connection 
has  been  voluntary  or  involuntary.  Thus  rupture  of  the  hymen,  lacera- 
tion of  the  vagina  with  effusion  of  coagula  of  blood,  swelling  and  inflamma- 
tion of  the  vulva,  and  stains  of  blood  upon  the  person,  dress,  or  furniture, 
may  be  met  with  iu  both  cases.  In  making  an  examination  the  greatest 
care  should  be  taken  by  the  practitioner  to  fix,  at  the  time  of  examination, 
a  probable  date  for  the  marks  of  injury  to  the  genitals  or  other  parts  of  the 
body,  as  it  is  by  the  aid  of  such  observations  that  the  truth  or  falsity  of  a 
charge  may  be  sometimes  clearly  established. 

Girls  and  unmarried  young  women  are  liable  to  muco-piirulent  dis- 
charges from  the  vagina,  as  a  result  of  which  the  hymen  may  be  de- 
stroyed. This  kind  of  discharge  arises  from  inflammation  of  the  vacina 
( vaginitis),  and  it  has  been  observed  to  follow  an  attack  of  scarlatina.  When 
it  exists  its  real  cause  requires  the  closest  scrutiny.  At  a  more  advanced 
asie  young  w^omen  are  frequently  subject  to  leucorrhoea.  These  cases  are 
not  likely  to  be  mistaken  for  gonorrhoea;  as  here  the  female  has  it  in  her 
power  to  give  some  account  of  the  circumstances  from  which  a  medical 
opinion  may  be  easily  formed.  It  is  possible,  however,  that  a  woman 
lal)oring  under  leucorrhoea  may  charge  a  man  with  the  crime  of  rape,  and 
affirm  that  this  discharge  had  arisen  from  the  act  of  the  man.  An  inflamed 
and  partially  ulcerated  (aphthous)  state  of  the  lining  membrane  of  the 
vulva  naay  apparently  give  support  to  the  accusation.  The  discharge  in 
leucorrhoea  is  of  a  mucous  nature  ;  that  of  gonorrhoea  is  of  a  purulent 
character  ;  but  purulent  discharges  may  take  place  from  the  vagina  as  the 
result  of  intense  inflammation,  and  quite  irrespective  of  impure  intercourse. 
(Chelius's  Surgerv,  by  South,  vol.  i.  p.  160.)  It  would  be  impossible  to 
distinguish  such  discharges  from  those  of  gonorrhoea  ;  while  a  leucorrhoea! 
discharge  under  great  inflammatory  action  may  resemble  that  of  gonor- 
rhoea. Such  discharges  commencing  before,  but  continuing  and  some- 
times becoming  aggravated  after  marriage,  have  given  rise  to  unfounded 
suspicions  of  infection  from  venereal  disease  imparted  by  the  husband,  and 
have  thus  led  to  suits  of  divorce.  In  a  case  reported  by  Legneau,  a  young 
42 


058  SIGNS    OF    VIRGINITY. 

married  woman  suffered  from  a  discharge  which  was  pronounced  by  a 
medical  man,  whom  she  consulted,  to  be  gonorrhceal.  This  led  to  an  ap- 
plication for  a  divorce.  A  further  examination  b}^  other  medical  practi- 
tioners, with  a  complete  histoiy  of  the  symptoms  from  which  she  had  suf- 
fered, justified  the  conclusion  that  she  was  laboring  under  severe  leucor- 
rhoea  when  she  was  married,  and  that  this  was  followed  by  granular  vagi- 
nitis, which  accounted  for  the  muco-purulent  discharge.  (Ann.  d'Hyg., 
1870,  t.  2,  p.  192.) 

Defloration.  Signs  of  Virginity — It  will  be  necessary  to  say  a  few 
words  respecting  the  signs  of  virginity.  Independently  of  cases  of  rape, 
this  question  may  occasionally  assume  a  practical  bearing  in  relation  to 
the  signs  of  defloration  In  civil  cases  a  medical  witness  may  be  asked 
whether  a  woman  has  ever  had  intercourse  or  not;  and  proof  of  the  fact 
may  be  necessary  in  order  to  confirm  or  rebut  statements  made  by  her  in 
evidence.  The  question  may  be,  not  whether  a  woman  has  had  a  child, 
for  this  would  resolve  itself  into  a  proof  whether  delivery  had  or  had  not 
taken  place — it  may  be  limited  to  the  probability  or  possibility  of  inter- 
course on  her  part  at  some  antecedent  period.  A  medical  jurist,  when 
consulted  in  such  a  case,  can  be  guided  only  by  the  presence  or  absence  of 
the  external  signs  of  virginity.  The  hymen  may  be  intact,  but  this  does 
not  prove  non-intercourse,  because  females  have  been  known  to  become 
pregnant  with  the  hymen  uninjured;  and  an  operation  for  a  division  of 
this  membrane  has  been  rendered  necessary  before  delivery  could  take 
place.  (Henke's  Zeitschr.  der  S.  A.,  1843,  Bd.  2,  p.  149.)  Two  instances 
of  impregnation  without  rupture  of  the  h.vmen  are  reported.  (JSTew 
Orleans  Med.  Gaz.,  1858,  pp.  2IT,  220.)  the  hymen  in  each  case  re- 
quired to  be  divided  to  allow  of  the  delivery  of  the  child.  Other  cases  are 
reported.  (Amer.  Jour.  Med.  Sci.,  1860,  p.  5T6.)  Two  have  been  pub- 
lished by  Braun  (Vierteljahrsschr.  fur  Gerichtl.  Med.,  1873,  2,  p.  197)  ; 
and  oneVell-marked  case  by  St.  Clair  Gray  (Glasgow  Med  Jour.,  1873). 
A  woman,  aet.  29,  had  been  seven  years  married  before  this  her  first  con- 
finement. It  was  found  that  she  had  a  persistent  hymen  of  such  size  and 
form  as  completely  to  occlude  the  meatus  except  in  its  central  part,  where 
there  was  a  small  aperture.  This  had  admitted  of  the  menstrual  flow  and 
of  impregnation.  A  crucial  incision  was  made  through  it,  and  the  woman 
Avas  then  delivered.  In  one  case  of  pregnancy  with  unruptured  hymen, 
the  membrane  was  dense  and  concave,  admitting  the  point  of  one  finger, 
and  by  gradual  pressure  two  fingers.  This  membrane  was  ruptured  in 
delivery.  (Brit.  Med.  Jour.,  1878,  i.  p.  862.)  These  facts  generally  ad- 
mit of  explanation  by  the  membrane  being  of  abnormal  structure.  Thus 
it  has  been  found  hard,  dense,  fibrous,  resisting,  and  sometimes  small  in 
extent,  thus  only  partially  closing  the  vagina.  Under  opposite  conditions, 
the  persistence  of  this  membrane  might  fairly  lead  to  the  inference  that 
the  female  was  chaste,  and  that  there  had  been  no  intercourse.  In  the 
case  of  Reppingull  v.  Reppingull,  in  which  the  husband  sued  for  a  divorce, 
the  evidence  showed  that  the  wife  had  not  allowed  her  husband  to  have 
intercourse  with  her,  and  the  marriage  had  never  been  consummated.  At 
the  same  time,  it  was  proved  that  she  had  privately  visited  the  co-respon- 
dent ;  but  she  denied  that  there  had  been  any  intercourse.  She  was,  sub- 
sequently to  this,  examined  by  Oldham,  Gervis,  and  Barnes,  and  they 
deposed  from  the  state  of  the  hymen,  that  she  was  still  virgo  intacta. 
On  this  the  jury  found  that  there  had  been  no  adultery. 

The  hvmen  may  be  destroyed  by  ulceration,  as  a  result  of  inflammation 
of  the  genital  organs.     When  the  membrane  has  been  thus  destroyed  by 


RAPE — DEFLORATION.  659 

disease  or  othei*  causes,  or  when  it  is  congenitally  absent,  a  medical  opinion 
must  be  more  or  less  conjectural ;  for  one  intercourse  could  hardly  so 
affect  the  capacity  of  the  vayina  as  to  render  the  fact  evident  through  life, 
and  there  is  no  other  datum  upon  which  an  opinion  could  be  based.  The 
presence  of  the  hymen  is  usually  considered  to  be  quite  incompatible  with 
the  assumption  that  a  woman  has  borne  a  child.  A  question  of  this  kind 
incidentally  aro.se  in  Frazer  v.  Bagley  (Com.  Pleas,  Feb.  1844).  It  was 
alleged  by  the  defendant  that  the  plaintiff,  a  married  man,  had  had  an 
adulterous  intercourse  with  a  young  woman,  and*  that  at  an  antecedent 
period  she  had  left  her  home  for  the  purpose  of  giving  birth  to  a  child 
privately.  Ashwell  was  called  upon  to  examine  the  woman,  and  he  de- 
posed that,  in  his  opinion,  she  was  a  virgin  and  had  never  borne  a  child. 
In  spite  of  this  evidence,  the  jury  returned  a  verdict  for  the  defendant.  "It 
is  quite  possible,  however,  that  abortion  may  take  place  at  the  early 
periods  of  pregnancy,  without  the  necessary  destruction  of  the  hymen. 
(See  Henke,  Zeitschrift,  1844,  Bd.  1,  p.  259.)  Stolz,  after  remarking  on 
the  fact  that  women  may  conceive  without  the  destruction  of  the  hymen 
being  necessarily  involved,  alleges  that  this  membrane  may  still  remain, 
even  after  a  woman  bas  been  delivered  of  a  child.  He  quotes  an  instance 
within  his  own  knowledge  in  which  a  young  woman,  whose  hymen  was 
in  the  form  of  a  ring  or  loose  diaphragm  open  in  the  centre,  Avas  delivered 
without  any  alteration  being  produced  in  it.  It  was  only  destroyed  at 
her  second  delivery.  (Ann.  d'Hyg.,  1873,  t.  2,  p.  148.)  The  peculiar 
form  of  the  hymen  in  this  case  might  account  for  its  persistence.  Such 
cases  must  depend  upon  some  exceptional  conditions  of  the  membrane. 

This  question  is  of  importance,  not  only  as  it  may  affect  the  reputation 
of  a  woman,  but  the  credibility  and  character  of  a  person  who  makes  an 
imputation  of  unchastity.  In  1845,  an  assistant-surgeon  was  brought  to 
a  court-martial  on  the  charge  of  having  deliberately  and  falsely  asserted 
that  on  several  occasions  he  had  had  connection  with  a  woman.  This  was 
denied  by  the  woman,  and  evidence  was  adduced  to  show  that  she  had 
still  what  is  commonly  regarded  as  the  main  sign  of  virginity,  namely, 
an  unruptured  hymen.  In  consequence  of  this,  the  medical  officer  was 
found  guilty,  and  cashiered.  The  woman  was  at  the  time  about  to  be 
married,  and  this  rendered  the  investigation  all  the  more  important  to  her. 
A  surgeon,  who  examined  the  woman,  deposed  that  he  found  the  mem- 
brane of  a  semilunar  form,  and  tensely  drawn  across  the  vagina  ;  and  his 
evidence  was  corroborated  by  that  of  a  midwife.  The  inculpated  person 
took  up  a  double  line  of  defence — first,  that  the  examination  of  the  woman 
was  incomplete  ;  and  second,  that  the  hymen,  if  present,  would  not  justify 
the  witnesses  in  saying  that  intercourse  could  not  possibly  have  taken 
place.  On  the  first  point,  it  is  unnecessary  here  to  make  a  remark;  but  it 
appeared,  from  their  own  admissions,  that  the  witnesses  had  never  before 
examined  women  with  this  particular  object.  Assuming  that  there  was 
no  mistake,  it  becomes  a  question  whether  non-intercourse  could  in  such  a 
case  be  inferred  from  the  presence  of  the  membrane.  Fruitful  intercourse, 
it  is  admitted,  may  take  place  without  rupture  of  the  hymen  ;  but  such 
cases  may  be  regarded  as  of  an  exceptional  nature  (p.  658,  ante).  The 
real  question  is  whether,  unless  the  hymen  be  in  an  abnormal  state,  inter- 
course can  possibly  occur  between  young  and  active  persons  without  a 
rupture  of  this  membrane.  Intercourse  is  not  likely  to  be  confined,  under 
these  circumstances,  to  a  mere  penetration  of  the  vulva.  The  membrane 
in  this  woman  is  stated  to  have  been  tensely  drawn  across  the  canal,  and 
it  was  not  tough  ;  it  was  therefore  in  a  condition  to  render  it  most  easy 
for  rupture.     In  the  case  of  an  old  man,  or  of  one  of  weak  virile  pov/er, 


660       MEDICAL  PROOFS  OF  ALLEGED  UNCHASTITY. 

vulval  intercourse  might  be  had  without  destroying-  the  membrane  ;  but 
such  a  case  could  only  be  decided  by  the  special  circumstances  which 
accompanied  it.  The  presence  of  an  unruptured  hymen  affords  a  pre- 
sumptive, but  not  an  absolute  proof  that  the  woman  is  a  virgin  ;  and  if  of 
the  ordinary  size  and  shape,  and  in  the  ordinary  situation,  it  shows  clearly 
that,  although  attempts  at  intercourse  may  have  been  made,  there  can 
have  been  no  vaginal  penetration.  Admitting  the  statements  of  the  ex- 
aminers to  have  been  correct,  it  is  improbable  that  this  woman  had  had 
sexual  intercourse  several  times,  or  even  on  one  occasion 

In  the  case  of  Delafosse  v.  Fortescue  (Exeter  Lent  Ass.,  1853) — an 
action  for  defamation  of  character — the  plaintiff,  a  married  man,  sei.  64, 
had  been  charged  with  committing  adulter}^  with  a  certain  woman.  Sev- 
eral witnesses  for  the  defendant  positively  swore  that  they  had  seen  these 
persons  in  carnal  intercourse.  This  was  denied  by  the  plaintiff;  and,  as 
an  answer  to  the  case,  medical  evidence  was  tendered  to  the  effect  that  the 
woman  with  w^hom  the  adulterous  intercourse  was  alleged  to  have  taken 
place  had  been  examined  and  the  hymen  was  found  intact.  This  was  ad- 
mitted not  to  be  a  conclusive  criterion  of  virginity.  A  verdict  was  re- 
turned for  the  defendant.  The  form  and  situation  of  the  hymen  in  this 
case  were  not  described  ;  but  it  is  to  be  presumed  that  these  were  not  such 
as  to  constitute  a  physical  bar  to  intercourse,  or  this  would  have  been 
stated  by  the  medical  witness.  Hence  the  persistence  of  the  membrane 
Avas  not  considered  to  disprove  the  allegations  of  eye-witnesses.  In  Howes 
V.  Barber  (Common  Pleas,  June,  1865),  the  defendant  alleged  that  he  had 
seen  the  plaintiff,  as  he  believed,  in  intercourse  with  an  unmarried  woman. 
This  was  denied  by  the  plaintiff  and  the  woman,  and  to  support  this  de- 
nial medical  evidence  was  called  to  show  that  there  had  been  no  inter- 
course. Oldham  and  Barnes  examined  the  lady,  and  deposed  that  the 
hymen  was  entire  and  that  she  was  vii^go  intacta.  In  Scotland  this  kind  of 
medical  evidence  is  not  admissible.  A  wife  sued  the  husband  for  divorce,  on 
the  ground,  inter  alia,  that  he  had  committed  adultery  with  C.  In  defence, 
the  defendant  denied  the  adultery  and  adduced  C.  as  a  witness,  who 
swore  that  such  connection  had  never  taken  place.  She  also  swore  that 
she  had  submitted  to  an  inspectio  corporis  by  Simpson.  The  defendant 
then  proposed  to  examine  Simpson,  that  he  might  speak  to  the  result  of 
his. examination.  He  argued  that  this  was  the  best  evidence  that  he  could 
adduce  in  support  of  his  innocence,  as,  if  the  girl  were  still  a  virgin,  the 
adultery  alleged  could  not  have  been  committed.  The  court  refused  to 
admit  the  evidence,  on  the  ground  that  it  was  merely  in-  the  form  of  an 
opinion;  that  other  medical  men  might  differ  from  him,  even  from  the 
same  observations;  and  that,  as  the  court  could  not  compel  C  to  submit 
to  another  examination,  the  proposed  evidence  must  be  considered  ex 
parte  and  inadmissible.  (Sess.  Cases,  Edin.,  Feb.  1860.)  In  Hunt  v. 
Hunt,  a  verdict  was  obtained  against  the  alleged  paramour  in  a  case  of 
adultery,  and  the  damages  were  assessed  at  50^.  It  was  subsequently 
proved  that  the  lady  was  virgo  intacta.  But  so  long  as  there  are  facts 
Avhich  show  that  women  have  actually  conceived  with  the  hymen  still  in 
its  normal  state,  it  is  inconsistent  to  apply  the  term  "  virgo  intacta  "  to 
women  merely  l)ecause  this  membrane  is  entire.  A  woman  may  assuredly 
have  an  unruptured  hymen,  and  yet  not  be  a  virgo  ivtacta.  This  can  be 
decided  only  by  the  special  circumstances  proved  in  each  case.  Such 
virgines  intacfae  hsive  fve({uer\t]y  required  the  assistance  of  accoucheurs, 
and  in  due  time  have  been  delivered  of  children  (p.  658  ante). 

A  question  of  this  kind  arose  in  Reg.  r.  Harmer  (C.  C.  C,  June,  1812). 
The  prisoner  was  indicted  for  perjury.    He  was  a  waiter  at  a  tavern,  and, 


MEDICAL  PROOFS  OP  ALLEGED  UNCHASTIXy.        661 

being'  called  as  a  witness  in  a  divorce  suit,  swore  that  he  had  soon  the 
parties  in  adulterous  intercourse  on  more  than  one  occasion.  Tlie  lady 
with  whom  the  adultery  was  alleged  to  have  been  coniniitted  denied  this 
on  oath,  and  Lee  and  another  medical  expert  gave  evidence  that  they  had 
examined  this  lady,  and  found  her  to  be  a  virgo  intacta,  no  doubt  from 
the  persistence  of  the  hymen.  The  recorder,  in  summing  up,  told  the  jury 
that  this  evidence  was  of  the  highest  importance,  and  it  was  for  them  to 
consider  whether  it  was  sufficient  to  satisfy  them  of  the  guilt  of  the  pris- 
oner.    He  was  found  guilty. 

In  reference  to  these  cases  of  persistent  hvmen,  it  is  a  question  whether 
medical  men,  in  forming  an  opinion,  have  sufficiently  considered  the  varia- 
ble structure  of  this  membrane.  It  has  been  found  to  consist  in  some  in- 
stances of  tough  fibrous  or  fibro-elastic  tissue,  and  in  such  cases  it  might 
remain  unruptured  in  married  life  as  well  as  in  oases  of  actual  rape.  St. 
Clair  Grray  has  properly  directed  the  attention  of  the  profession  to  this 
subject.  What  may  be  true  of  a  thin  semilunar  membrane  placed  in  its 
normal  position  will  not  be  applicable  to  those  instances  in  which  its 
structure  is  abnormal!}^  firm,  hard,  and  resisting.  He  published  several 
cases  (Glasgow  Med.  Jour.,  1873,  p.  346)  which  show  that  the  hymen 
may  be  persistent  for  years  in  married  women,  in  spite  of  attempts  at  in- 
tercourse. In  one  case,  a  woman,  get.  43,  who  had  been  married  twenty- 
four  years,  the  hymen  was  found  by  him  entire — closing  the  meatus,  with 
the  exception  of  a  small  aperture  which  allowed  of  the  menstrual  flow.  In 
a  second  case,  a  woman,  get.  30,  had  been  married  ten  years  and  was  child- 
less. On  examination  the  hymen  was  found  entire,  and  its  persistence 
was  evidently  due  to  the  presence  in  the  tissue  of  fibrous  or  fibro-elastic 
bands,  which  rendered  the  structure  as  a  whole  very  resilient.  In  this 
case  the  hymen  was  forcibly  ruptured  by  a  speculum.  In  three  cases  of 
women  who  had  been  living  in  habits  of  prostitution  for  seven,  eight,  and 
eleven  years  respectively,  the  hymen  was  found  unruptured.  Its  structure 
in  these  instances  also  accounted  for  its  persistence.  In  all  it  was  firm 
and  elastic,  and  in  one  of  them  it  had  almost  a  cartilaginous  hardness. 

From  cases  already  quoted,  these  facts,  it  will  be  seen,  acquire  some 
medicolegal  importance.  Intercourse  may  have  taken  place,  although 
the  hymen  is  found  entire.  In  spite  of  its  presence,  a  woman  may  have 
been  guilty  of  a  want  of  chastity.  Even  rape  might  be  attempted,  and 
legally  perpetrated  on  adult  women  without  necessarily  rupturing  this 
membrane.  Married  women  have  not  always  been  conscious  of  this  ab- 
normal condition,  but  a  woman  desirous  of  separating  from  a  husband 
might  sue  fur  a  divorce  on  the  ground  that  the  marriage  had  never  been 
consummated  ;  and  a  medical  man  unacquainted"  with  these  facts  might  give 
an  erroneous  opinion  from  this  persistent  condition  of  the  hymen,  Tardieu 
has  given  excellent  illustrations  of  the  various  forms  of  hymen,  (Atten- 
tats sur  les  Moeurs.) 


6t)2  EAPE    ON    ADULT    WOMEN. 


CHAPTER    LX. 

RAPE    OX    MAKBIED    AXD    ADVLT    WOMEX. CIKCUMSTAXCES    rXDEE    WHICH    IT    MAT    BE    PEK- 

PETEATED    OS    ADULT    WOMEX. LOSS    OF    PHYSICAL    EVIDENCE. PEEGXANCY    FOLLOWING 

EAPE  MICEOSCOPICAL    EVIDEXCE. SODOMY. 

On  Ilarried  and  Adult  Women. — The  remarks  already  made  apply 
generally  to  married  women,  with  this  diliereuce,  that  when  a  woman  has 
already  been  in  habits  of  sexual  intercourse,  there  is  commonly  much  less 
injury  done  to  the  genital  organs.  The  hymen  will  in  these  cases  be 
found  destroyed,  and  the  vulva  dilated.  Still,  as  the  intercourse  is  pre- 
sumed to  be  against  the  consent  of  the  woman,  it  is  most  likely  that  when 
there  has  been  a  proper  resistance  some  injury  will  be  apparent  on  the 
pudendum;  and  there  will  be  also,  probably,  extensive  marks  of  violence 
on  the  bodv  and  limbs.  Such  cases  are  generally  determined  without 
medical  evidence,  by  the  deposition  of  tho  woman,  corroborated,  as  it 
should  always  be,  by  circumstances.  This  statement  regarding  the  pres- 
ence of  marks  of  violence  on  the  pudendum  of  a  married  woman,  on 
whom  a  rape  is  alleged  to  have  been  committed,  requires  some  qualifica- 
tion. In  two  cases  of  rape  on  married  women,  in  Avbich  the  crime  was 
completed  in  spite  of  the  resistance  of  the  women,  there  were  no  marks  of 
violence  on  the  genital  organs  in  either  case.  (Reg.  v.  Owen  and  others, 
Oxford  Circ,  1839.)  This  may  happen  when  the  assailant  is  aided  by 
accomplices. 

On  the  other  hand,  the  vagina  alone  may  be  the  seat  of  violence,  and  no 
marks  to  indicate  a  struggle  or  the  application  of  force  be  found  on  the 
body.  In  1862,  a  woman  was  knocked  down,  her  clothes  were  pulled 
over  her  face,  and  the  crime  of  rape  was  perpetrated  by  the  assailant.  In 
the  position  in  which  she  was  held,  with  her  arms  and  hands  covered 
over,  she  was  half  suffocated,  and  unable  to  offer  any  effectual  resistance. 
She  was  examined  on  the  evening  of  the  day  of  the  assault.  No  marks 
of  violence  on  her  body  were  found,  but  the  mucous  membrane  of  the 
vao-ina  at  its  commencement  was  confused,  and  lacerated  in  some  portions, 
with  blood  oozinq:  from  them.  It  was  considered  that,  under  these  cir- 
cumstances, the  statement  of  the  woman  was  consistent  with  the  fact  that 
there  were  no  marks  of  violence  on  her  body.  There  was  no  reason  to  sup- 
pose that  the  injury  to  the  vagina  had  been  caused  in  any  other  way  than 
by  a  criminal  assault. 

*  When  a  charge  of  rape  is  made  by  a  prostitute,  it  is  justly  received  with 
suspicion,  and  the  case  is  narrowly  scrutinized.  Something  more  than 
medical  evidence  would  be  required  to  establish  a  charge  under  these  cir- 
cumstances. The  question  turns  here,  as  in  all  cases  of  rape  upon  adult 
women,  on  the  fact  o^  consent  having  been  previously  given  or  not.  This 
is  the  point  at  Avhich  the  greater  number  of  these  cases  of  alleged  rape 
break  down  ;  and  it  need  hardly  be  observed,  that  this  question  has  no 
relation  to  the  duties  of  a  medical  witness:  all  that  he  can  do  is  to  estab- 
lish, occasionally,  whether  or  not  sexual  intercourse  has  been  had  with  or 
Mithout  some  violence.  It  is  obvious  that  there  may  be  marks  of  vio- 
lence about  the  pudendum,  or  on  the  person,  and  yet  the  conduct  of  the 
woman  may  have  been  such  as  to  impl\-  consent  on  her  part :  we  must 


RAPE  ON  ADULT  WOMEN.  603 

not  suppose  that  medical  proof  of  intercourse  is  tantamount  to  legal  proof 
of  rape. 

Fossibilitij  of  perpetrating  Rape  on  Adult  Women. — Some  medical 
jurists  have  argued  that  a  rape  cannot  be  perpetrated  on  an  adult  woman 
of  g-ood  health  and  vigor ;  and  they  have  treated  all  accusations  made 
under  these  circumstances  as  false.  Whether,  on  any  criminal  charge,  a 
rape  has  been  committed  or  not,  is  of  course  a  question  of  fact  for  a  jury, 
and  not  for  a  medical  witTie.ss.  The  fact  of  the  crime  having  been  actually 
perpetrated  can  be  determined  only  from  the  evidence  of  the  prosecutrix  and 
of  other  witnesses ;  still,  a  medical  man  may  be  able  to  point  out  to  the 
court  circumstances  which  might  otherwise  escape  notice.  Setting  aside 
the  cases  of  infants,  idiots,  lunatics,  and  weak  and  delicate  or  aged  women, 
it  does  not  appear  probable  that  intercourse  could  be  accomplished  against 
the  consent  of  a  healthy  adult,  except  under  the  following  conditions: — 

1.  When  the  state  of  unconsciousness  arises  from  natural  infirmity,  as 
in  idiocv  or  iral)ecility,  carnal  intercourse  with  a  woman  is  regarded  as 
rape.     (48  and  49  Vict.,  c.  69.) 

2.  When  narcotics  or  intoxicating  liquids  have  been  administered  to 
her,  either  by  the  prisoner  or  through  his  collusion,  provided  that  the 
intent  be  to  stupefy  or  overpower,  with  the  intention  of  having  intercourse 
with  the  woman.  The  nature  of  the  substance  whereby  insensibility  is 
produced  is,  of  course,  unimportant.  Thus  the  vapors  of  ether  and  chlo- 
roform have  been  criminally  u.sed  in  attempts  at  rape.  In  a  case  which 
occurred  in  France,  a  dentist  was  convicted  of  a  rape  upon  a  woman,  to 
whom  he  had  administered  the  vapor  of  ether.  The  prosecutrix  was  not 
perfectly  unconscious,  but  she  was  rendered  wholly  unable  to  offer  any  re- 
sistance. (Lond.  Med.  G-az.,  vol.  xl.  p.  865.)  A  dentist  was  convicted  of 
rape  under  somewhat  similar  circumstances  in  the  United  States;  but  it 
was  thought  that  tlie  woman  had  made  the  charge  under  some  hallucina- 
tion or  delusion.  In  Reg.  v.  Snarey  (Winchester  Lent  Ass.,  18.59),  there 
was  a  clear  attempt  at  fraud.  The  complainant  asserted  that  she  was 
indanthj  rendered  insensible  by  the  prisoner  forcibly  applying  a  handker- 
chief to  her.fa'ce,  and  she  accused  him  of  having  committed  a  rape  on  her. 
The  charge  was  disproved  by  a  distinct  alibi,  as  well  as  by  the  improba- 
bility of  all  the  circumstances.  Nevertheless,  these  cases  must  be  viewed 
with  extreme  suspicion.  It  is  sometimes  difficult  to  convince  a  respect- 
able woman,  on  recovery  from  the  effects  of  an  amesthetic,  that  a  criminal 
'attempt  had  not  been  made  upon  her  ;  and  the  efforts  made  to  force  a 

woman  down  during  the  administration  of  the  anaesthetic,  and  whilst  she 
is  in  a  state  of  semi-consciousness,  are  apt  to  be  misinterpreted.  In  one 
instance  a  young  lady  was  accompanied  to  a  dentist  by  her  affianced  lover, 
who  never  left  her  whilst  an  anaesthetic  was  administered  and  a  tooth  ex- 
tracted. Yet  this  lady  could  scarcely  be  convinced  subsequently  that  the 
dentist  had  not  attempted  to  ravish  her.  In  Reg.  v.  Collier  and  Jones 
(Durham  April  Ass.,  1885),  the  prisoners,  two  young  men,  dosed  a  girl, 
a3t.  IT,  with  brandy  till  she  was  in  a  semi-intoxicated  state,  dragged  her 
into  a  field,  and  in  turn  each  had  connection  with  her,  the  other  man 
holding  the  woman  to  prevent  resistance.  Ten  hours  after,  when  ex- 
amined by  Arthur,  there  was  no  bruising  visible,  and  no  injury  beyond 
such  as  would  result  from  a  first  connection  with  consent.  Penetration 
had  been  complete,  and  the  vaijinal  mucus  contained  spermatozoa.  The 
only  external  injury  was  a  slight  abrasion  of  the  back  of  each  elbow. 

In  Reg.  V.  White  (Northampton  Wint.  Ass.,  1856),  the  judge,  in 
charging  the  jury,  stated  that  some  doubts  were  entertained  whether  the 
crime  of  rape  could  be  committed  (in  law)  on  the  person  of  a  woman  who 


664:  RAPE    ON    ADULT    WOMEiST. 

had  rendered  herself  perfectly  insensilDle  by  drink  so  as  to  be  unable  to 
make  any  resistance  :  he  thought  it  could  not  be  alleged  as  an  excuse  for 
the  man.  The  question  was  not  reserved,  as  the  prisoner  Avas  acquitted 
of  rape,  and  found  guilty  of  an  indecent  assault.  But  if  a  person  applies, 
administers,  or  causes  to  be  taken  by  any  woman  or  girl  any  drug, 
matter,  or  thing,  with  intent  to  stupefy  or  overpower,  so  as  thereby  to 
enable  anv  person  to  have  unlawful  carnal  connection  with  such  woman 
or  girl,  he  or  she  is  guilty  of  a  misdemeanor  (48  and  49  Vict.,  c. 
69,  s.  3.) 

It  may  be  a  question  whether  a  man  can  have  intercourse  with  a  woman 
without  her  knowledge  while  in  a  state  of  unconsciousness  from  statural 
sleep.  Casper  met  with  a  solitary  case  in  which  a  girl,  aet.  16,  accused  a 
man  of  having  had  intercourse  with  her  while  she  was  sleeping  in  her  bed, 
of  which  she  was  not  conscious  until  he  was  in  the  act  of  withdrawing 
from  her.  According  to  her  own  statement,  she  was  virgo  intacta  up  to 
the  date  of  this  occurrence.  Upon  the  facts  of  the  case,  Casper  came  to 
the  conclusion  that,  if  her  statement  was  true,  the  man  could  not  have  had 
intercourse  with  her  without  causing  pain  and  rousing  her  to  a  conscious- 
ness of  her  position.  The  hymen  was  not  destroyed,  but  presented  lacei'a- 
tions  in  two  places.  This  and  other  facts  showed  that  there  had  been 
intercourse,  but  did  not  prove  that  this  had  taken  place  without  the 
consciousness  of  the  woman.  (Klin.  Novellen,  1863,  p.  31  )  A  man  was 
charged  with  rape,  and  the  prosecutrix  swore  that  be  had  effected  his 
purpose  during  her  sleep.  The  bare  possibility  of  the  offence  being  per- 
petrated under  these  circumstances  cannot  be  denied;  but  this  admission 
could  only  apply  to  a  case  in  which  the  woman  had  been  accustomed  to 
sexual  intercourse,  and  in  which  the  sleep  was  preternatural  or  . lethargic. 
In  this  instance  the  woman  was  a  prostitute,  and  the  charge  improbable. 
The  respectable  wife  of  an  innkeeper,  who  had  children,  threw  herself 
on  her  bed  with  her  clothes  on  late  one  evening  and  fell  fast  asleep.  She 
Avas  first  awakened  by  finding  a  man  upon  her  body  in  the  act  of  with- 
drawing from  her.  This  man,  McEwan,  a  servant  in  the  house,  was 
given  into  custody  on  a  charge  of  rape.  In  the  first, instance  he  did  not 
deny  the  act,  and  there  was  no  reason  to  believe  that  the  prosecutrix  was 
aware  of  the  prisoner's  conduct  until  the  crime  was  completed,  and  she 
was  awakened  in  the  manner  described,  apparently  by  the  weight  of  the 
prisoner's  body.  The  prisoner  was  convicted.  (Edin.  Month.  Jour., 
1862,  ii.  p.  570.)  A  case  which  may  serve  to  throw  light  upon  this 
question  occurred  to  Casper.  (Gerichtl.  Med.,  Bd.  2,  p.  574.)  A  married 
woman  alleged  that  a  man  had  had  intercourse  with  her  while  in  bed  and 
when  she  was  asleep.  In  her  depo.sition,  however,  she  admitted  she  was 
con.scious  that  some  one  was  lying  upon  her  and  that  she  asked  who  it 
was — showing,  as  Casper  remarks,  that  she  had  a  knowledge  of  what  was 
going  on,  and  some  doubt  whether  the  person  was  her  husband. 

In  reference  to  this  question  whether  it  is  possible  to  commit  a  rape 
upon  a  woman  while  asleep,,  a  majority  of  the  Scotch  judges  decided,  in 
the  case  of  Sweenie  (Irvine's  Just.  Rep.,  vol.  3,  p.  109),  that  the 
feloniously  having  connection  with  a  woman  while  asleep  was  not  indict- 
able under  the  name  of  rape,  inasmuch  as,  apart  from  the  force  implied 
in  the  act  of  connection  there  was  no  force  used  to  overcome  the  will  of 
the  woman.  But  they  held,  however  improbable  it  might  be,  it  was  quite 
possible  that  a  man  might  have  connection  with  a  woman  while  asleep. 
(Edin.  Month.  Jour.,  1862,  ii.  p.  570  ) 

The  condition  of  the  so-called  magnetic  or  unnatural  (hypnotic)  sleep 
has  given  rise  to  a  question   connected  with  the  alleged  perpetration  of 


RAPE    DURING    SLEEP.  66o 

rape.  A  ,Q:ir],  xt.  18,  consulted  a  therapeutic  niagnetizer  as  to  her  health. 
She  visited  him  daily  for  some  days.  Four  months  and  a  half  afterwards 
she  discovered  that  she  was  preg-iiant,  aud  made  complaint  to  the  autliori- 
ties  a:^'ainst  the  magnetizer.  They  directed  a  physician  and  surgeon  to 
determine  the  date  of  her  pregnancy,  and  whetlier  the  complainant  might 
have  then  been  violated  and  rendered  pregnant  contrary  to  her  will;  i.  e. 
whether  her  volition  could  have  been  completely  or  partially  annihilated 
by  magnetism.  The  medical  inspectors  were  satisfied  that  the  pregnancy 
did  not  extend  further  back  than  four  months  and  a  half;  and  founding 
their  opinion  on  Husson's  report  made  to  the  Academy  in  1831,  con- 
cluded that,  as  a  person  in  magnetic  sleep  is  insensible  to  every  kind  of 
torture,  sexual  intercourse  might  then  take  place  with  a  young  woman 
without  the  participation  of  her  will — without  consciousness  of  the  act, 
and  consequently  without  the  power  to  resist  the  act  consummated  on 
her.  This  opinion  was  confirmed  by  that  of  Deveruie.  (Gaz.  MeJ.  de 
Paris,  and  Edin.  Month.  Jour.,  1860,  ii.  p.  566.)  There  is  another  view 
of  this  case  which  does  not  seem  to  have  occurred  to  the  French  medical 
experts,  namely  :   "  Non  omnes  dormiunt  quoe  clauses  habent  oculos." 

A  trial  for  rape  took  place  at  Rouen  Assizes  (Aug.  1878),  in  which  a 
new  theory  was  suga-ested  by  certain  French  physicians.  A  girl,  get.  20, 
consulted  a  dentist  (Levy),  w^ho  placed  her  in  his  professional  chair,  and 
brought  her  to  a  horizontal  position.  He  was  charged  with  committing 
a  rape.  There  was  no  doubt  that  intercourse  had  taken  place,  and  the 
dentist  admitted  it, — but  that  it  was  with  the  consent  of  the  girl.  Her 
statement  was  that  the  accused  passed  something  over  her  gums  which 
gave  a  sensation  of  burning-.  In  a  few  minutes  she  lost  all  consciousness, 
and  when  she  awoke  she  felt  pain  in  her  sexual  organs,  aud  there  were 
marks  of  blood  on  her  thighs.  No  examination  was  made  for  two  months, 
Four  physicians  who  gave  evidence  as  experts  agreed  that  no  anfesthefic 
had  been  used,  but  that  the  girl,  being  of  an  excitable  temperament,  had 
fallen  at  the  time  into  an  hysterical  sleep,  in  which  she  would  not  be  con- 
scious of  the  act.  One  of  them  thought  it  might  have  been  owing  to 
hypnotism  induced  by  the  dentist.  It  seems  that  during  this  time  the 
mother  was  in  the  room  with  her,  and,  although  the  girl  uttered  a  cry, 
she  did  not  interfere,  not  suspecting  anything  wrong.  The  dentist  was 
convicted.  This  theory  of  hysterical  sleep  coming  on  suddenly,  aud 
being  so  profound  as  to  destroy  all  consciousness  of  a  first  intercourse,  is 
not  supported  by  any  experience.  It  is  far  more  probable  that  the  woman 
retained  a  sufficient  amount  of  consciousness  to  resist  the  assailant,  or  that, 
if  partially  stupefied  from  any  cause,  she  would  have  been  roused  by  the  act. 

3.  A  rape  may  be  committed  on  an  adult  woman  if  she  falls  into  a  state 
of  syncope,  or  is  rendered  powerless  by  terror  and  exhaustion  from  long 
struggling  with  her  assailant.  Lord  Justice  Clerk  Hope  suggested  to  the 
author  that,  in  his  opinion,  too  great  distrust  is  commonly  shown  in  refer- 
ence to  the  amount  of  resistance  offered  by  women  of  undoubted  character. 
Inability  to  resist  from  terror,  or  from  an  overpowering  feeling  of  help- 
lessness, as  well  as  horror  at  her  situation,  may  lead  a  woman  to  succumb 
to  the  force  of  a  ravisher,  without  offering  that  degree  of  resistance  which 
is  generally  expected  from  a  woman  so  situated.  As  a  result  of  long  ex- 
perience he  thought  that  injustice  was  often  done  to  respectable  women  by 
acting  on  the  opinion  that  resistance  was  not  continued  long  enough. 

4.  When  several  are  combined  against  the  woman,  in  which  case  we 
may  expect  to  find  some  marks  of  violence  on  her  person,  if  not  on  the 
genital  organs. 

Recently  two  youths,  each  ast.  IG,  were  tried  for  the  rape  of  a  girl  ast. 


666  PREGNANCY    FOLLOWING    RAPE. 

14,  but  who  appeared  somewhat  older  (Reg.  v.  Goldingand  Neal,  C.  C.  C, 
March,  1891).  It  was  alleged  that  the  girl  was  seized  by  the  arms  by 
Neal  and  held  against  some  palings,  whilst  Goldiug  had  connection  with 
her,  she  being  in  the  standing  posture.  She  then  ran  away  ;  but  was 
pursued  and  seized  by  the  arms  by  Golding,  whilst  Neil  now  had  con- 
nection, standing.  The  girl  went  home  agitated,  but  made  no  complaint 
to  her  mother,  who  next  day  washed  the  girl's  under-linen,  but  observed 
nothing  unusual.  When  niedicallyexamined  six  days  after  the  occurrence 
the  vagina  was  dilated  and  inflamed  and  the  hymen  ruptured  and  healed. 
The  connection  was  not  denied,  the  defence  being  that  the  girl,  who  had 
been  sliding  on  the  ice  with  the  boys,  was  an  inviting  party.  There  was 
an  acquittal  on  the  charge  of  rape,  and  a  conviction  for  intercourse  with  a 
girl  under  sixteen  years  of  age.  It  seems  impossible  for  a  youth  to  rape 
a  girl  whilst  standing,  since  mere  stooping,  or  bowing  of  the  body,  when 
held  by  the  arms,  would  suffice  to  prevent  penetration. 

5.  A  woman  may  yield  to  a  ravisher  under  threats  of  death  or  duress  ; 
in  this  case  her  consent  does  not  excuse  the  crime,  but  this  is  rather  a 
legal  than  a  medical  question.  An  aged  woman  can  scarcely  be  expected 
toresist  a  strong  man.  Chevers  mentions  a  case  in  which  a  man  was  con- 
victed of  rape  and  aggravated  assault  on  a  woman  of  seventy  years  of  age. 
Rape  may  be  perpetrated  on  a  female  at  any  age.  Rape  on  female  in- 
fants and  children  are,  as  has  been  already  stated,  frecpent.  Boys  have 
been  on  several  occasions  convicted  of  rape  on  young  females.  At  the 
Lewes  Sum.  Ass.,  1874,  a  boy  of  14  was  convicted  of  a  rape  on  a  girl 
under  12.  The  boy  confessed  the  circumstances  with  great  frankness  and 
apparent  unconsciousness  of  the  nature  and  gravity  of  the  offence. 

Loss  of  Physical  Evidence. — It  is  necessary  to  observe,  in  relation  to 
the  examination  of  married  women,  that  the  indications  of  rape  on  the 
genitals,  however  well  marked  they  may  have  been  in  the  first  instance, 
either  soon  disappear  or  become  obscure,  especially  in  those  Avho,  have  been 
already  habituated  to  sexual  intercourse.  After  two,  three,  or  four  days, 
unless"  there  has  been  an  unusual  degree  of  violence,  no  traces  of  the  crime 
may  be  found  about  the  genital  organs.  In  the  ca.se  of  an  adult  married 
woman  examined  by  Mayne,  the  appearance  of  injury  which  he  discov- 
ered in  and  about  the  vagina  had  begun  to  heal  in  less  than  forty-eight 
hours ;  but  in  a  case  examined  by  Casper  on  the  ninth  day  the  lining 
membrane  of  the  vagina  was  still  reddened,  and  the  parts  were  still  pain- 
ful. In  married  women,  or  in  those  accustomed  to  sexual  intercourse,  no 
inference  can  be  drawn  from  a  dilated  state  of  the  vagina.  In  unmarried 
women,  and  in  children  where  there  has  been  much  violence,  these  marks 
may  persi-st  and  be  apparent  for  a  week  or  longer.  If  there  has  been  any 
great  lacei'ation  of  the  sexual  organs  then  certain  appearances  in  the  form 
of  cicatrices  may  remain  ;  but  in  all  cases  great  caution  should  be  ob- 
served in  giving  an  opinion  of  rape  having  been  perpetrated,  from  an  ex- 
amination made  two  or  three  Aveeks  after  the  alleged  commission  of  the 
offence.  Marks  of  violence  on  the  person  can  never  establish  a  rape  ;  the}- 
merely  indicate,  axteris  paribus,  that  the  crime  may  have  been  attempted. 
Pregnancy  following  Rape. — It  has  l^een  a  question  whether,  when  in- 
tercour.se  has  taken  place  against  the  will  of  the  woman,  i.  e.  in  the  per- 
petration of  rape  by  violence,  pregnancy  could  possibly  follow.  It  was  at 
one  time  thought  that  the  will  of  a  woman  was  always  necessary  to  the 
act  of  impregnation,  and  therefore  if  she  became  pregnant  she  must  have 
con.sented  to  the  act  and  that  the  charge  of  rape  was  unfounded.  Such  a 
defence  would  neither  be  admitted  as  an  answer  to  a  charge  of  rape,  nor 
show,  under  any  circumstances,  that  intercourse  had  been  had  with  con- 


MICROSCOPICAL    EVIDENCE.  667 

sent.  Conception  does  not  depend  on  the  consciousness  or  volition  of  a 
woman.  If  the  uterine  organs  be  at  the  time  in  a  condition  favorable  to 
impregnation,  this  ma v  take  place  as  readily  as  if  the  intercourse  had  been 
voluntary;  even  penetration  to  the  vagina  is  not  absolutely  necessary  for 
impregnation.  (Lond.  Med.  Gaz.,  vol.  xliv.  p.  48.)  A  woman  became 
pregnant  after  a  rape  committed  on  her  by  a  man  who  subsequently  mar- 
ried her;  the  date  of  intercour.se  was  thereby  accurately  fixed,  and  a  child 
was  born  after  2G3  days'  gestation.  (See  also  Stolz,  Ann.  d'Hyg.  1873 
t.  2,  p.  146.) 

It  has  been  supposed  that,  in  ca.ses  of  pregnancy  following  rape,  in  spite 
of  resistance  at  first,  a  woman  may  in  the  end  have  voluntarily  joined  in 
the  act.  We  know  of  no  ground  for  adopting  this  theory;  the  general 
opinion  is  that  conception  may  occur,  and  is  neither  accelerated  nor  pre- 
vented by  the  volition  of  the  sexes.  Many  women  in  married  life  who 
anxiously  wish  for  children  have  none,  and  vice  versa;  and  phy.sical  im- 
pediments do  not  suffice  in  all  cases  to  explain  these  facts.  Women  are 
reported  to  have  conceived  during  the  states  of  asphyxia,  intoxication,  or 
narcotism.  Ryan  mentions  a  case  in  which  a  young  woman  became  un- 
consciously pregnant  from  intercourse  had  with  her  by  a  man  while  she 
was  in  a  state  of  intoxication,  and  in  v\rhich  it  was  clearly  impossible  that 
her  volition  could  have  taken  any  share.  (Med.  Jurispr.,  p.  245.)  In 
married  life  women  frequently  become  pregnant  against  their  will,  and  in 
a  great  number  of  cases  without  any  consciousness  of  their  condition  until 
pregnancy  is  far  advanced.  Those  who  affirm  that  without  the  active  will 
of  the  woman  there  can  be  no  conception,  must  deny  the  existence  of  cases 
of  impregnation  in  a  state  of  unconsciousness  (see  ante)  ;  but  the  facts 
are  too  strong  and  too  numerous  to  be  met  with  a  simple  denial.  A  med- 
ical jurist,  therefore,  who  relied  upon  pregnancy  following  alleged  rape  as 
a  proof  of  consent  on  the  part  of  a  woman,  and  who  would  infer  from  this 
result  that  the  intercourse  must  have  been  voluntary  on  her  part,  would 
inflict  great  injustice  by  such  an  opinion.  The  extrusion  of  an  ovum  does 
not  depend  on  the  will  of  a  woman,  but  it  is  a  periodical  condition;  the 
action  of  the  spermatozoa  on  the  ovum  is  as  much  removed  from  the  will 
of  the  woman  as  it  is  from  that  of  the  man. 

This  subject  would  have  hardly  required  so  much  notice  but  for  the  fact 
that  in  some  trials  it  has  been  put  forward  with  a  view  to  discredit  the 
evidence  of  a  woman,  where  pregnancy  has  followed  intercourse  in  a  state 
of  alleged  unconsciousness.  Any  statement  of  this  kind  certainly  re- 
quires a  close  examination,  because  generally  there  is  a  strong  motive 
for  falsehood  on  the  part  of  the  woman.  In  the  case  of  Bromwich  v. 
Waters  (see  ante),  the  woman  Whalley  had  had  a  child,  but  stated  that 
she  had  not  been  conscious  of  any  intercourse.  The  fact  that  she  had 
borne  a  child  did  not  prove  that  her  statement  was  false,  although  a  sug- 
gestion to  this  effect  was  made.  We  ma)^  fairly  doubt  whether  a  woman 
could  have  intercourse  unconsciously,  but  because  impregnation  follows 
this  is  no  proof  that  she  is  guilty  of  falsehood  or  perjury. 

Microscopical  Evidence. — As  part  of  the  medical  evidence  in  cases  of 
rape  it  may  be  necessary  to  examine  spots  or  stains  on  the  linen  of  the 
prosecutrix  and  the  accused.  Cases  of  rape  are,  however,  commonly  tried 
in  this  country  without  reference  to  this  species  of  evidence  ;  and  it  is  not 
easy  to  perceive  how  this  can  be  necessary  to  the  proof  of  the  crime  in 
the  living,  when  the  present  law  of  England  demands  only  proof  of  pene- 
tration, and  not  of  emission.  Thus,  a  rape  may  be  legally  completed 
without  reference  to  emission  ;  and,  medically  speaking,  it  appears  quite 
possible  that  there  might  be  marks  of  emission  without  any  penetration, 


668  MICROSCOPICAL    EVIDENCE. 

as  in  a  protracted  resistance  on  the  part  of  a  woman.  Admitting'  that 
certain  stains  of  this  description  are  found  on  the  clothes  of  an  accused 
person,  are  these  to  be  taken  as  furnishing  undeniable  proof  of  the  legal 
completion  of  rape  by  penetration  ?  It  appears  that,  without  corrob- 
orative evidence  from  the  state  of  the  female  organs,  thev  cannot  be  so 
taken  ;  and  therefore  the  affirmative  evidence  from  the  microscope,  under 
these  circumstances,  is  as  liable  to  lead  to  error  as  that  which  is  purely 
negative.  The  fact  that  spermatic  stains  are  found  on  the  linen  of  the 
prosecutrix  may,  however,  become  occasionally  of  great  importance  in 
charges  of  assault  with  intent. 

Examination  of  Stains. — There  are  no  chemical  tests  on  which  we 
can  safely  rel}^  for  the  detection  of  spermatic  stains.  The  appearance  pro- 
duced by  a  dried  spermatic  stain  on  linen  or  cotton  is  like  that  produced 
In'  a  diluted  solution  of  albumen.  The  fibre  of  the  stuff"  is  stiffened,  and 
the  stain,  particularlv  at  the  margin,  has  a  slightly  translucent  appeai'- 
ance,  as  if  the  stuff  had  been  wetted  bv  diluted  gum  or  albumen,  but  with- 
out any  shining  lustre.  In  the  dry  state  the  stains  present  no  well-marked 
color  or  odor.  Slips  of  the  stained  linen,  when  soaked  in  water,  yield  a 
slightly  alkaline,  opaque,  muco-albuminous  liquid.  This  liquid,  unlike  a 
solution  of  albumen,  is  rendered  rather  strongly  yellow  by  diluted  nitric 
acid.  By  the  action  of  warm  water  the  stained  linen,  even  although  it 
may  have  been  kept,  dry  for  a  considerable  period,  has  been  observed  to 
evolve  the  peculiar  faint  odor  of  the  spermatic  secretion. 

The  stained  linen,  or  a  part  of  it,  should  be  cut  into  small  pieces,  taking 
care  that  it  is  not  roughly  handled.  These  should  be  placed  in  a  watch- 
glass,  with  a  sufficiency  of  a  3  per  cent  solution  of  common  salt  to  soak  it 
thoroughly,  and  to  alloAV  the  fibre  of  the  stuff  to  become  quite  penetrated 
by  the  water.  It  is  advisable  not  to  move  the  stuff  or  agitate  the  liquid, 
but  to  allow  it  to  be  quietly  imbibed.  The  watch-glass  should  be  covered 
so  as  to  prevent  evaporation.  After  half  an  hour,  the  fibres  may  be 
turned  and  allowed  to  macerate  for  some  time  longer.  The  stained  linen 
may  then  be  removed,  and  the  soaked  fibres  of  the  stuff"  gently  pressed  on 
several  glass  slides.  The  liquid  thus  obtained  by  pressing  the  stained 
linen  is  slightly  opaline.  It  is  found  that  this  opalescence  is  removed  by 
the  addition  of  a  small  quantity  of  ammonia  or  diluted  acetic  acid  ;  these 
liquids  do  not  aff"ect  the  forms  of  the  spermatozoa.  Care  must  be  taken 
not  to  use  more  liquid  than  is  actually  required  to  moisten  the  stained  stuff 
and  to  allow  a  small  portion  to  be  pressed  out  of  it. 

The  liquid  on  the  slide  may  be  then  covered  with  thin  glass,  and  ex- 
amined under  the  microscope.     The  dead  spermatozoa  may  then   be  seen 

as   in    the   annexed    engraving    (Fig.    55). 
Fig.  55.  They  have  flattened  ovoid  heads,  with  long, 

tapering  tails  which  are  from  nine  to  twelve 
times  the  length  of  the  head.  They  are 
usually  associated  with  granular  bodies  and 
epithelial  scales.  Fibres  of  cotton,  linen,  or 
woollen  ma}^  be  mixed  with  them,  and  there 
may  be  also  pus,  mucus,  or  blood-globules. 
Their  form  is  so  peculiar  that,  when  once 
well  seen  and  examined,  they  cannot  be  con- 
founded with  any  other  substance,  veget- 
able or  animal,  nor  with  ordinary  care  can 
any  vegetable  fibres  be  mistaken  for  them, 
although  these  may  be  mistaken  for  their 
Sperraatozoa.magnified  450  diameters,     tails  or  filaments.     Particular  notice  should 


EXAMINATION    OF    SPERMATIC    STAINS.  669 

be  tiiken  of  any  hiurs  or  fibres  found  in  such  stains.  They  may  be  human 
or  animal  hairs,  and  the  fibres  may,  by  their  nature,  form,  and  color,  be 
connected  with  some  article  of  dress  worn  by  the  woman  or  the  person 
accused  of  rape.  Spermatozoa  appear  to  retain  life  long-  after  the  death 
of  tlie  body.  Hofniaun  states  that  lie  has  observed  the  active  movements 
of  these  bodies  from  eig-hty  to  a  hundred  hours  after  death. 

Some  observers  have  advised  that  the  expressed  liquid  obtained  from 
spermatic  stains  should  be  allowed  to  dry  spontaneously  on  the  slide  and 
then  examined  in  the  dry  state.  When  humid,  the  bodies  and  especially 
the  tails  are  so  transparent  that  the  whole  spermatozoon  may  escape  ob- 
servation. One  part  only  may  come  into  focus  at  a  time.  They  become 
opaque  by  drying,  and  may  be  seen  in  darker  lines,  sometimes  in  their 
whole  leng'th.  Roussin  recommends  the  addition  of  a  solution  of  iodine 
in  iodide  of  potassium  to  the  liquid  submitted  to  examination.  He  has 
found  that  it  brings  out  the  entire  form  of  the  spermatozoon  of  a  deep 
yellow  color,  and  thus  makes  a  distinction  between  it  and  other  fibrous 
substances.  (Ann.  d'Hyg-.,  1861,  t.  1,'p.  154.)  Eosin  may  also  be  used 
to  color  spermatozoa. 

E.  Ungar  (Zeitschr.  f.  Gerichtl.  Med.,  1887,  i.  31G),  adverting-  to  the 
g-rcat  diEficultv  often  experienced  of  obtaining-  unbroken  specimens  of 
spermatozoa  from  dried  seminal  stains,  states  that  this  is  not  due  solely 
to  the  separation  of  the  head  from  the  tail  of  the  organism  by  mechanical 
rupture.  Spermatozoa  are  indeed  very  brittle,  and  easily  ruptured  by 
any  rough  handling  of  the  fabric  on  which  they  may  be  shed  ;  but  Ungar 
asserts  that  the  separation  of  the  head  from  the  tail  also  takes  place  dur- 
ing- the  swelling  of  the  dried  spermatozoa  when  moistened  with  water  for 
the  purpose  .of  examination.  His  method  of  examination  is  as  follows. 
A  piece  of  the  fabric  with  the  stain  is  moistened  with  very  dilute  hydro- 
chloric acid — one  drop  in  1^  fluid  oz.  of  water — on  a  watch-glass,  with 
one  end  of  the  stuff  only  immersed  in  the  liquid;  and  the  soaking  is  con- 
tinued for  five  hours.  The  fabric  is  then  removed  with  forceps  and 
<lropped  several  times  on  to  slides,  avoiding  tearing  and  much  jjressure. 
The  liquid  on  the  slides  is  then  allowed  to  dry  in  air.  A  cover  glass  held 
by  means  of  forceps  is  then  passed  two  or  three  times  through  a  naked 
flame  and  then  deposited  on  the  slide,  which  is  then  placed  with  the  pre- 
pared surface  downwards  in  the  staining  fluid  (2^  percent,  eosin  in  spirit). 
When  the  staining  has  proceeded  for  a  sufficient  length  of  time,  the  slide  is 
removed,  washed  with  dilute  alcohol,  and  examined.  Or,  a  second  stain- 
ing may  be  given  with  hgematoxylin,  in  which  case  the  hinder  part  of  the 
head  acquires  a  deep  blue  tint,  whilst  the  front  and  middle  of  the  head  and 
the  tail  are  stained  deep  red. 

As  it  has  been  elsewhere  stated,  the  spermatozoa,  ah  hough  peculiar  to 
the  seminal  fluid,  are  not  found  in  the  very  young,  the  very  old,  or  in 
those  who  are  laboring  under  long-standing  disease  of  the  testicles. 
Even  in  the  cases  of  healthy  married  men  who  have  had  children, 
spermatozoa  are  not  always  found  in  the  spermatic  secretion;  their  pres- 
ence, size,  and  number  are  subject  to  great  uncertainty.  Exhaustion  from 
frequent  intercourse,  or  constitutional  causes  without  actual  bodily  dis- 
ease, appear  to  influence  their  production.  There  are  also  various  other 
conditions  in  which  they  are  not  found;  these  have  been  fully  examined 
by  Casper.  (Gerichtl.  Med.,  Bd.  2,  ]).  141.)  Hence  the  discovery  of 
spermatozoa  in  stains  on  articles  of  clothing  demonstrates  that  they  have 
been  produced  by  the  spermatic  liquid ;  but  their  non-discovery,  under 
these  circumstances,  does  not  prove  that  the  stains  have  not  been  caused 
by  this  liquid. 


670  MICROSCOPICAL    EVIDENCE. 

The  detection  of  dead  or  motionless  spermatozoa  in  stains  may  be  made 
at  long  periods  after  emission,  when  the  fluid  has  been  allowed  to  dry 
(Fiff.  56).     In  three  cases,  at  intervals  of  from  one 
Fig.  56.  week  to  seven  weeks  after  the   perpetration  of  the 

crime,  Casper  was  enabled  to  demonstrate  the  presence 
of  spermatozoa  on  articles  of  clothing,  and  thus  to  fur- 
nish strong  corroborative  evidence.  Koblanek  made 
experiments  on  this  subject,  in  reference  to  different 
periods  of  time  ;  he  found  these  bodies  distinctl}^  after 
twelve  months.  The  discovery  of  one  distinct  and 
entire  body  is  quite  sufficient  to  justify  a  medical 
io:Q":(ii^  V  "^o^^  opinion  of  the  spermatic  nature  of  the  stain.  Bayard 
'^^-'■^itl?^^^  states  that  he  has  been   able  to  detect  spermatozoa 

'''"'^^'^^^^B^^        in  stains  after  six  years  (Man.  Prat,  de  Med.  Lei,-., 
■•-'■*  p.   2*1*1);  and  Roussin,  after  the  long  period  of  eigh- 

, Sperraptozoa  in  stains  teen  years.  (Ann.  d'Hyg.,  1867,  t.  1,  p.  152.)  The 
mSnifiTd  500  diameTei'  editor  has  found  them  in  a  stain  after  the  lapse  of  three 
years. 
A  medical  Avitness  must  be  prepared  to  consider  the  precise  value  of 
evidence  furnished  by  the  microscope  in  the  examination  of  stains  on  the 
dress  of  a  man  accused  of  rape.  A  shirt  may  present  stains  of  blood, 
urine,  mucus,  or  gonorrhoea!  discharge,  some  of  which,  but  for  the  micro- 
scope, might  be  mistaken  for  spermatic  stains.  Admitting  that,  by  the 
process  above  described,  the  microscope  enables  an  examiner  to  affirm 
that  the  stains  have  really  been  caused  by  the  spermatic  secretion,  this 
does  not  prove  that  a  rape  has  been  committed,  or  even  that  intercourse 
has  been  necessarily  had  with  a  woman.  Such  stains  may  arise  from 
spontaneous  natural  discharge,  or  from  disease  (spermatorrhoea),  and 
therefore  in  themselves  they  afford  no  proof  of  intercourse.  Ifj  from  other 
circumstances  in  the  case,  it  should  be  clearly  and  satisfactorily  proved 
that  there  has  been  intercourse,  then  the  presence  of  blood  mixed  with  the 
spermatic  stains  might,  in  certain  cases,  justify  an  opinion  that  violence 
had  been  used.  The  discovery  of  spermatic  stains  on  the  dress  of  a 
woman  furnishes  stronger  evidence  of  intercourse,  attempted  or  f)erpe- 
trated,  than  their  discovery  on  the  dress  of  a  man  ;  but  admitting  that 
intercourse  is  thus  proved,  it  may  still  have  taken  place  with  the  consent 
of  the  woman.  These  stains,  when  found  on  the  clothing  of  girls  and 
infants,  afford  a  strong  corroborative  proof  of  the  perpetration  of  the 
crime. 

Microscopical  Evidence  from  the  Woman. — It  may  become  necessary 
to  determine,  in  reference  to  a  jvoman,  whether  intercourse  has  or  has  not 
recently  taken  place.  All  observers  agree  that,  within  a  certain  period 
after  connection,  the  fact  may  be  established  by  an  examination  of  he 
vaginal  mucus.  A  small  quantity  of  this  mucus  placed  upon  glass,  and 
diluted  with  water,  will  be  found  to  contain  spermatozoa  if  the  suspicion 
be  correct.  In  addition  to  other  characters,  it  may  be  remarked  that  the 
living  spermatozoa  move  for  many  hours  out  of  the  body  when  kept  at  a 
temperature  of  98°  F.,  and  they  even  retain  their  rapid  motions  when  the 
spermatic  liquid  is  mixed  with  water;  but  these  motions  sometimes  cease 
immediately  on  the  addition  of  urine  or  chemical  reagents.  According  to 
Miiller,  the  spermatozoa  may  retain  vitality  (or  free  motion)  in  the  body 
of  a  woman  for  the  period  of  seven  or  eight'days,  and  even  longer.  Bayard 
states  that  he  has  thus  detected  them  in  the  vaginal  mucus  of  females  not 
subject  to  morbid  discharges,  at  various  intervals  up  to  three  days  after  in- 
tercourse (op.  cit.,  p.  277)  ;  and  Donn^  found  them  under  similar  circum- 


EVIDENCE  OF  VIOLATION  IN  THE  DEAD.         671 

stances  in  a  woman  who  had  been  admitted  into  the  hospital  the  day  before 
(op.  cit.,  p.  305).  This  evidence  may  become  of  value  in  a  charge  of  rape, 
but  it  may  be  easily  destroyed  by  the  presence  of  leucorrhoea  ;  and  it  is  open 
to  an  objection  that  in  certain  morbid  states  of  the  vaginal  mucus  of  the 
human  female  there  is  found  in  it  a  microscopic  animalcule,  called  by 
Donne  the  Trichomonas  vaginse  ;  but  this  has  a  much  larger  body  and  a 
shorter  tail  than  the  spermatozoon.  Other  substances  may  be  sometimes 
found  in  the  vaginal  mucus.  (See  case  by  Lender  in  Vierteljahrsschr. 
fur  Gerichtl.  Med.,  1865,  p.  355.) 

Marks  of  Blood  on  Clothing. — Marks  of  blood  upon  the  linen  can,  of 
course,  furnish  no  evidence  unless  taken  with  other  circumstances.  The 
linen  may  be  intentionally  spotted  or  stained  with  blood  for  the  purpose 
of  giving  apparent  support  to  a  false  accusation.  Bayard  met  with  a  case 
of  this  kind,  in  which  a  woman  charged  a  youth  with  having  committed  a 
rape  upon  her  infant  child.  On  examination  the  sexual  organs  were  found 
uninjured;  and  on  inspecting  the  marks  of  blood  on  the  clothes  of  the 
child  it  was  observed  that  the  stains  had  been  produced  on  the  outside  of 
the  stuif,  and  bore  the  appearance  of  smearing  ;  the  whole  fibre  had  not 
even  been  completely  penetrated  by  the  liquid.  The  falsehood  of  the 
charge  was  thus  established.  (Ann.  d^Hyg.,  1847,  t.  2,  p.  219.)  A  case 
involving  a  false  charge  of  rape  was  tried  at  the  Glasgow  Aut.  Circuit, 
1859.  One  of  the  witnesses,  an  accomplice,  proved  that  she  had  pur- 
chased some  blood  and  handed  it  to  the  woman  who  made  the  charge,  and 
she  saw  her  smear  it  over  her  person  and  on  some  sheets  on  which  it  was 
alleged  the  rape  was  perpetrated.  The  woman  (Boyle)  and  her  husband, 
who  made  this  false  charge,  were  convicted  of  conspiracy. 

It  may  be  a  question  whether  marks  of  blood  on  the  linen  of  a  prosecu- 
trix were  caused  by  effusion  as  a  result  of  violence  or  by  the  menstrual 
fluid.  In  its  normal  state  this  fluid,  in  respect  to  the  presence  of  red  cor- 
puscles and  of  serum,  resembles  blood.  That  fibrin  is  frequently  present 
is  obvious  from  its  being  occasionally  discharged  in  a  clotted  state;  hence 
the  discovery  of  fibrin  in  a  stain  would  by  no  means  necessarily  imply 
that  the  blood  was  not  derived  from  the  menstrual  fluid.  The  French 
Academy  of  Medicine  appointed  as  a  committee  Adelon,  Moreau,  and 
Le  Canu,  to  examine  this  question  in  the  most  comprehensive  manner. 
These  gentlemen  reported  that,  in  the  then  stjite  of  science,  there  was  no 
certain  method  by  which  menstrual  blood  could  be  distinguished  from 
that  effused  from  the  bloodvessels  in  a  case  of  child-murder  or  abortion, 
and  this  statement  still  holds  good.  (Ann.  d'Hyg  ,  1846,  t.  1,  p.  181; 
see  ante.)  Even  the  presence  of  epithelial  scales  and  mucus  would  not 
prove  the  stain  to  be  menstrual,  unless  it  could  be  shown  that  the  mucus 
was  actually  effused  with  the  blood  which  caused  the  stain.  The  epithe- 
lial scales  naturally  found  in  vaginal  mucus  are  flat  nucleated  cells,  oval, 
round,  or  polygonal  in  shape,  and  vary  in  size.  They  are  spread  over  the 
mucous  membrane,  not  only  of  the  vagina,  but  of  the  mouth,  pharynx, 
gullet,  conjunctiva,  and  the  serous  and  synovial  membranes.  There  must 
be  great  caution  in  relying  upon  this  microscopical  evidence. 

Evidence  of  Violation  in  the  Dead. — The  body  of  a  child  or  woman  is 
found  dead,  and  a  medical  witness  may  be  required  to  determine  whether 
her  person  has  or  has  not  been  violated  before  death.  There  is  here  some 
difficulty,  because  there  will  be  no  statement  from  the  prosecutrix  herself. 
The  witness  can  seldom  do  more  than  express  a  conjectural  opinion  from 
the  discovery  of  marks  of  violence  on  the  person  and  about  the  genital 
organs.     Even  if  spermatozoa  were  detected  in  the  liquid  mucus  of  the 


672  UNNATURAL    OFFENCES. 

vagina,  or  on  the  dress  of  a  woman,  this  would  merely  prove  that  there 
had  been  intercoursr^e.  In  a  case  of  alleged  murder  tried  at  Edinburgh, 
the  first  point  to  be  determined  in  examining  the  dead  body  was  whether 
a  rape  had  or  had  not  been  committed.  The  examination  of  the  stains 
on  the  dress  was  conclusive  when  taken  in  conjunciion  with  the  other 
evidence.  The  jury  convicted  the  man  of  a  rape,  but  acquitted  him  of  the 
murder.  (For  another  case  in  which  evidence  was  obtained  on  the  ex- 
amination of  a  dead  body,  see  Casper's  Klin.  Novellen,  p.  17.) 

Rajje  by  Females  on  Males. — So  far  as  we  can  ascertain,  this  crime  is 
unknown  to  the  English  law.  Several  cases  of  this  kind  have,  however, 
come  before  the  French  criminal  courts.  In  1845,  a  female,  aged  eighteen, 
was  charged  with  having  been  guilty  of  an  act  of  indecency,  with  violence, 
on  the  person  of  Xavier  T.,  a  boy  under  the  age  of  fifteen  years.  She 
was  found  guilty.  In  another  case,  a  girl,  aged  eighteen,  was  charged 
with  rape  on  two  children — the  one  eleven  and  the  other  thirteen  years 
of  age.  It  appeared  in  evidence  that  the  accused  enticed  the  two  boys 
into  a  field  and  there  had  forcible  connection  with  them.  This  female  was 
proved  to  have  had  a  preternatural  contraction  of  the  vagina  which  pre- 
vented intercourse  with  adult  males.  She  was  found  to  be  laboring  under 
syphilitic  disease,  and  the  proof  of  her  offence  was  completed  by  the  dis- 
ease having  been  communicated  to  the  two  boys.  She  was  condemned. 
(Ann.  d'Hyg.,  1847,  t,  1,  p.  463.)  Casper  describes  cases  of  this  descrip- 
tion which  have  fallen  under  his  observation.  (Grerichtl.  Med.,  Bd.  2, 
p.  129  ;  and  Klin.  Novellen,  1863,  p.  15.)  By  the  Penal  Code  of  France 
it  is  a  crime  in  either  sex  to  attempt  intercourse  with  the  other,  whether 
with  or  without  violence,  when  the  child  is  under  eleven  years  of  age. 
That  this  offence  is  perpetrated  in  England  under  the  mistaken  notion  that 
gonorrhoea  and  syphilis  are  thereby  cured  cannot  be  doubted.  It  is  by 
no  means  unusual  to  find  in  the  wards  of  hospitals  mere  bo3^s  affected  with 
venereal  disease  In  some  instances  this  may  be  due  to  precocious  puberty  ; 
but  in  others  it  can  only  be  ascribed  to  that  unnatural  connection  of  adult 
females  with  male  children  which  is  punished  as  a  crime  in  the  other  sex. 
The  only  accessible  medical  proof  would  consist  in  the  transmission  of 
gonorrhoea  or  sj'philis  from  the  woman  to  the  child. 

Unnatural  Offences. 

Pederastia.  Sodomy.  Buggery. — This  crime  is  defined  to  be  the  un- 
natural connection  of  a  man  with  mankind,  or  with  an  animal.  The 
evidence  required  to  establish  this  crime  is  the  same  as  in  rape,  and  there- 
fore penetration  alone  is  sufficient  to  constitute  it.  There  are,  however, 
two  exceptions:  first,  it  is  not  necessary  to  prove  the  offence  to  have  been 
committed  against  the  consent  of  the  person  upon  whom  it  was  perpe- 
trated ;  and  second,  both  agent  and  patient  (if  consenting)  are  equally 
guilty  ;  but  the  guilty  associate  is  a  competent  witness.  In  one  case  (Rex 
■u.  Wiseman),  a  man  was  indicted  for  having  committed  this  offence  with 
a  woman,  and  a  majority  of  the  judges  held  that  this  was  within  the 
statute.  Unless  the  person  is  in  a  state  of  insensibility  it  is  not  possible 
to  conceive  that  this  offence  should  be  perpetrated  on  an  adult  of  either  sex 
against  his  or  her  will ;  the  slightest  resistance  would  suffice  to  prevent  its 
perpetration.  In  1849,  a  question  on  this  point  was  referred  to  the  author 
from  Jamaica.  A  man  was  convicted  of  the  crime  of  sodomy,  alleged  to 
have  been  committed  on  the  complaining  party  while  he  was  asleep. 
The  only  evidence  against  him  was  the  statement  of  the  complainant. 


UNNATURAL    OFFENCES.  673 

The  opinion  given  aviis  in  conformity  with  that  of  Ferguson,  namely, 
that  the  perpetration  of  the  act  during  a  state  of  natural  sleep  was  con- 
trary to  all  probability.  The  remarks  already  made  in  reference  to  rape 
during  sleep  may  be  applied  with  greater  force  to  acts  of  this  nature 
(p.  664,  ante).  If  this  crime  is  committed  on  a  boy  under  fourteen  years 
it  is  felony  in  the  agent  only  ;  and  the  same,  it  appears,  as  to  a  girl  under 
twelve.  (Archbold,  p.  409.)  The  act  must  be  in  the  part  where  it  is 
usually  committed  in  the  victim  or  associate  of  the  crime. 

Sodomy  is  commonly  understood  to  signify  unnatural  intercourse  be- 
tween man  and  man,  while  bestiality  (buggery)  implies  unnatural  inter- 
course with  animals.  Continental  medical  jurists  have  invented  a  new 
term,  Pederastia  (natSbi  Ipaarr,?,  pueri  amalor),  comprising  those  cases, 
not  unfrequent,  in  which  boys  at  about  the  age  of  puberty  are  made  the 
victims  of  the  depraved  passions  of  men  ;  but  this  term  is  not  applicable 
to  the  crime  conimitted  by  and  between  adults.  The  medical  aspects  of 
this  subject  have  been  fully  examined  by  Tardieu  (Attentat  aux  Moeurs) ; 
also  by  Toulmouche  (Ann.  d'Hyg.,  1868,  t.  2,  p.  121}  and  by  Penard' 
(Ann.  d'Hyg.,  1860,  t.  5,  p.  367).  The  symptoms  indicative  of  this  un- 
natural intercourse  both  in  agent  and  patient  are  fully  described  by  these 
writers.  Casper  has  also  dealt  with  this  crime  and  the  medical  evidence 
required  to  prove  it.     (Gerichtl.  Med.,  Bd.  2,  p.  176.) 

The  facts  are  commonly  sufficiently  proved  without  medical  evidence, 
except  in  the  cases  of  young  persons,  when  marks  of  physical  violence 
will  in  general  be  sufficiently  apparent.  In  some  instances  proof  of  the 
]ierpetration  of  the  crime  may  be  obtained  by  resorting  to  microscopical 
evidence.  Stains  upon  the  linen  of  young  persons  may  thus  furnish  evi- 
dence that  the  crime  has  been  attempted  if  not  actually  .perpetrated. 

Unless  an  examination  is  made  soon  after  the  perpetration  of  the  crime, 
the  signs  of  it  will  disappear.  In  the  case  of  one  long  habituated  to  these 
unnatural  practices,  certain  changes  have  been  pointed  out  as  medical 
proofs — among  them  a  funnel-shaped  state  of  the  parts  between  the  nates, 
with  the  appearance  of  dilatation,  stretching,  or  even  a  patulous  state  of 
the  anus  and  a  destruction  of  the  folded  or  puckered  state  of  the  skin  in 
this  part.  There  may  be  also  marks  of  laceration,  cicatrices,  etc.,  and 
sometimes  evidence  may  be  derived  from  the  presence  of  syphilitic  dis- 
ease. This  condition  of  parts  would  represent  the  chronic  state  induced 
by  these  practices  in  the  patient  or  succubus.  In  the  recent  or  acute  form, 
fissure  and  laceration  of  the  sphincter  ani,  with  bruising  and  etfusion  of 
blood,  will  be  found. 

Trials  for  sodomy  and  bestiality  are  very  frequent,  and  convictions  of 
men  and  boys  have  taken  place  for  unnatural  intercourse  with  cows,  mares, 
and  other  female  animals.  Medical  evidence  is  seldom  required  to  sustain 
the  prosecution.  There  may  be,  however,  circumstances  which  can  only 
be  properly  interpreted  by  a  scientific  expert.  The  hair  of  the  animal  may 
be  found  on  the  perpetrator,  or  marks  of  blood  or  feculent  matter  upon 
his  dress,  and  in  such  cases  chemical  analysis  or  the  microscope  may  en- 
able a  witness  to  express  an  opinion  in  proof  or  disproof  of  the  charge. 
In  one  case,  where  a  man  was  charged  with  having  had  unnatural  inter- 
course with  a  cow,  the  prosecution  was  able  to  show  that  some  short, 
colored  hairs  found  on  the  prisoner's  person  resembled  those  of  the  ani- 
mal. In  another  case  (Reg.  v.  Brinkley,  Lincoln  Ass.,  April,  1887),  the 
editor  found  the  peculiar  colored  hairs  of  a  mare  upon  the  prisoner's  cloth- 
ing and  spermatozoa  on  his  trousers.  False  charges  of  sodomy  are  fre- 
quent, and  are  made  for  the  purpose  of  extortion. 
43 


674  UNNATURAL    OFFENCES. 

A  question  may  arise  here  respecting  the  examination  of  an  accused 
person,  which  has  ah-eady  been  considered  in  reference  to  women  charged 
Avith  infanticide.  The  examination  should  be  with  the  consent  of  the 
accused,  and  not  made  against  his  will,  since  no  one  is  bound  to  furnish 
evidence  against  himself  (see  ante).  (In  reference  to  the  evidence  de- 
rivable from  the  hair  of  animals,  see  Vierteljahrsschr.  fiir  Gerichtl.  Med., 
1865,  1,  160.) 


DEFINITIONS    OF    INSANITY.  675 


INSANITY. 


CHAPTER   LXI. 

WHAT    IS    INSANITY  ? MEDICAL    DEFINITIONS. DISTINCTION     OF     SANE     FROM     INSANE     PER- 
SONS.  MORAL    INSANITY. LEGAL     DEFINITIONS. "  NON     COMPOS     MENTIS." — SYMPTOMS 

OF    INCIPIENT    INSANITY.  —  HALLUCINATIONS    AND    ILLUSIONS. LUCID    INTERVALS. 

What  is  Insanity?  Medical  Definitions. — The  terms  "insanity," 
"lunacy,"  "unsoundness  of  mind,''  "mental  derangement,"  "mad- 
ness, "  and  "  mental  alieDation  or  aberration,  "  have  been  indifi'erently 
applied  to  those  states  of  disordered  mind  in  which  a  person  loses  the 
power  of  regulating  his  actions  and  conduct  according  to  the  ordinary 
rules  of  society.  In  all  cases  of  real  insanity  the  intellect  is  more  or  less 
affected — hence  the  term  intellectual  insanity.  In  a  medical  sense  this 
implies  a  deviation  of  the  mental  faculties  from  an  assumed  normal  or 
healthy  standard.  In  an  insane  person,  his  language  and  habits  are 
changed — the  reasoning  power  which  he  may  have  enjoyed  in  common 
with  others  is  lost  or  perverted,  and  he  is  no  longer  fitted  to  discharge 
those  duties  which  his  social  position  demands.  Further,  from  perversion 
of  reason,  he  may  show  a  disposition  to  commit  acts  which  may  endanger 
his  own  life  or  the  lives  of  those  around  him.  It  is  at  this  period  that  the 
law  interferes  for  his  own  protection  and  for  that  of  society. 

Many  attempts  have  been  made  by  psj'chologists  to  define  insanity ; 
but  the  definitions  given  are  so  imperfect  that  it  would  be  difficult  to  find 
one  which  includes  all  who  are  insane  and  excludes  all  who  are  sane.  The 
difficulty  is  fully  accounted  for  by  the  fact  that  mental  disorder  varies  in 
its  degree  a»  well  as  in  its  characters  ;  and" the  shades  of  disordered  intel- 
lect in  the  early  stages  are  so  blended  as  to  be  scarcely  distinguishable 
from  a  state  of  insanity.  It'  is  this  twilight  condition  of  the  mind,  when 
it  is  fluctuating  between  sanity  and  insanity,  which  no  definition  can 
comprise,  especially  as  the  mind  differs  in  its  power  and  manifestations  in 
most  persons,  and  it  is  therefore  difficult  to  fix  upoQ  a  standard  by  which 
a  fair  comparison  can  be  made.  The  vulgar  notion  of  insanity  is  that  it 
consists  in  an  entire  deprivation  of  reason  and  consciousness  ;  but  the 
slightest  acquaintance  with  the  insane  proves  that  they  are  not  only  per- 
fectly conscious  of  their  actions  in  general,  but  that  they  rea^son  upon  their 
feelings  and  impressions.  Abercrombie  considered  insanity  to  consist  in  a 
loss  of  the  faculty  of  attention — that  power  by  which  we  are  eapalile  of 
changing,  controlling,  arresting,  or  fixing  the  current  of  our  thoughts. 
Conolly  regarded  it  as  a  disorder  of  the  power  of  comparison  or  judgment, 
and  Marc  as  a  loss  of  the  faculty  of  volition  ;  so  that,  in  the  latter  point 
of  view,  the  acts  of  the  insane  are  in  a  certain  sense  involuntary,  and  de- 
pend upon  impulses  which,  owing  to  mental  disease,  they  are  unable  to 
control.     This  view  is  now  largely  held  by  alienists. 

These  definitions  are  defective,  inasmuch  as  they  are  not  adapted  to  the 


676  ■  MORAL    INSANITY. 

various  forms  of  the  disease.  Etyniolog'ically,  the  term  implies  the  ne- 
gation of  something,  and  not  a  positive  state  (OrangeJ.  In  some  cases 
of  insanit}^  as  in  confirmed  idiocy,  there  is  no  evidence  of  any  exercise 
of  the  intellectual  faculties ;  but  in  most  instances  these  faculties  and  the 
moral  feelings  are  partially  diseased  or  partially  destroyed,  in  every 
variety  and  degree.  Thus  we  may  meet  with  cases  in  which  the  faculties 
of  attention,  comparison,  and  volition  are  more  or  less  impaired  or  absent, 
or,  if  present,  they  are  never  perfect,  although  each  may  not  be  equally 
affected.  When  no  two  cases  are  precisely  similar,  no  definition  can  in- 
clude all  varieties  of  the  disorder.  A  medical  witness  who  ventures  upon 
a  definition  will  therefore  generally  find  himself  involved  in  numerous 
inconsistencies,  for  no  words  can  possibly  comprise  the  variable  characters 
which  this  malady  is  liable  to  assume.  Savage  is  of  opinion  that  no  stan- 
dard of  sanity,  as  fixed  by  nature,  can  under  'any  circumstances  be  con- 
sidered definitely  to  exist.  (Insanity,  p.  1.)  Bucknell  defines  insanity 
as  a  disease  of  the  brain  affecting  the  integrity  of  the  mind,  whether 
marked  by  intellectual  or  emotional  disorder  ;  whilst  Maudsley  considers 
it  to  be  a  disorder  of  the  supreme  nerve-centres  of  the  brain — the  special 
organs  of  mind.  It  will  be  observed  that  these  definitions  include  some- 
thuig  more  than  mere  intellectual  insanity.  Those  who  take  an  interest 
in  definitions  of  insanity  and  who  think  they  can  defend  them  from  the 
critical  acumen  of  lawyers,  will  find  them  set  forth  in  their  medical  and 
medico-legal  aspects  in  a  paper  by  Rorie.  (Edin.  Month.  Jour.,  1865,  ii. 
p.  18.)  [Dr.  Buckham  quoted  a  large  number  in  his  work  on  Insanity. 
The  largest  collection  yet  published,  doubtless,  is  that  by  the  editor  of  the 
Medico-Legal  Journal,  and  contained  in  the  several  volumes  of  that  work  : 
Vid.  vol.  4,  pp.  346-436  ;  vol.  5,  pp.  65-211-323-459  ;  vol.  6,  pp.  101-203 
-314  ;  vol.  *I,  J).  528.]  There  are,  however,  cases  in  which  a  medical  man 
may  find  himself  compelled,  if  not  to  define  insanity,  at  least  to  draw 
some  clear  distinction  between  a  sane  and  an  insane  person.  Thus  in 
cases  in  which  there  has  been  an  alleged  breach  of  the  law  regarding  the 
custody  of  lunatics,  it  may  be  pleaded  that  the  person  is  sane,  and  a  medi- 
cal expert  must  then  be  prepared  to  say  whether  the  person  concerning 
whom  the  question  is  raised  is  idiotic,  lunatic,  or  of  unsound  mind  and  to 
assign  satisfactory  reasons  for  his  opinion. 

Bloral  Insanity. — In  addition  to  that  form  of  insanity  in  which  the. 
mind  is  affected,  known  as  ivtellectiial  insanity,  Prichard  and  other 
medico-legal  writers  have  described  a  state  which  they  call  vioral  insanity 
{mania  sine  clelirio),  which  is  manifested  simply  by  a  perverted  or  dis- 
ordered state  of  the  feelings,  passions,  and  emotions,  irrespective  of  any 
apparent  intellectual  aberration.  There  are  no  hallucinations  or  illusions, 
and  there  is  no  evidence  of  delusion,  but  simply  a  perversion  of  the  moral 
sentiments.  Thus  it  is  alleged  that  this  form  of  insanity  may  appear  in 
the  shape  of  a  causeless  suspicion,  jealousy,  or  hatred  of  others,  especially 
of  those  to  whom  the  affected  person  ought  to  be  attached  ;  and  it  may 
also  manifest  itself  under  the  form  of  a  wild,  reckless,  and  cruel  disposi- 
tion towards  mankind  in  general.  It  does  not  seem  probable,  however, 
ihnt  moral  insanity,  as  thus  defined,  ever  exists  or  can  exist  in  any  person 
without  greater  or  less  disturbance  of  the  intellectual  faculties.  The 
mental  powers  are  rarely  disordered  without  the  moral  feelings  partaking 
of  this  disorder;  and  conversely,  it  is  not  to  be  expected  that  the  moral 
feelings  should  become  to  any  extent  perverted  without  the  intellect 
being  affected,  for  perversion  of  moral  feelings  is  generally  observed  to  be 
one  of  the  early  symptoms  of  disordered  reason.  The  intellectual  dis- 
turbance may  sometimes  be  difficult  of  detection  ;    but  in  every  case  of 


LEGAL    DEFINITIONS    OF    INSANITY.  677 

true  insanity  it  is  more  or  less  present,  and  it  would  be  a  highly  dan- 
gerous practice  to  pronounce  a  person  insane  when  some  evidence  of  its 
existence  was  not  forthcoming-.  The  law  does  not  eerlainly  recognize 
moral  insanity  as  an  independent  state  ;  hence,  however  perverted  the 
affections,  n]oral  feelings,  or  sentiments  may  be,  a  medical  jurist  should 
always  look  for  some  indications  of  disturbed  reason.  Medically  speak- 
ing, there  are,  according  to  Prichard,  two  forms  of  insanity,  moral  and 
intellectual ;  but  in  law,  apparently,  there  is  only  one — that  which  affects 
the  mind.  Moral  insanity  is  sometimes  admitted  as  a  bar  to  responsi- 
bility for  civil  or  criminal  a(^ts,  when  accompanied  by  intellectual  disturb- 
ance. Mayo  denied  its  existence  and  contended  that  no  abnormal  state 
of  mind  should  confer  irresponsibility  unless  it  involves  intellectual  as 
well  as  moral  perversion.  (Med.  Testimony,  p  69.)  Brodie  also  con- 
sidered that  there  are  no  reasonable  grounds  for  admitting  this  to  be  an 
independent  form  of  insanity.  There  has  been,  as  he  suggests,  much 
mystification  on  the  subject.  The  term  has  been  applied  to  cases  in  which 
the  name  of  insanity  ought  not  to  have  been  applied  at  all,  i.  e.  to  "  moral 
depravity,"  and  also  to  cases  in  which  delusions  have  really  existed,  and 
which  might  therefore  have  been  more  properly  classed  with  cases  of  ordi- 
nary mental  aberration.  (Psych.  Inquiries,  p.  99.)  Others,  however, 
stoutly  contend  for  its  legal  recognition. 

[There  has  been  a  conflict  of  opinions  and  decisions  of  the  courts  as 
to  moral  insanity.  Some  confusion  has  arisen  as  to  what  constitutes 
and  what  has  been  recognized  by  the  courts  as  moral  insanity.  Mere 
beliefs,  opinions,  or  prejudices,  unless  involving  some  insane  delusion, 
do  not  constitute  moral  insanity.  Opinions  as  to  the  moral  qualUy, 
of  acts,  unaccompanied  by  delusions  which  subvert  the  will  and  reason 
and  dominate  the  conduct,  do  not  constitute  moral  insanit^^  Moral  per- 
versity is  not  moral  insanity.  Moral  insanity,  as  recognized  by  the  courts, 
involves  either  a  disorder  of  the  brain  which  aflects  the  moral  faculties,  or 
produces  an  inability  to  discriminate  between  right  and  wrong,  which 
has,  as  a  disease  of  the  brain,  proceeded  so  far  as  to  destroy  the  reasoning 
faculties  of  the  mind  and  impair  or  destroy  the  volition.  This  has  had 
iudicial  recognition  in  American  courts:  Com.  v.  Moster  (Gibson,  C.  J.), 
*4  Pa.  St.  266 ;  Forman's  Will,  54  Bar.  274  ;  Boswell  v.  The  State  of 
Alabama,  307  ;  Wharton  Horn.,  §  574  ;  St.  Louis  Mut.  Life  Ins,  Co.  v. 
Graus,  6  Bush.  268;  Anderson  v.  The  State,  43  Conn.  515;  Buswell  on 
Insanity,  §  12  ;  Ray's  Contributions  to  Mental  Pathology,  115  ;  per  contra, 
State  V.  Spencer,  1  Zab.  196.] 

Of  one  fact  we  may  be  well  assured  :  if  in  these  cases  of  alleged  moral 
insanity  there  is  no  indication  of  a  perversion  of  intellect,  medical  evi- 
dence is"  not  required  to  determine  the  degree  of  responsibility  in  refer- 
ence to  such  persons.  Those  who  administer  the  law,  and  any  man  en- 
dowed with  ])lain  common  sense,  will  be  as  well  qualified  as  a  medical 
expert  to  decide  the  question  of  criminal  responsibility.  Further,  until 
medical  men  can  produce  a  clear  and  well-defined  distinction  between 
moral  depravity  and  moral  insanity,  such,  a  doctrine,  employed  as  it  has 
been  for  the  exculpation  of  persons  charged  with  crime,  should  be  rejected 
as  inadmissible. 

Legal  Definitions. — The  law  of  England  recognizes  two  states  of 
mental  disorder  or  alienation:  (1)  Z'(^??<e??<za  ??o^Hra^is,  corresponding  to 
idiocy  ;  and  (2)  Dementia  adventilia,  or  accidentalis,  signifying  general 
insanity  as  it  occurs  in  persons  who  have  once  enjoyed  reasoning  power. 
To  this  state  the  term  "  lunacy"  is  also  applied,  from  an  influence  for- 
merly supposed  to  be  exercised  on  the  mind  by  the  moon  and  still  believed 


678  UN-SOUNDNESS    OF    MIND. 

in  by  many  attendants  on  the  insane.  Lunacy  is  a  terra  generally  applied 
to  those  disordered  states  of  mind  which  are  known  to  medical  men  under 
the  names  of  mania,  melancholia,  and  dementia;  and  which  are  frequently, 
although  not  necessarily,  accompanied  with  lucid  intervals.  One  main 
character  of  insanity,  in  a  legal  view,  is  considered  to  be  the  existence  of 
delusion;  i.  e.  that  a  person  should  believe  something  to  exist  which  does 
not  exist  and  that  he  should  act  upon  this  belief.  Many  persons  may 
labor  under  harmless  delusions  and  still  be  fitted  for  their  social  duties ; 
but  should  these  delusions  be  such  as  to  lead  them  to  injure  themselves 
or  others  in  person  or  property,  then  the  case  is  considered  to  require 
legal  interference. 

In  addition  to  the  terms  Idiocy  and  Lunacy,  we  find  another  frequently 
employed  in  legal  proceedings,  namely  "  unaoundness  of  mind  "  {non  com- 
pos mentis) — of  the  exact  meaning  of  which  it  is  impossible  to  give  a 
consistent  definition. 

[The  words  "  no)i  compos  mentis''''  have  received  judicial  interpretation. 
The  doctrine  of  Lord  Coke,  "  total  deprivation  of  sense,''''  is  not  recognized 
now  by  the  courts,  either  in  England  or  America,  as  correct  in  regard  to 
what  constitutes  ''non  compos  mentis  :^^  Carew  v.  Johnston,  2  Sch.  & 
Lef.  280  ;  Browning  v.  Reane,  2  Phil.  69  ;  Dew  v.  Clark,  3  Add.  Ecc.  T9, 
87  ;  Lord  Tenterden  in  House  of  Lords  in  Mannin  v.  Ball,  Smith  &  Batty, 
183;  Bueurle  on  Insanity,  §  5,  §  6;  Commonwealth  v.  Schneider,  59  Pa. 
St.  828 ;  Commonwealth  v.  Haskell,  2  Brews.  491 ;  although  there  has 
been  a  conflict  of  American  decisions,  the  weight  of  American  authority 
sustains  the  English  doctrine  laid  down  in  Mannin  v.  Ball,  before  cited: 
Hale  V.  Hill,  8  Conn.  39  ;  Dennett  v.  Dennett,  44  N.  H.  531 ;  Carmichael 
in  re,  36  Ala.  514  ;  Hover  v.  Chase,  52  Maine,  304  ;  Blanchard  v.  Nestle, 
3  Denio,  47  ;  Stanton  v.  Wetherwas,  16  Barb.  (N.  Y.)  259. 

In  New  York,  Massachusetts,  and  several  of  the  American  States  stat- 
utes have  been  passed  defining  the  terms  "insane  person,"  "lunatic," 
"non  compos,^'  and  "insane,"  so  as  to  embrace  all  forms  of  insanity 
except  "idiocy."  In  man}^  of  the  American  States  the  law  has  made  the 
words  "lunatic,"  insane,  and  "non  compos  mentis'^  synonymous  and 
convertible  terms,  and  that  these  embrace  all  recognized  forms  or  phases 
of  insanity,  and  at  law  it  may  be  said  "  that  he  is  insane,"  "  a  lunatic," 
or  "non  compos  menus'"  whose  mind  is  affected  by  general  fatuity  or  is 
subject  to  one  or  more  specific  delusions:  Bushnell  on  Insanity,  §  18.] 

According  to  Winslow,  the  phrase  "unsoundness  of  mind"  was  first 
used  by  Lord  Eldon  to  designate  a  state  of  mind  not  exactly  idiotic,  and 
not  lunatic  with  delusions,  but  a  condition  of  intellect  occupying  a  place 
between  the  two  extremes,  and  unfitting  the  person  for  the  government  of 
himself  and  his  affairs.  (Lancet,  1872,  i.  p.  108.)  This  definition  has 
been  since  generally  accepted  and  acted  on  by  all  thS  judges.  From 
various  legal  decisions  it  would  appear  that  the  test  for  unsoundness  of 
mind  in  law  has  no  immediate  reference  to  the  existence  of  delusion  in 
the  mind  of  a  person,  so  much  as  to  proof  of  incapacity  from  some  morbid 
condition  of  intellect  to  manage  his  affairs  Math  ordinary  care  and  pro- 
priet}^.  (Amos.)  Neither  condition  will  suffice  to  establish  unsoundness 
Avithout  the  other;  for  the  intellect  may  be  in  a  morbid  state,  and  yet 
there  may  be  no  legal  incompetenc}^ ;  or  the  incompetency  alone  may 
exist  and  depend  on  bodily  infirmity  or  want  of  education — conditions 
which  must  not  be  confounded  with  mental  disorder.  Thus,  then,  a  person 
may  be  of  unsound  mind,  i.  e.  legally  incompetent  to  the  control  of  his 
property,  and  yet  not  come  up  to  the  strict  legal  standard  of  lunacy  or 
idiocy.    A  modern  writer  of  the  legal  profession,  on  the  subject  of  insanity, 


UNSOUNDNESS    OF    MIND,  679 

thus  defines  the  disease:  "  Sanity  exists  when  the  brain  and  the  nervous 
system  are  in  such  a  condition  that  the  mental  functions  of  feeling  and 
knowing,  emotion  and  willing,  can  be  performed  in  their  regular  and 
usual  manner,  Insanity  means  a  state  in  which  one  or  more  of  the  above- 
named  mental  functions  is  performed  in  an  abnormal  manner,  or  not  per- 
formed at  all,  by  reason  of  some  disease  of  the  brain  or  nervous  system." 
(Stephen,  J.,  Hist,  of  the  Crim.  Law  of  Eng.,  vol.  iii.  p.  130.) 

Some  medical  practitioners  have  attempted  to  draw  a  distinction  be- 
tween insanity  and  unsoundness  of  mind.  A  case  occurred  in  1839,  in 
which  a  medical  man  hesitated  to  sign  a  certificate  for  the  confinement  of 
an  alleged  lunatic  because  in  it  the  words  "  unsound  mind  "  were  used. 
He  said  he  would  not  have  hesitated  to  sign  it  had  the  term  "insane" 
been  employed.  The  difiTerence,  if  any  exist,  is  purely  arbitrary,  and  de- 
pends on  the  fact  that  "unsound  mind"  is  a  legal  and  not  a  medical 
phrase,  referring  to  an  incapacity  to  manage  affairs,  which  insanity,  in  its 
most  enlarged  sense,  does  not  always  imply.  The  law,  however,  appears 
to  admit  some  sort  of  distinction  ;  for,  according  to  Chitty,  it  is  a  criminal 
and  an  indictable  act  maliciously  to  publish  that  any  person  is  afflicted 
Avith  insanity,  since  it  imputes  to  him  a  malady  generally  inducing  man- 
kind to  shun  his  society  ;  although  it  is  not  libellous  to  say  that  a  man  is 
not  of  sound  mind,  because  no  one  is  of  perfectly  sound  mind  but  the 
Deity.  "Soundness"  is  here  used  as  synonymous  with  "perfection." 
(Med.  Juris.,  vol.  i.  p.  351.)  In  reference  to  the  signing  of  certificates  of 
insanity  it  is,  however,  an  error  to  suppose  that  the  use  of  one  term  can 
involve  a  practitioner  in  any  greater  share  of  responsibility  than  the  use 
of  the  other. 

[It  may  be  said  that  both  the  English  and  the  American  courts,  by  a 
long  line  of  decisions,  have  established  the  rule  of  law  to  be  that  the 
presence  or  absence  of  delusion  in  the  mind  of  the  subject  was  the  true 
criterion  of  the  presence  or  absence  of  insanity  in  any  case :  Dew  v. 
Clark,  3  Add.  Ecc.  79;  Wheeler  v.  Anderson,  8  Hagg.  Ecc.  5U ;  Mc- 
Elrov's  Case,  6  W.  &  S.  451 ;  Am.  Seaman's  Fund  Soc.  v.  Hopper,  83 
N.  Y.  619;  Duffield  I'.  Morris,  2  Harr.  875;  Sutton  v.  Sadler,  5  Harr. 
459;  Frere  v.  Peacock,  1  Rob.  Ecc.  442;  Stanton  v.  Whetherwax,  16 
Barb.  259;  Mullin  v.  Cottrell,  41  Miss.  291 ;  Buswell  on  Insanity,  §  14; 
Forraan's  Will,  54  Bar.  274. 

The  courts  have  made  exceptions  to  this  general  rule  where  '■'  delusion" 
is  not  the  criterion:  1.  Insanity  congenital  "ex  nativitate.''^  2.  Cases 
where  the  mind  has  become  enfeebled,  weakened,  or  disorganized,  due  to 
disease  or  to  the  gradual  development  of  senile  dementia.  The  law  now 
recognizes  insanitv  as  existing  in  certain  cases  without  delusions  :  Nichols 
V.  Binns,  1  Sw.  &  Tr  239  ;  Am.  Seam.  Fund  Soc.  v.  Hopper,  83  N.  Y. 
619  ;  Regina  v.  Shaw,  L.  R.  1  C.  C.  145  ;  Buswell  on  Insanity,  §  16.] 

As  regards  this  legal  view  of  insanity  in  its  bearings  upon  crime,  a 
distinguished  Judge,  already  quoted,  has  summed  up  a  description  of  mad- 
ness as  known  to  the  law  in  the  following  terms  (Stephen's  Hist,  of  the 
Crim.  Law  of  England,  vol.  ii.  p.  145) :  "Any  one  or  more  of  numerous 
causes  may  produce  diseases  of  the  brain  or  nervous  system  which  inter- 
fere more  or  less  with  the  feelings,  the  will,  and  the  intellect  of  the  per- 
sons affected.  Commonly,  the  disease,  if  it  runs  its  full  coarse,  affects 
the  emotions  first,  and  afterwards  the  intellect  and  the  will.  It  may  affect 
the  emotions  either  by  producing  morbid' depression  or  by  producing  mor- 
bid excitement  of  feeling.  In  the  first,  which  is  much  the  commoner  of 
the  two  cases,  it  is  called  melancholia,  and  in  the  second  mania.  Mel- 
ancholia often  passes  into  mania.      Both  melancholia  and  mania  com- 


680  UNSOUNDNESS    OF    MIND. 

monly  cause  delusions  or  false  opinions  as  to  existing  facts,  which  suggest 
themselves  to  the  mind  of  the  sulTerer  as  explanations  of  his  morbid  ieel- 
ings.  These  delusions  are  often  accompanied  by  hallucinations,  which  are 
deceptions  of  the  senses.  Melancholia,  mania,  and  the  delusions  arising 
from  them  often  supply  pow^erful  motives  to  do  destructive  and  mis- 
chievous acts;  and  cases  occur  in  which  an  earnest  and  passionate  desire 
to  do  such  acts  is  the  first,  and  perhaps  the  only  marked,  symptom  of 
mental  disease.  It  is  probable  that  in  such  cases  some  morbid  state  of  the 
brain  produces  a  vague  craving  for  relief  by  some  sort  of  passionate  action, 
the  special  form  of  which  is  determined  by  accidental  circumstances  ;  so  that 
such  impulses  may  differ  in  their  nature  and  mode  of  operation  from  the 
motives  which  operate  on  sane  and  insane  persons  alike.  The  difference 
may  be  compared  to  the  difference  between  hunger  prompting  a  man  to  eat, 
and  the  impulse  which,  when  he  suffers  violent  and  sudden  pain,  prompts 
him  to  relieve  himself  by  screaming.  Insanity  affecting  the  emotions  in  the 
forms  of  melancholia  and  mania  is  often  succeeded  by  insanity  affecting  the 
intellect  and  the  will.  In  this  stage  of  the  disease  the  characteristic  symp- 
tom is  the  existence  of  permanent  incurable  delusions,  commonly  called 
monomania.  The  existence  of  any  such  delusion  indicates  disorganization 
of  all  the  mental  powers,  including  not  only  the  power  of  thinking  correctly, 
but  the  power  of  keeping  before  the  mind  and  applying  to  particular  cases 
general  principles  of  conduct.  The  last  stage  of  insanity  is  one  of  utter 
feebleness,  in  which  all  the  intellectual  powers  are  so  much  prostrated  as 
to  reduce  the  sufferer  to  a  state  of  imbecility.  Lastly,  paralysis  and 
epilepsy  are  so  closely  allied  with  insanity  that  insanity  frequently  forms 
a  symptom  of  each.  In  all  the  cases  above  referred  to,  the  sufferer  is  sup- 
posed to  have  been  originally  sane,  but  sanity  may  never  be  enjoyed  at 
all.     This  happens  in  cases  of  idiocy."  ' 

[The  use  of  the  term  monomania,  even  in  the  sense  named  by  the 
learned  Judge,  was  misleading  and  improper.     The  state  to  which  allusion 
was  made  is  not  "  commonly  called  monomania.'"      That  term  among 
judges,  lawyers,  and  lexicographers  has  been  understood  to  mean  derange- 
ment of  a  single  faculty  of  the  mind,  or  with  regard  to  a  particular  sub- 
ject only  as  defined  by  Webster     This  has  had  judicial  construction  in  the 
courts. "  Legally,  monomania  has  been  held  to  exist  where  the  mind  is 
deranged  upon  one  subject,   the  insanity  relating  to  one  delusion,  and 
retaining  the  other  intellectual  powers.     It  excuses  only  when  this  delu- 
sion leads  to   an  insane  impulse  which  controls  the  will  and  judgment, 
obliterates  the  understanding  of  right  and  wrong  to  the  commission  of  an 
act  which  the  accused  ^vas  unable  to  resist,  or  to  refrain  from  and  yield- 
ing to  its  domination  :  Stevens  v.  State,  31  Ind.  485  ;  State  v.  Johnson,  40 
Conn.  136;  Com.  v.  Rogers,  47  Mass.  (7  Mete.)  500;   s.  c.  1  Lead,  C.  C. 
94;  Brailly  15.  State,  31  Ind.  492;  Com.  v.  Haskell,   2  Brewster  (Pa.), 
401 ;  Com.  v.  Frith,  5  Clark  (Pa.  L.  J.),  455;  Life  Ins.  Co.  v.  Teny,  21 
U.  S.   (15  Wall.)  580;  on  21  L.  Ed.  32fi  ;  United  States  v.  Hewson,  1 
Bost.  L.  R.  361 ;  Span  v   State,  47  Ga.  553  ;  Roberts  v.  State,  3  Ga.  310 ; 
Hopps  V.  People,  31   Me.  385  ;  State  v.  Felter,  25  Iowa,  67  ;  Wesley  v. 
State,  37  Miss.  327;  Scott  v.  Commonwealth,  4  Met.  (Ky.)  227;  and  as 
to  responsibilitv  :  Com.  v.  Mosier.  4  Pa.  St.  264  ;  State  v.  Huling,  21  Mo. 
464;  Rovceu 'Smith,  9  Graft    (Va.)  704;   Rex  v.  Offord,  5  Carr.  &  P. 
168;  Willis  ;;.  People,  5  Park.  Crim.  R.  (N.  Y.)  621 ;  Reg.  v.  Burton,  3 
Fost.  &  F.  772  ;  Rex  v.  Townley,  3  Post.  &  F.  839. 

Among  medical  men  and  authors  the  term  monomonia  means  quite 
another  thing,  as  was  intended  by  Esquirol.  its  author,  and  so  understood 
by  all  modern  American,  French,   German,   and  Italian  scientists   and 


SYMPTOMS    OF    INCIPIENT    INSANITY.  681 

writers.  Its  use  is  therefore  misleading,  and  it  is  now  generally  aljan- 
doned  by  the  better  medical  authorities  for  that  reason  :  Yid.  Article 
Monomania,  2  Bell's  Medico-Legal  Studies,  p.  101.  Maudsley,  Pliny 
Earl,  and  many  writers  and  observers,  deny  the  existence  of  an  insanity 
limited  to  one  subject,  leaving  the  brain  normal  and  healthy  on  all  other 
subjects.  For  these  reasons  the  term  monomania  should  not  be  longer 
employed  by  medico-legal  writers  or  in  text-books.j 

The  same  writer  points  out  the  chief  points  on  which  medical  and  legal 
writers  differ  respecting  the  plea  of  irresponsibility  (Ibid.  vol.  iii.  ch. 
xvii.) ;  and  this  chapter  should  be  perused  by  all  phj^sicians  who  have  to 
deal  with  insane  criminals.  It  may  be  Avell  to  give  an  outline  of  the 
views  therein  expressed. 

"The  different  legal  authorities"  (he  says,  p.  125)  "upon  the  subject 
have  been  right  in  holding  that  the  mere  existence  of  madness  ought  not 
to  be  an  excuse  for  crime,  unless  it  produces  in  fact  one  or  the  other  of 
certain  consequences."  The  English  law  with  respect  to  madness  is  thus 
stated,  the  doubtful  points  being  placed  within  square  brackets  :  "  No  act 
is  crime  if  the  person  who  does  it  is  at  the  time  when  it  is  done  prevented 
[either  by  defective  mental  power  or]  by  any  disease  affecting  the  mind, 
(a)  from  knowing  the  nature  or  quality  of  his  act ;  or  (6)  from  knowing 
the  act  is  wrong;  [or  (c)  from  controlling  his  own  conduct,  unless  the 
absence  of  the  power  of  control  has  been  produced  by  his  own  default]. 
But  an  act  may  be  a  crime  although  the  mind  of  the  person  who  does  it 
is  affected  by  disease,  if  such  disease  does  not,  in  fact,  produce  upon  his 
mind  one  or  other  of  the  effects  above  mentioned,  in  reference  to  the  act." 
Speaking  of  knowledge  of  right  and  wrong,  he  says,  "  I  think  that  any 
one  would  fall  within  that  description  (inability  to  know  the  quality  of 
his  act)  who  was  deprived,  by  disease  affecting  the  mind,  of  the  power  of 
passing  a  rational  judgment  on,  the  moral  character  of  the  act  which  he 
meant  to  do  "  (p.  163).  And  again,  "  Knowledge  and  power  are  the  con- 
stituent elements  of  all  voluntary  actions,  and  if  either  is  seriously  im- 
paired the  other  is  disabled.  It  is  as  true  that  a  man  who  cannot  control 
himself  does  not  know  the  nature  of  his  acts,  as  that  a  man  who  does  not 
know  tiie  nature  of  his  acts  is  incapable  of  self-control  "  (p.  171). 

The  true  legal  meaning  of  the  word  "know,"  as  applied  to  madness,  is 
by  no  means  easy  to  determine  ;  and  it  is  also  clear  that  the  term  responsi- 
hility  is  used  in  different  senses  by  legal  and  medical  authorities  respec- 
tively. The  lawyer  understands  by  it  responsibility  to  the  law  of  the 
land  ;  medical  writers  on  insanity,  on  the  other  hand,  have  habitually 
used  the  term  in  a  vague  and  undefined  sense  as  referring  to  what  ought 
in  their  opinion  to  be  the  law,  and  as  referring  to  some  moral  standard. 
The  word  wrong,  too,  is  used  in  two  senses — it  may  mean  either  immoral 
or  illegal. 

It  is  here  right  to  observe  that  "  irresistible  "  is  a  term  often  applied  bv 
medical  writers  to  impulses  which  can  be  controlled.  Stephen,  J.,  quotes 
a  remarkable  instance  of  a  woman  who  felt  what  was  termed  an  "  irre- 
sistible impulse"  to  murder  her  child,  and  yet  did  successfully^  resist  her 
impulse. 

Symptoms  of  Incipient  Insanity. — The  symptoms  by  which  insanity 
is  indicated  at  an  early  stage  are  liable  to  great  variation,  according  to 
the  sex,  age,  and  social  position  of  the  person.  In  reference  to  suicide, 
the  execution  of  wills,  or  the  perpetration  of  crime,  we  often  find,  after 
the  death  of  the  person,  or  at  the  trial  which  follows  the  crime,  that  the 
most  trivial  and  irrelevant  circumstances  are  brought  forward  as  indica- 
tions of  insanity,     This  subject  has  been  ably  treated  by  Winslow.     (Ob- 


682  HALLUCINATIONS  AND  ILLUSIONS. 

scure  Dis.  of  the  Brain,  p.  88.)  The  facts  are  there  gathered  chiefly  from 
the  accounts  furnished  to  him  by  those  who  have  recovered.  There  is 
great  irritability  at  the  most  trifling  circumstances — impatience  of  contra- 
diction, loquacity,  great  difficulty  in  directing  attention  to  and  steadily 
occupying  the  mind  with  any  train  of  thought,  neglect  of  usual  employ- 
ment, sleeplessness,  depression  of  spirits  without  reasonable  cause,  a  dis- 
position to  seclusion,  doubts  about  personal  identity,  followed  by  halluci- 
nations and  illusions.  A  lady,  who  was  gradually  affected,  remained  in- 
sane for  nearly  eleven  months:  she  informed  Winslow  that  during  the 
whole  of  that  time  she  fancied  she  was  in  hell  and  tormented  by  evil 
spirits  ;  she  thought  every  person  near  her  was  the  devil.  Sometimes  a 
patient  fancies  he  is  continually  watched  by  spies,  that  policemen  are 
looking  after  him,  and  that  conspiracies  and  plots  among  his  relatives  or 
friends  are  going  on  secretly  against  him  ;  he  believes  that  his  food  is 
drugged  or  poisoned,  and  will  refuse  to  eat.  Great  anxiety  on  any  sub- 
ject followed  by  headache  may  be  the  forerunners  of  an  attack  ;  there  is 
generally  an  entire  loss  of  interest  in  the  usual  occupations,"  a  silent  man- 
ner, and  a  great  desire  for  sohtude.  In  one  instance  fits  of  immoderate 
laughter  at  the  most  trivial  occurrences  preceded  the  attack.  Sooner  or 
later  these  symptoms  are  attended  b}-  perverted  taste  or  smell — by  illu- 
sions of  hearing  or  sight;  voices  are  heard,  and  objects  are  seen,  which  at 
first  perplex  and  then  confuse  the  patient ;  they  continue  until  he  feels 
overpowered  mentally  and  bodily  ;  and  then  he  falls  into  delusions  re- 
garding himself,  his  friends  who  are  about  him,  his  profession  or  occupa- 
tion, and  his  worldly  circumstances. 

In  incipient  insanity  delusion  does  not  necessarily  exist.  There  is  an 
antecedent  state,  in  which  the  most  prominent  feature  is  intense  self-con- 
ceit. A  man  may  retain  the  knowledge  of  his  personal  identity,  but  he 
may  fancy  himself  to  be  wiser,  richer,  or  stronger  than  he  really  is.  An- 
other feature  is  misanthropy ,  a  general  dislike  to  others  without  cause, 
but  especially  directed  against  those  who  have  the  greatest  claim  on  his 
affection.  This  feeling  may  after  a  time  become  complicated  with  some 
delusion.  A  third  symptom  is  a  suspiciovs  disposition,  which  sooner  or 
later  leads  to  delusion,  and  the  person  imagines  that  there  are  conspiracies 
to  poison  him  or  to  do  him  some  bodily  injury.  (Lancet,  1873,  i.  p.  471.) 
Intense  self-conceit,  misanthropy,  and  distrust  without  delusion  may  be 
regarded  as  the  most  marked  forerunners  of  an  attack  of  insanity. 

Hallucinations  and  Illusions. — These  are  the  most  striking  symptoms 
which  are  met  with  in  a  confirmed  state  of  insanity.  Hallucinations  are 
those  sensations  which  are  supposed  by  the  patient  to  be  produced  by 
external  impressions,  although  no  material  objects  act  upon  his  senses  at 
the  time  ;  illusions,  on  the  other  hand,  are  sensations  produced  by  a  false 
perception  of  objects.  A  man  has  visions  of  all  kinds,  including  the  forms 
of  the  dead  and  the  living,  floating  before  him  when  he  is  gazing  upon 
vacancy.  He  fancies  he  hears  voices  speaking  or  mysteriously  whisper- 
ing to  him,  while  there  is  profound  silence  :  these  are  hallucinations.  An- 
other may  erroneously  imagine  that  the  taste  or  smell  of  his  ordinary  food 
is  earthy,  metallic,  or  poisonous — when  the  perversion  is  in  his  own 
senses:  these  are  illusions.  Both  conditions  depend  upon  a  disordered 
state  of  the  mind.  Instances  of  hallucination  are  furnished  by  the  act  of 
dreaming  :  while  illusions  occur  often  during  the  act  of  suddenly  waking 
from  sleep,  giving  rise  occasionally  to  serious  questions  involving  criminal 
responsibility.  The  state  of  insanity  is  in  other  points  of  view  analogous 
\o  dreaming.  There  is  equally  a  want  of  power  in  the  two  states  to 
change   or   control   the  current  of  thought  passing   through   the  mind. 


LUCID    INTERVALS.  683 

Thinp^s  which  are  impossible  and  inconsistent  are  believed  to  have  an 
actual  existence.  A  voice  heard  during-  the  act  of  dreaming  sometimes 
becomes  an  illusion  connected  with  a  current  of  thought  then  passing 
throuuh  the  mind;  it  is  the  same  in  a  case  of  confirmed  insanity,  Avith 
this  difference  in  the  latter,  that  some  power  of  will  or  some  exercise  of 
reason  may  still  exist. 

Illusions  are  sometimes  met  with  in  the  sane,  but  when  arising-  from 
external  objects  the  false  perception  is  soon  corrected  by  a  reference  to 
the  other  senses  ;  and  herein  consists  the  main  difference  between  sanity 
and  insanity — namely,  delusion,  or  a  misleading  of  the  mind.  When  the 
hallucination  or  illusion  is  believed  to  have  a  positive  existence,  and  this 
belief  is  not  removed  either  by  reflection  or  an  appeal  to  the  other  senses, 
the  person  is  insane  ;  but  when  the  false  sensation  is  immediatel\'  detected' 
b}^  the  judgment,  and  is  not  acted  on  as  if  it  were  real,  then  the  person  is 
sane.  Delusion,  therefore,  properly  refers  to  the  judgment,  and  illusion 
to  the  senses.  The  meaning  of  these  terms  is  often  confounded  ;  but 
while  delusion  is  always  connected  with  insanity,  illusion  is  not  neces- 
sarily indicative  of  mental  disorder.  Hallucinations  and  illusions  are  the 
main  features  of  those  forms  of  insanity  which  are  known  as  mania  and 
primary  delusional  mania.  They  are  rarely  met  with  in  cases  of  idiocy 
and  imbecility,  sometimes  in  dementia,  but  they  are  most  common  In 
paroxysms  of  mania.  Acts  of  murder  may  often  be  traced  to  their  exist- 
ence; for  the  person  laboring  under  mania  of  general  or  specific  delusions 
is  unable  during  a  paroxysm  to  divest  his  mind  of  the  belief  that  what  he 
sees  has  a  positive  existence  before  him.  He  feels  impelled  to  suicide  by 
the  hallucination  of  voices  calling  to  him,  and  to  murder  by  the  illusion 
that  he  is  not  destroying  a  wife,  child,  or  friend,  but  an  evil  spirit  substi- 
tuted for  them.  The  acts  of  the  insane  are  generally  connected  with  their 
delusions,  although  it  is  not  easy  to  trace  the  connection  except  by  their 
own  admissions.  When  the  acts  are  unusual  and  strange,  it  is  most  prob^ 
able  that  they  depend  on  hallucination,  illusion,  or  both. 

Lucid  Intervals. — By  a  lucid  interval  we  are  to  understand,  in  a  legal 
sense,  a  temporary  cessation  of  the  insanity  or  a  perfect  restoration  to 
reason.  In  a  remission  there  is  a  mere  abatement  of  the  symptoms.  It 
has  been  said  that  a  lucid  interval  is  only  a  more  perfect  remission,  and 
that  although  the  lunatic  may  act  rationally  and  talk  coherently,  yet  his 
brain  is  in  an  excitable  state,  and  he  labors  under  a  greater  disposition  to 
a  fresh  attack  of  insanity  than  one  whose  mind  has  never  been  affected. 
Of  this  there  can  be  no  doubt,  but  the  same  reasoning  Avould  tend  to  show 
that  insanity  is  never  cured ;  for  the  predisposition  to  an  attack  is  un- 
doubtedly greater  in  a  recovered  lunatic  than  in  one  who  is  and  has 
always  been  perfectly  sane.  Even  admitting  the  correctness  of  this  reason- 
ing, it  cannot  be  denied  that  lunatics  do  occasionally  recover  for  a  longer 
or  shorter  period,  to  such  a  degree  as  to  render  them  perfectly  conscious 
of  and  legally  responsible  for  their  actions  like  other  persons.  The  law 
intends  no  more  than  this  by  a  lucid  interval — it  does  not  require  proof 
that  the  cure  is  so  complete  that  even  the  predisposition  to  the  disease  is 
entirely  extirpated.  Such  proof,  if  it  could  even  be  procured,  would  be 
totally  irrelevant.  If  a  man  acts  rationally  and  talks  coherently,  we  can 
have  no  better  proof  of  a  restoration  to  reason.  If  no  delusion  affecting 
his  conduct  remains  in  his  mind,  we  need  not  concern  ourselves  about  the 
degree  of  latent  predisposition  to  a  fresh  attack  which  may  still  exist. 
Lucid  intervals  sometimes  appear  suddenly  in  the  insane :  the  person 
feels  as  if  awakened  from  a  dream,  and  there  is  often  a  perfect  conscious- 
ness of  the  absurdity  of  the  delusion  under  which  he  w^s  previously  labor- 


684  VARIOUS    FORMS    OF    INSANITY. 

ing.  The  duration  of  the  interval  is  uncertain  :  it  may  last  for  a  few 
minutes  only,  or  may  be  protracted  for  da^^s,  weeks,  months,  and  even 
years.  In  a  medico-legal  view,  its  alleged  existence  must  be  always 
looked  upon  with  suspicion  and  doubt  Avhen  the  interval  is  very  short. 

Lucid  intervals  are  most  frequently  seen  in  cases  of  mania  and  those 
forms  of  insanity  accompanied  by  specific  delusions;  they  occasionally 
exist  in  dementia  when  this  state  is  not  chronic,  but  has  succeeded  a  fit  of 
intermittent  or  periodical  mania.  They  are  never  met  with  in  cases  of 
idiocy  and  imbecility.  It  is  sometimes  a  matter  of  great  importance  to 
be  able  to  show  whether  or  not  there  exists  or  has  existed  a  lucid  interval, 
since  in  this  state  the  acts  of  a  person  are  deemed  valid  in  law.  The 
mind  should  be  tested,  as  in  determining  whether  the  patient  is  laboring 
under  insanity  or  not.  He  should  be  able  to  describe  his  feelings,  and 
talk  of  the  subject  of  his  delusion  without  betraying  any  sign  of  unneces- 
sary vehemence  or  excitement.  It  may  happen  that  the  person  who  is 
the  subject  of  a  Commission  of  Inquiry  is  at  the  time  of  examination 
under  a  lucid  interval,  in  which  case  there  may  be  some  difficulty  in  form- 
ing an  opinion  of  the  existence  of  insanity.  It  has  been  said  that  a  person 
in  a  lucid  interval  is  considered  by  law  to  be  responsible  for  his  acts, 
whether  these  are  of  a  civil  or  criminal  nature.  In  regard  to  criminal 
offences  committed  during  a  lucid  interval,  it  is  the  opinion  of  many  alien- 
ists that  no  person  should  be  convicted  under  such  circumstances,  because 
there  is  a  probability  that  he  might  at  the  time  have  been  under  the  in- 
fluence of  that  degree  of  cerebral  irritation  which  renders  a  man  insane. 
This  remark  applies  especialh'  to  those  instances  in  which  the  lucid  interval 
is  very  short.  Juries  now  seldom  convict,  however  rationally  in  appear- 
ance a  crime  may  have  been  perpetrated,  if  it  is  proved  that  the  accused 
was  insane  within  a  short  period  of  the  time  of  its  perpetration. 

The  number  of  lunatics  in  England  and  Wales  in  1883  was  '78,528, 
exclusive  of  228  so  found  by  inquisition,  but  including  535  criminal 
lunatics. 


CHAPTER    LXII. 

VARIETIES  OF  IXSANITT. — MAXTA. — ABSTINEXCE  FROM  FOOD.  —  DELUSIONS  REGARDING  POI- 
SON.  DELIRIUM  DISTINGUISHED  FROM  MANIA. PRIMARY  DELUSIONAL  INSANITY. DE- 
MENTIA.  IDIOCY. IMBECILITY. HEREDITARY        TRANSMISSION. FEIGNED       INSANITY. 

APPEARANCES  AFTER  DEATU. ECCENTRICITY. 

Varieties  of  Insanity. — Medical  jurists  have  commonly  recognized  four 
distinct  forms  of  insanity:  Mania,  Primary  delusional  insanity,  (Mono- 
mania), Dementia,  and  Idiocy  (Amentia).^  This  division  was  proposed 
by  Esquirol,  and  although  of  a  purely  artificial  nature  it  is  convenient  for 
the  arrangement  and  classification  of  the  facts  connected  with  the  subject. 
In  some  instances  there  is  great  difficulty  in  assigning  a  particular  case  to 
either  of  the.^e  divisions,  owing  to  the  circumstance  that  these  states  of 
disordered  mind,  if  we  except  idiocy,  are  frcquentl}'  intermixed,  and  are 
apt  to  pass  and  repass  into  each  other.  On  other  occasions,  a  ease  may 
represent  mixed  characters  which  appertain  to  all  the  divisions.     Melan- 

'  [The  title  Monomania  is  no  longer  U3pd  by  advanced  alienists  in  classifications  of 
insanity  for  reasons  given  heretofore. — (Editor.)] 


MANIA DELIRIUM.  685 

cliolia  may  be  regcarded  as  chronic  mania.  General  2^0'i^O'lysis  of  the 
insane  is  a  cause  or  symptom  of  insanity,  and  not  a  separate  division 
of  it. 

Mania. — In  this  form  of  insanity  there  is  a  general  derangement  or  per- 
version of  the  mental  faculties,  accompanied  by  greater  or  less  excitement, 
sometimes  amounting  to  violent  fury.  (Pagan's  Med.  Jur.  of  Insanity, 
p.  59;  Marc,  De  la  Folic,  vol.  i.  p.  211.)  Ideas  flow  through  the  mind 
without  order  or  connection,  the  person  losing  all  control  over  his 
thoughts,  and  believing  and  acting  upon  them,  however  absurd  and  incon- 
sistent they  may  be.  Rapidity  of  utterance  and  incessant  agitation 
accompany  this  state;  there  is  also  great  irritability,  so  that  not  the  least 
contradiction  can  be  borne.  Mania  may  take  place  suddenly,  as  after  a 
violent  moral  shock,  but  in  general  it  comes  on  slowly.  It  may  be  chronic 
or  acute,  recurrent  or  continued.  There  are  very  few  cases  which  do  not 
present  remissions,  more  or  less  complete;  and  in  some  instances  after  a 
violent  attack  the  reason  appears  to  be  perfectly  restored,  forming  then 
what  is  termed  a  lucid  interval,  the  clear  distinction  of  which,  in  a  legal 
point  of  view,  is  of  material  importance.  In  recurrent  mania  the  attack 
comes  on  without  any  obvious  cause.  It  may  last  for  a  week,  a  month, 
or  even  longer.  There  is  usually  a  stage  of  excitement  followed  by  de- 
pression before  recovery.  Persons  laboring  under  mania,  especially  when 
it  is  associated,  as  it  frequently  is,  with  paralysis,  are  comparatively 
insensible  to  severe  injuries.  They  will  bear  exposure  to  cold  without 
complaining,  and  even  conceal  the  existence  of  a  fracture  or  other  injury 
which  would  cause  great  pain  to  a  sane  person.  They  will  also  sustain 
the  privation  of  food  for  a  great  length  of  time  without  any  apparent  in- 
jury to  health.  In  some  instances,  owing  to  a  suspicion  that  the  food  is 
poisoned,  they  refuse  to  take  any  ;  it  is  then  necessary  to  feed  them  with 
a  stomach-pump.  This  delusion  respecting  the  poisoning  of  food  is  very 
common  in  the  early  stages  of  mania.  The  patient  will  fancy  that  he 
himself,  or  some  favorite  animal,  is  undergoing  a  process  of  slow  poison- 
ing by  a  secret  enemy.  We  have  met  with  a  great  number  of  instances 
in  which  this  delusion  of  being  the  victim  of  poison  was  the  principal 
feature  of  the  mental  disorder.  In  mania  there  is  excitement  coming  on 
in  paroxysms  without  any  obvious  cause,  and  leading  the  person  to  acts 
of  violence  either  towards  himself  or  others. 

It  is  necessary  that  a  medical  jurist  should  be  able  to  distinguish  mania 
from  delirium  depending  on  bodily  disease  and  from  the  action  of  poisons. 
Delirium  closely  resembles  the  acute  form  of  mania, — so  closely  that  mis- 
takes have  occurred,  and  persons  laboring  under  it  have  been  improperly 
ordered  into  confinement  as  maniacs.  The  following  are,  perhaps,  the 
best  diagnostic  differences:  a  disordered  state  of  the  mind  is  the  first 
symptom  remarked  in  mania :  while  delirium  is  a  result  of  bodily  disease, 
and  there  is  greater  febrile  excitement  in  it  than  in  mania.  Delirium, 
being  a  mere  symptom  attendant  on  the  disease  which  produces  it,  exists 
as  long  as  that  disease,  and  no  longer ;  while  mania,  depending  on 
widely  different  causes,  is  persistent.  Delirium  disappears  suddenly,  leav- 
ing the  mind  clear;  while  mania  commonly  experiences  only  remissions. 
(See  Pagan's  Med.  Jur.  of  Insanity,  p.  69.)  In  delirium  there  is  gener- 
ally great  acuteness  of  the  senses.  Inflammation  of  the  brain  or  its  mem- 
branes is  distinguished  from  acute  mania  by  the  mode  of  its  attack,  the 
presence  of  severe  pain  in  the  head,  and  excessive  sensibility  with  intoler- 
ance of  light  and  sound. 

Frimary  Delusional  Insanity.  {Monomania.') — This  name  is  some- 
times applied  to  that  condition  in  which  the  mental  alienation  is  apparently 


G86  MO>'OMANIA  —  DELIRIUM. 

only  partial ;  in  other  words,  it  is  nothing  more  than  insanity  manifesting 
itself  in  one  direction.^  In  mania,  the  mind  is  disordered  on  all  kinds  of  sub- 
jects ;  in  this  form  the  disorder  is  confined  chiefly  either  to  one  subject  or 
to  one  class  of  subjects.  Those  thus  affected  are  infected  Avith  false  ideas 
on  certain  points,  of  which  they  cannot  divest  themselves,  and  out  of 
which  they  cannot  be  reasoned :  they  start  from  false  principles,  but, 
setting  this  aside,  their  inferences  and  deductions  from  these  principles 
often  possess  logical  accuracy.  In  ever}-  subject  not  connected  with  their 
special  delusions  they  are  like  the  rest  of  the  world;  they  talk  and  reason 
345  justly  upon  facts  as  before  the  access  of  their  malady,  but  their  general 
deportment,  habits,  and  character  are  changed.  Thus  a  miser  may  become 
a  spendthrift,  and  a  hard-working  and  industrious  mechanic  ma}^  pass  his 
time  in  idleness ;  a  man  of  moral  habits  will  become  immoral  in  conversa- 
tion and  conduct ;  and  an  abstemious  man  may  become  a  drunkard.  [The 
term  " primo.ry  delusional  insanity''''  is  better  and  less  misleading  than 
"  monomania  f  Yid.  Report  Com.  on  Classification  of  Insanity;  vol.  iv. 
]Sled.  Leg.  Jour.,  p.  209,  also  ib.  vol.  v.  p.  465.] 

The  mental  disturbance  may  be  so  slight  that  the  person  will  have  the 
power  of  so  controlling  his  thoughts  and  actions  as  to  appear  like  one 
who  is  sane,  provided  the  subject  of  his  delusion  is  not  referred  to.  There 
is  no  doubt  that  those  who  are  thus  affected  in  an  early  stage  are  frequently 
able  to  direct  their  minds  with  reason  and  propriety  to  the  performance  of 
their  social  duties,  so  long  as  these  do  not  involve  any  of  the  subjects  of 
their  delusions.  Their  power  of  controlling  their  thoughts  and  feelings, 
as  well  as  of  concealing  their  delusions,  implies  a  certain  consciousness 
of  their  condition  not  usually  met  with  in  ordinary  mania;  and  it  also 
appears  to  imply  the  existence  of  such  a  control  over  their  conduct  as  to 
render  them  equally  responsible  with  sane  persons  for  many  of  their  acts. 
In  a  case  of  confirmed  single  delusion,  however,  it  is  not  to  be  supposed 
that  a  man  is  insane  upon  one  point  only  and  sane  upon  all  other  subjects. 
The  only  admissible  view  of  this  disorder  is  that  which  was  taken  b}^  Lord 
Lyndhurst  in  one  of  his  judgments.  If  the  mind  is  unsound,  it  is  not 
unsound  in  one  point  only  and  sound  in  all  other  respects,  but  this  un- 
soundness manifests  itself  principally  with  reference  to  some  particular 
object  or  person.  There  is  no  doubt  that  all  the  mental  faculties  are 
more  or  less  affected,  but  the  affection  is  more  strikiuglj^  manifested  in  some 
of  these  than  in  the  others. 

The  delusion  of  such  a  person  will  be  generally  uppermost  in  his  mind ; 
his  will  is  powerless  to  dismiss  it,  just  as  in  mania  the  will  is  powerless 
to  stop  the  continuous  and  rapid  succession  of  different  and  incongruous 
ideas  which  present  themselves  to  the  mind  in  that  form  of  insanity.  In 
the  first  stage  the  judgment  may  be  strong  and  the  mind  apparently  sound 
upon  every  point  except  the  particular  subject  of  delusion  ;  and  even,  in 
some  instances,  there  may  be  such  a  control  over  this  delusion  that  it 
would  be  difficult  to  discover  whether  or  not  there  was  any  just  ground 
for  imputing  mental  unsoundness;  but  in  a  more  advanced  form  of  the 
disease  the  delusion,  whatever  it  may  be,  whether  relating  to  wealth, 
ambition,  religion,  or  politics,  so  overpowers  the  patient  that  he  loses 

1  [Although  courts  have  held  that  insanity  may  exist  where  there  is  only  one 
specific  delusion,  and  the  manifestations  are  limited  to  that  one  subject,  with  the 
mind  clear  and  unimpaired  on  all  other  subjects,  based  upon  the  opinions  of  medical 
men  and  j»opular  belief,  alienists  of  the  highest  attainments  and  largest  experience 
deny  such  a  condition,  and  they  are  undoubtedly  correct.  If  the  brain  is  diseased 
to  such  an  extent  as  to  produce  a  state  of  insanity  in  any  respect,  it  is  difficult  to 
conclude  that  the  subject  is  sane  in  all  other  respects. — (Editor.)] 


MONOMANIA — DEMENTIA.  687 

self-control.  His  character  is  changed,  and  his  habits  are  such  as  to 
render  him  unfit  for  social  intercourse;  he  becomes  incoherent;  his  ideas 
are  preverted  on  all  subjects,  and  he  gradually  lapses  into  mania  or  de- 
mentia. The  last  condition  happens  when  the  disease  is  of  long  stand- 
ing. It  may  be  remittent  or  intermittent,  and  it  is  sometimes  accompanied 
with  lucid  intervals.  Its  progress  is  rapid,  and  its  termination  often  un- 
expected ;  in  some  instances  the  disease  ceases  suddenly  without  any  pre- 
vious warning,  owing  to  the  effects  of  a  strong  moral  shock  or  impression. 

This  form  of  insanity  in  its  early  stage  is  liable  to  be  confounded  with 
eccentricity;  but  there  is  this  difference  between  them.  In  the  insane 
there  is  obviously  a  change  of  character — the  person  is  different  from  what 
he  was  ;  in  eccentricity  such  a  difference  is  not  remarked — he  is,  and  always 
has  been,  singular  in  his  ideas  and  actions,  there  is  no  observable  change 
of  character.  An  eccentric  man  may  be  convinced  that  what  he  is  doing 
is  absurd  and  contrary  to  the  general  rules  of  society,  but  he  professes  to 
set  these  rules  at  defiance ;  tlie  insane  man  cannot  be  convinced  of  his 
error,  and  he  thinks  that  his  acts  are  consistent  with  reason  and  the  general 
conduct  of  mankind.  In  eccentricity  there  is  the  will  to  do  or  not  to  do ; 
in  insanity  the  controlling  power  of  the  will  appears  to  be  lost.  Eccen- 
tric habits  suddenly  acquired  are,  however,  presumptive  of  insanity.  It 
will  be  seen  hereafter  that  the  distinction  of  these  states  is  of  considerable 
importance  in  relation  to  testamentary  capacity. 

This  form  of  insanity  frequently  assumes  one  of  two  forms;  either  the 
thoughts  are  lively  and  gay,  or  they  are  oppressed  with  gloomy  melan- 
choly. In  the  first  state  the  persons  will  fancy  themselves  to  be  kings 
and  queens,  and  overflowing  with  wealth,  which  they  are  prepared  to 
distribute  with  regal  profusion  ;  in  the  second  state  we  find  silence,  seclu- 
sion, and  the  most  heart-rending  sorrow.  The  latter  condition,  by  no 
means  uncommon  as  a  form  of  this  disease,  is  called  Melancholia  (mania 
with  depression),  or  Lypemania  {xvjtri,  sorrow).  Those  who  are  affected 
with  it  suppose  they  have  committed  the  unpardonable  sin,  and  pass  their 
hours  in  silence  and  in  the  most  gloomy  forebodings  of  eternal  punishment. 
They  do  not  sleep,  will  sometimes  neither  eat,  speak,  nor  move ;  and  force 
must  be  used  to  make  them  tai^e  food  and  exercise.  In  some  instances 
no  persuasion  can  conquer  their  silence ;  one  patient  thus  affected  was  not 
heard  to  utter  a  word  during  four  years.  If  spoken  to,  they  shed  tears 
and  violently  repulse  the  person  who  addresses  them.  Melancholia  fre- 
quently leads  to  an  act  of  suicide  or  murder,  and  persons  affected  with 
it  require  close  watching.  In  the  lighter  forms  of  the  disease  there  is  no 
sign  of  mental  aberration,  and  the  patient  will  go  through  his.  usual 
routine  of  duty,  but  always  with  the  same  desponding  air,  so  that  his. 
occupation  seems  scarcely  to  distract  his  thoughts  from  the  delusion  for 
a  single  instant.  In  other  cases  the  delusion  is  so  well  concealed  that  no 
suspicion  exists  until  an  act  of  suicide  leads  to  inquiry,  and  some  evidence 
of  strangeness  of  conduct  is  then  for  the  first  time  forthcoming.  There 
is  either  an  entire  absence  of  motive  for  the  act  or  the  motive  is  based  on 
a  delusion. 

Dementia. — This  is  a  state  which,  althoua-h  sometimes  confounded  with 
mania,  is  very  different  in  its  characters.  Dementia,  when  confirmed,  con- 
sists in  a  total  absence  of  all  reasoning  power,  and  an  incapacity  to  per- 
ceive the  true  relations  of  things ;  the  language  is  incoherent,  and  the 
actions  are  inconsistent;  the  patient  speaks  without  being  conscious  of 
the  meaning  of  what  he  is  saying;  memory  is  lost,  and  sometimes  the 
same  word  or  phrase  is  repeated  for  many  hours  together ;  words  are 
no  longer  connected  in  meaning  as  they  are  in  mania  and  monomania. 


688  IDIOCY    AND    IMBECILITY. 

This  state,  often  called  Fatuity,  is  a  Dot  unfrequent  consequence  of  chronic 
mania. 

Dementia  varies  in  degree.  The  disordered  mind  of  aged  persons  is  one 
form  of  dementia  ;  here  we  find  memory  and  some  mental  poAver,  although 
the  memory  is  restricted  to  objects  long  since  past,  and  the  exertions  of 
the  mind  are  only  momentary.  Some  persons  in  dementia  are  quiet,  others 
are  in  constant  motion  as  if  in  search  of  something.  In  some  instances 
this  disease  comes  on  gradually — the  faculties,  both  moral  and  intellectual, 
decay  one  by  one;  while  in  other  instances,  although  much  more  rarely, 
dementia  may  occur  suddenh^  from  a  violent  shock  or  impression  on  the 
mind.  Dementia  may  be  acute  or  chronic,  remittent  or  intermittent.  The 
countenance  of  the  patient  is  generally  paie,  vacant,  and  wn'thout  expres- 
sion, the  look  vague  and  uncertain,  and  tears  are  abundantly  shed  from 
the  slightest  causes. 

The  following  may  be  taken  as  the  most  striking  differences  between 
mania  and  dementia:  In  mania  there  is  an  incoherence  of  ideas,  but  de- 
pending on  too  great  rapidity  of  thought  and  excitement  of  the  intellect- 
ual powers ;  in  dementia  there  is  a  want  of  ideas,  and  the  incoherence 
depends  on  the  loss  of  the  power  of  connecting  them,  owing  to  defect  of 
memory  ;  volition  is  lost  and  the  brain  seems  in  a  state  of  collapse.  (Es- 
quirol,  Mai.  Ment.,  t.  2,  pp.  224  and  232.)  In  fact,  in  dementia  there  is  a 
more  or  less  complete  abolition  of  the  moral,  intellectual,  and  voluntary 
powers;  in  mania,  and  also  in  monomania,  the}^  are  in  a  state  of  perver- 
sion. Dementia  is  often  a  consequence  of  these  states,  and  sometimes 
alternates  wMth  them. 

Idiocy.  Imbecility. — Idiocy  is  the  demejitia  naturalis  of  law-yers.  The 
term  "idiot"  is  applied  to  one  who  from  original  defect  has  never  had 
mental  power.  Idiocy  differs  from  the  other  states  of  insanity  in  the  fact 
that  it  is  marked  by  a  congenital  deficiency  of  the  mental  faculties.  There 
is  not  here  a  perversion  or  a  loss  of  what  has  once  been  acquired,  but  a 
state  in  which,  from  defective  structure  of  the  brain,  the  individual  has 
never  been  able  to  acquire  any  degree  of  intellectual  power  to  fit  him  for 
his  social  position.  It  commences  with  life  and  continues  through  it, 
although  idiots  are  said  rarely  to  live  beyond  the  age  of  thirty.  (Esqui- 
rol,  Mai.  Ment.,  t.  2,  p.  284.)  The  deficiency  of  intellect  is  marked  by  a 
peculiar  physiognomy,  an  absence  of  all  expression,  and  a  vague  and  un- 
meaning look  ;  there  is  no  power  of  speech,  or  only  the  utterance  of  a  cry 
or  sound  ;  there  is  no  will,  but  the  actions  of  these  beings  appear  to  de- 
pend upon  impulse,  a  power  of  imitation,  or  mere  animal  instinct ;  they 
recognize  no  one,  they  remember  no  one,  and  the  mind  seems  to  be  a 
blank.  Such  is  the  picture  of  what  may  be  termed  a  complete  idiot.  This 
state  of  idiocy  is  often  accompanied  with  great  bodily  deformity  and  en- 
largement of  the  thyroid  gland  (goitre),  both  in  males  and  females  ;  it  is 
then  termed  cretinism.  A  confirmed  idiot  may  in  almost  all  cases  be 
recognized  by  the  expression  of  countenance  and  the  form  of  the  skull. 

Idiocy  is  not  always  so  complete  as  this  description  implies.  There  is 
a  state,  scarcely  separable  from  idiocy,  in  which  the  mind  is  capable  of  re- 
ceiving some  ideas  and  of  profiting  to  a  certain  extent  by  instruction. 
Owing,  however,  either  to  original  defect,  or  to  a  defect  proceeding  from 
arrested  development  of  the  brain  as  a  result  of  disease,  or  other  causes 
operating  after  birth,  the  minds  of  such  persons  are  not  capable  of  being 
brought  to  a  healthy  standard  of  intellect,  like  that  of  an  ordinary  person 
of  similar  age  and  social  position.  This  state  is  called  iwbecility ;  it  is 
nothing  more  than  idiocy  in  a  minor  degree.  In  common  language,  per- 
sons laboring  under  it  are  often  called  idiots,  but  for  the  sake  of  precision 


IDIOCY    AND    IMBECILITY.  689 

in  medical  language  they  are  more  correctly  described  as  imbeciles.  (Es- 
qiiirol,  op.  cit.,  t.  2,  p.  289.)  In  imbecility  tlie  physical  organization  differs 
but  little  from  the  ordinary  standard  ;  the  moral  and  intellectual  faculties 
are  susceptible  of  cultivation,  but  to  a  less  degree  than  in  a  perfect  man, 
and  even  this  capacity  does  not  exist  beyond  a  certain  point.  Imbeciles 
never  attain  a  normal  standard  of  intellect,  and  when  placed  in  the  same 
circumstances  as  other  men  never  make  a  similar  use  of  their  intellectual 
powers.  They  can  form  no  abstract  ideas,  and  sometimes  their  capacity 
to  receive  instruction  is  restricted  to  a  certain  subject — as,  for  instance, 
arithmetic.  Their  memory  and  judgment  are  limited,  although  sometimes 
the  former  is  remarkably  strong.  They  express  themselves  in  a  hesitating 
manner,  and  differentl}'-  from  other  men  ;  they  require  time  to  perceive  the 
relations  of  objects  which  are  immediately  perceived  by  sane  persons.  The' 
degree  in  which  imbecility  exists  is  well  indicated  by  the  power  of  speech. 
In  idiots  there  is  no  speech,  or  only  an  utterance  of  single  words;  in  the 
better  class  of  imbeciles  the  speech  is  often  easy  and  unaflFected,  while 
there  is  every  grade  between  these  two  extremes.  Some  have  arranged 
imbeciles  in  classes,  according  to  their  capacity  to  receive  instruction, 
others  according  to  their  power  of  speech  ;  but  such  divisions  are  practi- 
cally without  value;  each  case  must  be  judged  by  itself.  The  precise 
boundary  between  idiocy  and  imbecility  cannot  be  defined.  The  major 
degrees  of  imbecility  approach  so  closely  to  those  of  idiocy  that  there  is 
no  distinction  between  them,  and  in  a  practical  view  no  distinction  is  re- 
quired. Idiocy  has  been  here  described  as  that  condition  in  which  the 
congenital  effect  is  not  susceptible  of  being  removed  by  any  kind  of  in- 
struction ;  but  many  medico-legal  writers  apply  the  term  "  idiot  "  to  one 
who  does  manifest  capacity  to  receive  instruction,  although  in  a  low  de- 
gree. The  difference  is  immaterial  so  long  as  the  meaning  of  the  word  is 
understood. 

How  are  the  minor  degrees  of  imbecility  to  be  distinguished  from  sanity  ? 
This  is  a  question  by  no  means  easy  to  answer,  for  the  reason  that  sane 
persons  differ  remarkably  in  their  mental  power  to  receive  instruction,  to 
retain  what  they  have  been  taught,  and  to  allow  them  to  make  a  practical 
use  of  it  in  the  world  for  their  own  benefit.  Many  persons  pass  through 
life  and  advance  in  the  world  who  are  yet  undoubtedly  weak-minded,  and 
who  have  the  reputation  among  all  who  know  them  of  being  so.  The 
truth  is,  the  lowest  degrees  of  intelligence  legally  constituting  sound  mind 
are  not  separable  from  the  minor  forms  of  imbecility,  so  far  as  the  moral 
and  intellectual  faculties  are  concerned 

Idiocy  and  imbecility  must  not  be  confounded  with  mania  and  mono- 
mania. In  idiots  and  imbeciles  ideas  are  wanting,  and  the  power  of 
thought  is  absent  or  defective;  in  maniacs  and  monomaniacs  the  ideas 
flow  freely,  but  they  are  perverted,  and  the  power  of  thought  is  irregular 
and  uncontrolled.  In  idiocy  and  imbecility  we  do  not  meet  with  the 
hallucinations  and  illusions  which  constitute  the  main  features  of  mania 
and  monomania.  Idiocy  is  much  more  likely  to  be  confounded  with  de- 
mentia, and,  indeed,  when  dementia  is  confirmed  and  complete  {fatuity) 
there  is  no  appreciable  difference,  for  in  neither  state  is  there  any  evidence 
of  the  exercise  of  mental  power.  In  idiocy  no  ideas  have  ever  been  formed ; 
in  imbecility  they  have  been  partially  formed,  but  arrested ;  in  dementia 
they  have  been  more  or  less  completely  formed,  but  have  subsequently 
become  entirely  obliterated.  It  is  important  to  remember  that  in  idiocy 
and  imbecility  there  is  no  gradual  loss  or  sudden  impairment  of  the  mental 
faculties,  as  is  generally  observed  in  dementia ;  the  person  is  what  he 
44 


690         HEREDITARY    TRANSMISSION  —  FEIGNED    INSANITY. 

alwa3^s  has  been — mentally  weak  and  unsusceptible  of  any  great  degree 
of  improvement  by  instruction. 

From  these  remarks  it  will  be  perceived  that  imbecility  is  a  state  exist- 
ing from  birth  or  from  childhood — for  it  is  possible  that  it  may  supervene 
from  disease  after  birth,  in  a  child  in  whom  there  was  no  reason  to  suspect 
its  existence — but  it  is  more  common  to  find  the  deficiency  congenital. 
Still,  the  term  is  often  applied  to  that  weakness  of  the  mental  powers  which 
takes  place  in  the  aged  at  the  close  of  life,  even  when  the  mind  has  been 
well  developed  in  maturity.  Thus  we  speak  of  the  imbecility  of  age  ;  this 
is  truly  nothing  more  than  a  state  of  senile  dementia,  and  to  apply  to  it 
the  term  "  imbecility"  tends  to  create  confusion. 

In  the  first  decennial  Revision  of  the  Nomenclature  of  Diseases  drawn 
up  by  the  Royal  College  of  Physicians  of  London,  idiocy  is  made  synony- 
mous with  congenital  imbecility,  and  dementia  is  made  to  include  acquired 
imbecility  ;  imbecility  pei^  se  having  no  recognition.  It  is  also  stated  that 
cases  of  monomania  should  be  named  according  as  the  prevailing  symp- 
toms are  those  of  mania,  melancholia,  or  dementia. 

Such,  then,  are  the  forms  under  which  insanity  or  mental  aberration 
may  present  itself  to  our  notice,  and  although  there  are  mixed  states,  as 
of  mania  and  dementia  (iv coherency),  yet  it  is  an  important  feature  in  the 
distinction  of  mental  disorders,  to  observe  that  in  intellectual  insanity  the 
characters  presented  to  us  in  any  given  case  do  not  vary  materially  from 
those  which  have  been  described  as  peculiar  to  each  of  these  states.  This 
classification,  it  must  be  remembered,  is  made  for  the  sake  of  convenience, 
because  by  it  a  medical  practitioner  may  be  led  to  form  a  safe  diagnosis  of 
the  real  state  of  mind  of  a  person.  It  is  not  recognized  in  any  of  the  law 
proceedings  connected  with  the  insane  ;  for  in  these  the  term  ynsoimclness 
of  mind — comprehending  lunacy,  idiocy,  imbecility,  and  all  forms  of 
mental  weakness — is  almost  exclusively  employed.  In  adopting  this 
arrangement,  a  medical  jurist  must  take  care  not  to  fall  into  an  error 
which  has  been  sometimes  committed — i.  e.  of  pronouncing  a  person  to  be 
of  sound  mind,  because  his  case  could  not  be  easily  placed  in  any  one  of 
these  four  great  divisions  of  insanity.  This  would  be  as  serious  an  error 
as  that  formerly  committed  by  some  law  authorities — namely,  of  giving 
restricted  and  incorrect  definitions  of  lunacy,  idiocy,  and  imbecility,  and 
then  contending  that  whoever  was  not  a  lunatic,  idiot,  or  imbecile  accord- 
ing to  these  arbitrary  legal  definitions,  must  be  a  person  of  sound  mind. 

Hereditury  Transmission. — The  hereditary  transmission  of  insanity 
often  presents  itself  a^s  a  medico-leo-al  question  in  relation  to  the  criminal 
responsibility  of  the  insane.  In  Reg.  v.  Ross  Touchet  (1844),  in  which 
the  accused  was  tried  for  shooting  a  man,  and  acquitted  on  the  ground  of 
insanity,  Maule,  J.,  held  that  evidence  that  the  grandfather  had  been  in- 
sane might  be  adduced  after  it  had  been  proved  by  medical  testimony 
that  such  a  disease  is  often  hereditary  in  a  family.  It  was  also  admitted 
in  Oxford's  case,  the  prisoner  having  been  tried  for  shooting  at  the  queen 
(Law  Times,  Oct.  26,  1844)  ;  and  since  that  date  it  has  been  admitted  in 
a  great  number  of  cases  in  which  insanity  was  urged  as  a  defence  on  a 
charge  of  murder.  This  kind  of  evidence  has,  however,  been  frequently 
rejected. 

Feigned  Insanity. — Insanity  is  sometimes  feigned  by  persons  accused 
of  criminal  offences  in  order  to  procure  an  acquittal  or  discharge.  In  the 
first  place,  when  feigning  is  suspected,  it  will  be  proper  to  inquire  whether 
the  person  has  any  motive  for  pretending  to  be  insane.     No  sane  person 


FEIGNED    DEMENTIA.  691 

feigns  without  a  motive.  Jt  is  necessary  to  remember  that  insanity  is 
never  assumed  until  after  the  commission  of  a  crime  and  the  actual  de- 
tection of  the  criminal.  No  one  feigns  insanity  merely  to  avoid  suspicion. 
In  general,  as  in  most  cases  of  imposture,  the  part  is  overacted — the  per- 
son does  either  too  much  or  too  little,  and  he  betrays  himself  by  incon- 
sistencies of  conduct  and  language  which  are  never  met  with  in  cases  of 
real  insanity.  There  is  commonly  some  probable  cause  to  which  insanity 
may  be  traced,  but  when  the  malady  is  feigned  there  is  no  apparent  cause  ; 
in  this  case  the  appearance  of  the  assumed  insanity  is  always  sudden — in 
the  real  malady,  the  progress  of  an  attack  is  generally  gradual ;  and  when 
the  attack  is  really  sudden,  it  will  usually  be  found  to  be  due  to  some 
great  moral  shock  or  other  very  obvious  cause.  We  should  observe 
whether  for  some  time  previously  there  has  been  any  marked  change  of 
character  in  the  person,  or  whether  his  conduct,  when  he  had  no  interest 
to  feign,  presented  any  of  the  usual  indications  of  a  disordered  mind. 
Some  difficulty  may  arise  when  fits  of  eccentricity  or  strangeness  of  char- 
acter are  deposed  to  by  witnesses  ;  but  these  statements  may  be  incon- 
sistent with  each  other,  and  the  previo.us  acts  of  the  person  may  bear  no 
resemblance  whatever  to  those  performed  by  him  in  the  recently  assumed 
condition.  A  difficulty  of  this  kind  rarely  presents  itself,  since  in  an  im- 
postor no  act  indicative  of  insanity  can  be  adduced  for  any  antecedent 
period  of  his  life;  it  is  only  after  the  perpetration  of  a  crime  and  its 
detection,  that  any  action  simulating  the  habits  of  the  insane  will  be  met 
with.  In  real  insanity,  the  person  will  not  admit  that  he  is  insane  ;  in 
the  feigned  state  all  his  attempts  are  directed  to  make  others  believe  that 
he  is  mad;  and  an  impostor  may  be  induced  to  perform  any  act,  if  it  be 
casually  observed  to  another  in  bis  hearing  that  the  performance  of  such 
an  act  will  furnish  strong  evidence  of  his  insanity. 

Mania  is  perhaps  more  frequently  assumed  than  any  other  form,  be- 
cause the  vulgar  notion  of  insanity  is  that  it  is  made  up  of  violent  action 
and  vociferous  and  incoherent  language  ;  but  mania  rarely  conies  on  sud- 
denly, or  without  some  obvious  cause.  A  maniacal  patient  is  equally 
furious  day  and  night,  while  an  impostor  is  obliged  to  rest  after  his  violent 
exertions.  Burrows  recommends  that  close  attention  should  be  paid  to 
the  expression  of  the  eye.  The  mobility  of  the  features  may  be  as  rapid 
as  the  imagination  is  vivid;  but  when  every  feature  may  vary,  or  be  kept 
under  control  and  be  steady,  the  eye  will  still  indicate  the  erring  thought 
— its  expression  cannot  be  easily  assumed.  There  is  about  the  eyes  in 
mania  a  restlessness  which  cannot  fail  to  attract  attention  ;  the  patient 
sleeps  but  little,  and  the  sleep  is  disturbed ;  an  impostor  sleeps  as  soundly 
as  a  healthy  person.  The  violence  of  a  maniac  continues  whether  he  is 
alone  or  not,  while  the  impostor  acts  his  part  only  when  he  thinks  he 
is  observed ;  hence  the  imposition  may  be  detected  by  watching  him 
unawares. 

The  feigning  of  so-called  vionomania  is  a  matter  of  some  difficulty,  and 
would  be  easily  susceptible  of  detection.  As  in  mania,  the  part  would  be 
overacted  and  an  impostor  would  thus  betray  himself.  Devxentia  is  more 
easily  feigned:  in  general,  this  state  comes  on  slowly,  and  is  obviously 
dependent  on  organic  changes,  as  old  age,  apoplexy,  paralysis,  or  hemi- 
plegia ;  or  it  is  a  consequence  of  recurrent  mania  or  monomania.  Idiocy 
and  Imbecility  could  hardly  l)e  feigned  successfully,  because  these  are 
states  of  congenital  deficiency  ;  they  must  have  existed  from  birth,  of 
which,  of  course,  there  would  be  some  evidence.  Among  modern  cases 
in   which  dementia  was  alleged  to  have  been  feigned  is  that  of  Lady 


692  APPEARANCES    AFTER    DEATH. 

Mordaunt.  (Mordaunt  v.  Mordaunt,  Divorce  Ct.,  Feb.  1870.)  In  con- 
sequence of  a  confession  made  by  this  lady  soon  after  her  confinement, 
that  she  had  committed  adultery  with  certain  persons,  her  husband  took 
proceedings  against  her  for  a  divorce.  At  the  date  at  which  she  was 
served  with  notice  of  the  writ,  April  30,  1869,  it  was  alleged  that  she  was 
insane,  and  from  mental  incapacity  she  was  unfit  or  unable  to  instruct  an 
attorney  for  her  defence.  On  the  part  of  the  husband  it  was  alleged  that 
she  was  really  fit  and  competent,  and  that  the  state  of  insanity  was 
assumed  in  order  to  avoid  the  exposure  of  a  public  trial.  The  jury,  upon 
hearing  a  large  amount  of  evidence  from  medical  experts  and  others,  found 
that  this  lady  was  laboring  under  "mental  disorder,"  and  that  she  was 
incompetent  to  give  instructions  for  her  defence. 

On  the  simulation  of  insanity,  see  a  paper  by  Laurent.  (Ann.  d'Hyg., 
1866,  t.  2,  p.  460.)  He  advises  the  complete  isolation  of  the  person,  with 
daily  watching  for  a  certain  time,  as  a  method  which  seldom  fails  to 
detect  the  imposition,  while  it  cannot  injure  the  really  insane.  One  re- 
markable circumstance  he  points  out,  namely,  the  influence  of  feigning 
insanity  on  the  feigner.  He  is  of  opinion  that  persons  who  have  for  some 
days  or  weeks  pretended  that  they  were  mad  have  become  so  in  the  end. 
In  support  of  this  view  he  quotes  the  cases  of  two  sailors  who  had  feigned 
madness  in  order  to  escape  imprisonment  in  the  hulks.  The  imposture 
was  at  first  successful,  but  in  the  end  it  had  an  unfortunate  result,  for 
they  became  really  mad.  An  impostor  must  be  ever  on  the  watch  that  he 
does  not  fail  in  any  one  point.  This  creates  a  great  strain  on  the  mind, 
and  as  a  result  of  the  anxiety  attendant  on  the  maintenance  of  such  an 
imposition  at  all  times  and  under  all  circumstances,  he  may  suffer  from 
cerebral  exhaustion  with  its  worst  consequences. 

Appearances  after  Death. — In  some  cases  a  medical  practitioner  may 
be  required  to  state  whether  certain  appearances  found  in  the  brain  of  a 
deceased  person  do  or  do  not  indicate  the  past  existence  of  insanity  or  im- 
becility. Such  a  question  is  only  likely  to  arise  in  chronic  cases,  in  which 
the  past  existence  of  insanity  from  oral  testimony  may  be  disputed. 
(Case  of  Stulz,  Prerog.  Court,  1852.)  The  appearances  commonly  met 
with  on  an  inspection  of  the  head  may  be — thickening  of  the  bones  of  the 
skull,  close  adhesions  of  the  dura  mater  (the  lining  membrane),  with  great 
congestion  of  the  pia  mater,  and  opacity  and  thickening  of  the  arachnoid 
or  inner  membrane  of  the  brain.  There  is  a  general  fulness  of  the  blood- 
ve.ssels  of  the  brain,  with  remains  of  old  cysts,  hardened  deposits,  or  even 
ab.sces.ses  in  various  parts  of  the  cerebral  substance.  Inferences  from  the 
exi.stence  of  these  appearances  in  the  brain  must,  however,  be  drawn  with 
caution,  because  it  cannot  be  said  that  they  necessarily  indicate  insanity  ; 
nevertheless,  such  chronic  changes  must  be  considered  as  likely  to  produce 
greater  or  less  derangement  of  the  mental  functions  ;  but  the  actual  degree 
in  which  the  impairment  is  alleged  to  have  existed  ought  properly  to  be 
determined  by  actions  of  the  deceased  during  life.  But,  as  Savage  has 
trulv  said,  "  One  of  the  greatest  difficulties  which  has  ever  presented 
it.seif  to  the  student  of  insanity  has  been  the  fact  that,  post-mortem,  so 
little  has  been  found  visible  to  the  naked  eye.  I  may  say  that,  with  my 
experience  of  years,  and  after  seeing  many  hundreds  of  post-viortem  ex- 
amination of  bodies  of  the  insane,  I  have  met  with  few  coarse  changes 
within  the  skull,  and  even  with  the  higher  powers  of  the  microscope  all 
that  can  often  be  detected  may  be  evidences  of  change  in  the  nutrition  of 
the  connective  tissue  of  the  brain."     (Insanity,  p.  9.) 

In  the  case  of  Roberts  v.  Kerslake  (Warwick  Aut.  Ass.,  1854,  the  main 


LUNACY    LAWS.  69B 

question  was  whether  certain  appearances  in  the  brain  and  its  membranes 
did  or  did  not  indicate  disease  of  long  standing  as  well  as  insanity  at  the 
particular  date  at  which  a  will  was  made.  Conolly  and  the  author  con- 
sidered that  the  appearances  were  not  inconsistent  with  the  supposition 
that  the  testator  was  sane  at  the  time  of  making  his  will.  (Jour.  Psych. 
Med.,  Oct.  1S54,  p.  573.) 


CHAPTER   XLIII. 

THE    LDXACT    LAWS. MEDICAL    CERTIFICATES. REGULATION    OF     LUXATICS     AND     IDIOTS. 

APPLICATION   OF  RESTRAINT. ILLEGAL  IMPOSITION  OF  RESTRAINT VIOLENCE  OF  TEMPER. 

DISCHARGE  OF  LUNATICS. NULLITY  OF  MARRIAGE. 

The  legal  relations  of  lunacy  are  regulated  by  an  executive,  at  the  head 
of  which  is  the  Lord  Chancellor,  as  Judge  in  Lunacy,  who  is  entrusted 
Avith  the  care  and  commitment  of  the  custody  of  the  person  and  estates  of 
lunatics.  He  acts  either  alone  or  jointly  with  any  one  or  more  of  the 
judges  of  the  Supreme  Court.  The  Judge  in  Lunacy  makes  orders  for  the 
custody  of  lunatics  so  found  by  inquisition  and  the  management  of  their 
estates.  Under  the  control  of  the  Judge  in  Lunacy  are  two  Masters  in 
Lunacy,  who  must  be  barristers  of  not  less  than  ten  years'  standing. 
They  have  to  deal  with  those  persons  who  are  found  to  be  lunatic  by  a 
Commission  of  Inquiry,  commonl}^  termed  Chancery  Lunatics.  The  term 
Commission  of  Inquiry  is  now  substituted  for  the  term  Commission  in 
Lunacy,  a  term  w^hich  was  apt  to  be  confounded  with  that  of  Commis- 
sioners in  Lunac3^  Acting  under  the  Masters  in  Lunacy  are  three  addi- 
tional Chancery  Visitors  (so  that  there  are  five  Chancery  Visitors),  two 
medical  men,  and  one  a  barrister  of  iive  years'  standing.  The  three  Chan- 
cery Visitors  and  the  two  Masters  in.  Lunacy  form  a  board. 

The  Commissioners  in  Lunacy  regulate  the  affairs  of  asylums  and 
supervise  such  lunatics  as  are  not  found  to  be  so  by  a  Commission  of 
Inquiry.  They  are  eleven  in  number,  five  of  whom,  including  the  perma- 
nent chairman,  are  unpaid ;  the  remainder,  three  barristers  and  three 
physicians,  are  paid.  Public  lunatics — i.  e.  criminal  and  pauper  lunatics 
— are  kept,  the  former  in  Broadmoor  Criminal  Lunatic  Asylum,  and  the 
latter  in  the  county  and  borough  asylums — asylums  which  every  local 
authority  is  bound  to  provide  and  maintain  for  the  accommodation  of 
pauper  lunatics.  The  local  authority  may  provide  asylum  accommoda- 
tion for  pauper  and  private  patients,  together  or  in  separate  asylums, 
and  may  provide  separate  asylums  for  idiots.  A  pauper  lunatic  cannot 
be  allowed  to  remain  in  a  workhouse  as  a  lunatic  unless  the  medical 
officer  of  the  workhouse  certifies  that  he  is  a  proper  person  to  be  allowed 
to  remain  in  a  workhouse  as  a  lunatic,  and  that  the  accommodation  of  the 
workhouse  is  sufficient  for  his  proper  care  and  treatment.  Private  lunatics 
— i.  e.  lunatics  other  than  those  found  lunatic  by  inquisition,  pauper  luna- 
tics, and  criminal  lunatics — may  be  detained  in  registered  hospitals, 
licensed  houses,  county  and  borough  asylums,  or  into  houses  as  single 
patients ;  but  the  commissioners  may  sanction  the  reception  of  more  than 
one  lunatic  in  a  house  under  special  circumstances  and  for  the  interest  of 
a  single  patient.  The  Lunacy  Act,  1890  (53  Vict.,  c.  5),  is  the  statute 
which  deals  with  the  detention  and  care  of  lunatics  and  their  property; 


694  RULES    FOR    IMPOSING    RESTRAINT. 

and  the  Idiots  Act,  1886  (49  and  50  Vict.,  c.  25),  similarly  deals  with  the 
care,  education,  and  training  of  idiots  and  imbeciles. 

Among  the  questions  which  may  come  before  a  medical  jurist  in  relation 
to  the  subject  of  insanity  are  the  following :  A  practitioner  may  be  re- 
quired to  say  whether  a  person  affected  witli  the  malady  should  or  should 
not  be  confined  in  an  asylum  ;  whether  he  should  be  deprived  of  his  civil 
rights  by  interdiction  ;  or  whether  he  is  so  completely  cured  of  his  malady 
as  to  justify  his  liberation  from  confinement.  Then,  again,  medical  evi- 
dence may  go  far  to  determine  whether  a  will  or  deed  executed  by  an 
alleged  lunatic  should  be  set  aside  ;  whether  a  marriage  contract  (Hunter 
V.  Hunter,  otherwise  Edney ;  Durham  v.  Durham,  otherwise  Milner; 
Cannon  v.  Cannon)  or  debt  should  be  annulled  ;  and  lastly,  whether  a 
criminal  act  was  committed  by  a  person  while  laboring  under  insanity — a 
question  involving  either  the  life,  or,  according  to  circumstances,  the  per- 
petual imprisonment  of  a  person  accused  of  crime. 

Ap2)lication  of  Restraint. — By  restraint,  in  a  legal  sense,  we  are  to 
understand  the  placing  of  attendants  to  watch  or  control  the  actions  of  an 
alleged  lunatic,  or  his  forcible  removal  from  friends  or  relatives  with  or 
without  the  confinement  of  his  person  by  physical  force.  What  are  the 
circumstances  which  will  justify  a  practitioner  in  applying  restraint  to  the 
insane?  The  law^  has  given  great  power  in  this  respect  to  members  of 
the  medical  profession,  but,  owning  to  certain  abuses,  the  power  has  been 
of  late  years  much  restricted  by  various  Acts  of  the  Legislature.  Most 
medico-legal  writers  agree  that  we  are  not  justified  in  ordering  restraint 
except  when,  from  symptoms  witnessed  -by  ourselves,  we  have  reason  to 
apprehend  that  the  lunatic  will  injure  himself  or  others  in  person  or 
property.  It  is  then  not  sufficient  to  seek  merely  for  evidence  of  the  ex- 
istence of  some  delusion,  but  to  determine  how  far  that  delusion,  if  present, 
affects  the  conduct  of  the  person.  The  real  question  is  whether  we  have 
reason  to  apprehend  imminent  danger.  Unless  the  delusion  is  such  as  to 
render  it  probable  that  the  patient  or  his  friends  may  be  injured  by  his 
insane  conduct,  careful  superintendence  will  answer  all  the  purposes  of  the 
closest  restraint.  The  act  of  resorting  to  restraint  on  all  occasions  has 
been  justified  on  the  principle  that  it  may  tend  to  the  cure  of  a  patient  by 
removing  his  .delusion.  In  this  point  of  view  the  subject  has  reference 
to  medical  practice,  and  not  to  legal  medicine.  It  may  be  urged  with 
more  plausibility  that,  by  withholding  restraint  in  incipient  cases,  mis- 
chief may  be  done  by  the  lunatic  to  himself  or  others,  and  that  then  it 
will  be  too  late  to  interfere ;  but  even  here  careful  superintendence  may 
render  close  confinement  unnecessary. 

The  legal  rule  for  interference  with  the  liberty  of  a  person,  which  re- 
straint alwa3''s  implies,  may  be  inferred  from  the  following  statement  by 
Stephen,  J. :  "  There  is  a  normal  state  in  which  all  human  creatures  act 
on  the  same  principles,  and  the  general  meaning  of  sanity  is  that  the  per- 
son conducts  himself  in  this  normal  manner;  that  he  is  acquainted  with 
the  circumstances  by  which  he  is  surrounded  ;  that  he  has  o])jects  in  view 
in  his  actions;  and  that  he  regulates  his  conduct  with  reference  to  them 
and  to  the  general  considerations  which  affect  matters  of  that  class. 
(General  View  of  the  Crim.  Law  of  England,  p.  87,  et  seq.)  It  cannot  be 
too  strongly  impressed  on  the  mind  of  a  medical  man  that,  before  he  em- 
]»loy3  the  powers  conferred  upon  him  by  law,  to  confine  a  person  who  is 
said  to  be  mad,  he  should  w^ell  consider  what  laAvycrs  imply  by  the  term 
"madness,"  in  a  practical  sense.  As  defined  by  Stephen  J.,  it  means 
conduct  of  a  certain  character — not  as  it  is  usually  interpreted  by  medical 
men,  a  certain  disease  of  the  brain  the  existence  of  which  is  speculative, 


i.ur-RuPER    APPLICATION    OF    RESTRAINT.  695 

but  one  of  the  effects  of  which,  if  present,  is  to  produce  such  conduct.  In. 
examining  an  alleged  lunatic,  with  a  view  of  determining  whether  he 
should  or  should  not  be  placed  in  confinement,  his  conduct  must  therefore 
be  compared  with  that  of  other  men,  and  more  especially  with  his  own 
conduct,  in  a  normal  state;  and  here,  in  order  to  constitute  sane  behavior, 
we  must  look  for  a  generic  and  not  for  a  specific  resemblance.  Any  de- 
gree of  ignorance,  vice,  or  folly  is  perfectly  consistent  with  sane  conduct 
in  a  legal  sense.  The  power  of  restraint  is  not  intended  to  be  applied  to 
such  cases  as  these ;  they  are  properly  under  certain  circumstances  amen- 
able to  the  criminal  law.  An  ignorant,  vicious,  or  foolish  man  may  do  a 
great  amount  of  mischief,  but  he  has  a  liberty  of  choice  and  freedom  of 
action  ;  and  if  from  folly  or  depravity  he  selects  a  bad  course,  he  is  not 
therefore  insane,  but  is  as  much  responsible  for  his  actions  as  a  sane  man 
who  prefers  a  good  course.  Such  a  man  should  not  be  treated  as  a  lunatic 
or  confined  in  an  asylum  under  a  medical  certificate.  It  may  be  sometimes 
difficult  to  define  the  line  which  separates  acts  of  depravity  from  those  of 
insanity  ;  but  medical  men  have  not  been  in  many  cases  sufficiently  cau- 
tious in  endeavoring  to  make  a  distinction.  Lawyers  look  closely  to  con- 
duct as  the  chief  ground  of  interference  with  personal  liberty;  the  conduct 
must  be  such  as  to  be  inconsistent  with  the  usual  behavior  of  a  normally 
sane  person  placed  under  similar  circumstances. 

In  examining  a  person  proposed  to  be  placed  under  restraint,  we  must 
take  care  not  to  confound  acts  depending  on  violence  of  temper  with  those 
which  proceed  from  unsoundness  of  mind.  A  man  may  have  always  had 
a  violent  temper,  subject  to  occasional  fits  of  aggravation  ;  but  this  con- 
dition must  not  be  mistaken  for  mental  disease.  In  order  to  determine 
whether  the  acts  of  a  person  be  due  to  violent  temper  or  insanity,  it  will 
be  proper  to  ascertain  what  may  have  been  his  natural  habits.  The  great 
feature  of  insanity  is  change  of  character — a  man  who  is  really  insane  is 
different  from  what  he  has  previously  been  ;  but  it  may  be  proved  of  a 
violent-tempered  man  that  he  has  always  been  the  same.  The  greatest, 
abuses  of  the  restraint  system  have  been  chiefly  observed  in  respect  to 
insane  persons  who  have  been  forcibly  imprisoned  and  confined  in  asylums, 
because  they  entertained  some  absurd  delusions,  over  which,  however,  they 
had  so  great  a  power  of  control  as  to  render  it  somewhat  difficult  even  for 
a  shrewd  and  experienced  examiner  to  detect  them.  When  at  last,  after 
many  hours'  cross-examination,  the  existence  of  a  delusion  has  been  made 
apparent,  the  result  has  been  looked  upon  as  furnishing  matter  for  triumph 
and  exultation;  but,  as  Conolly  justly  remarks,  one  point  in  these  cases 
appears  to  have  been  wholly  lost  sight  of,  namely — What  possible  injury 
could  have  resulted  to  the  patient  or  his  friends  from  the  existence  of  a 
delusion  over  which  he  had  such  complete  control  and  mastery  as  to  render 
it  a  most  laborious  task  to  obtain  any  evidence  whatever  of  its  existence? 
It  may  be  freely  admitted  that  where  delusion  does  exist,  there  is  reason 
to  suppose  that  the  mind  must  be  more  or  less  disordered  in  all  its  facul- 
ties ;  but  such  patients  require  only  close  watching,  not  a  rigorous  impris- 
onment in  an  asylum.  The  greatest  danger  is  to  be  apprehended  in  those 
cases  in  which  there  is  the  least  power  of  self-control.  The  forcible  re- 
moval of  a  person  from  his  or  her  home  to  a  lunatic  asylum,  unless  the 
circumstances  are  of  such  a  nature  as  to  render  immediate  interference 
necessary  on  the  ground  of  admitted  or  proved  insanity,  is  unjustifiable 
in  law  and  may  involve  those  concerned  in  the  removal  in  a  serious  re- 
sponsibility. In  cases  of  incipient  insanity,  such  interference  would  not 
be  legally  justifiable  and  a  practitioner  placing  restraint  on  a  person  so 
situated,  might  find  himself  a  defendant  in  an  action  for  damages. 


696  CERTIFICATES    OF    INSANITY. 

la  Hill  V.  Philip,  the  judges  decided  that  a  medical  man,  wheA  called 
upon  to  give  a  certificate  for  the  confinement  of  a  person,  may  act  upon 
the  directions  of  a  wife,  but  that  the  directions  must  be  considered  as  only 
<:uiding  his  judgment  and  not  as  absolutely  dictating  to  him  and  justifying 
his  proceedings;  that  he  is  still  bound  to  exercise  his  own  professional 
knowledge  and  discretion,  so  far  as  to  refrain  from  doing  anything  or 
adopting  any  course  which  might  be  injurious  to  the  patient.  A  medical 
man  is,  therefore,  ultimately  responsible  for  his  treatment  of  a  lunatic: 
no  person  caa  give  him  authority  to  do  that  which  is  not  in  accordance 
with  medical  practice  or  the  necessity  of  the  case.  (For  a  report  of  this 
case,  and  some  judicious  remarks  upon  the  decision,  see  Legal  Exam., 
1S52,  pp.  307,  318.)  In  Scott  v.  Wakem  (Guildford  Sum.  Ass.,  18G2),  a 
medical  practitioner  was  sued  for  damages  in  placing  under  restraint  and 
Avithout  necessity  or  authority,  a  man  laboring  under  delirium  tremens.  In 
this  ca.se  the  wife  denied  that  she  had  given  any  authority  for  interference, 
and  on  this  point  her  evidence  conflicted  with  that  of  the  defendant,  the 
medical  man  whom  she  had  consulted.  Fortunately,  the  facts  proved 
were  adverse  to  her  .statement.  In  future  cases  of  this  kind,  it  would  be 
desirable  for  a  medical  man  to  bear  in  mind  that  he  does  not  exceed  what 
is  necessary,  proper,  or  usual  for  the  treatment  of  the  person  ;  and  on  this 
he  must  always  exercise  his  own  judgment,  irrespective  of  the  opinions  or 
suggestions  of  others.  Medical  men,  even  when  acting  most  conscien- 
tiously in  the  discharge  of  their  duties,  cannot  hope  to  escape  harassing 
and  vexatious  actions  when  they  are  called  upon  to  deal  with  cases  of 
delirium  tremens.  The  peculiarity  of  this  disorder  is  that,  with  the  cause, 
it  may  soon  disappear  and  thus  medical  evidence  may  be  easily  procured 
to  show  that  the  person  was  in  a  sane  state  of  mind  and  not  in  a  condi- 
tion to  justify  any  interference  Avith  his  personal  liberty',  either  a  short 
time  before  or  after  the  imposition  of  restraint. 

The  .series  of  decisions  in  favor  of  Mrs.  T\'eldon  in  her  actions  against 
Semple  for  certifying  insanity,  and  Winslow  for  receiving  her  into  his 
private  asylum  on  the  representation  of  her  husband,  should  convey  a 
caution  to  medical  men  not  to  place  undue  credence  in  the  statements  of 
interested  relatives  as  to  the  insanity  of  an  individual.  As  Blaudford  per- 
tinently remarks,  madmen  have  an  unpleasant  way  of  revealing  family 
secrets,  and  it  is  convenient  to  call  such  revelations  delusions;  and  it  is 
well,  if  possible,  to  derive  independent  information  from  others  who  are 
not  primarily  concerned  in  the  patient,  rather  than  from  interested 
relatives. 

In  order  to  provide  for  the  protection  of  lunatics  and  for  the  prevention 
of  undue  violence  or  frequency  in  the  application  of  restraint,  the  law 
compels  the  keepers  of  asylums  to  certify  each  case  or  of  each  occa.sion  on 
which  any  mechanical  restraint  is  resorted  to.  An  omission  to  make  this 
entry  is  a  misdemeanor;  and  at  the  Maidstone  Lent  Ass.,  1851,  two 
medical  men  were  convicted  and  fined  for  placing  patients  under  restraint 
without  having  made  the  entries  required  by  law.  (Reg.  v.  Maddock; 
see  also  Lond.  Med.  Gaz.,  vol.  xlvii.  p.  556  ;  and  a  paper  on  the  "  JJae  and 
Abu.se  of  Restraint."  in  the  Jour.  F.sych.  Med.,  1849,  p.  240.)  By  a 
recent  enactment  (53  Yict.,  e.  5,  s.  330),  medical  men  and  others,  acting 
bona  fide  in  carrying  out  the  lunacy  laws,  are  protected  against  vexatious 
prosecution.?. 

Certificates  of  Insanity. — It  will  here  be  neces.sary  to  state  the  circum- 
stances which  require  the  attention  of  a  practitioner  w^hen  he  is  called 
upon  to  sign  a  certificate  of  insanity,  whereby  a  person  may  be  placed  in 
confinement  in  an  asylum.     The  act  which  specially  refers  to  this  subject 


RECEPTION    OF    LUNATICS.  697 

is  the  53  Vict.,  c.  5.  This  act  is  a  consolidation  of  the  statutes  on  the 
regulation  of  the  care  and  treatment  of  lunatics.  Its  provisions  are  very 
stringent,  both  with  respect  to  medical  men  who  sign  certificates,  and 
those  who  keep  asylums  for  the  reception  of  lunatics. 

Reception  of  Lunatics. — It  will  here  be  necessary  to  state  the  course  of 
procedure  necessary  to  procure  the  reception  of  a  lunatic  into  an  asylum, 
in  accordance  with  the  provisions  of  the  Lunacy  Act,  1890   (53  Vict. 
c.  5). 

In  cases  of  urgency,  where  it  is  expedient,  either  for  the  welfare  of  a 
person  (not  a  pauper)  alleged  to  be  a  lunatic,  or  for  the  public  safety,  that 
the  alleged  lunatic  should  be  forthwith  placed  under  care  and  treatment, 
he  may  be  received  and  detained  in  an  institution  for  lunatics,  or  as  a 
single  patient,  under  an  Urgency  Order,  made  (if  possible)  by  the  hu.s- 
band  or  wife,  or  by  a  relative  of  the  alleged  lunatic,  accompanied  by  one 
medical  certificnte  (see  below).  An  urgency  order  remains  in  force  for 
seven  days  from  its  date,  and  must  be  accompanied  by  a  Statement  of 
Particulars^.  If  it  be  desiralile  to  detain  the  patient  more  than  seven 
days,  a  petition  must  be  presented  and  a  reception  order  be  obtained,  as 
below. 

Should  the  case  not  be  urgent,  a  person,  not  being  a  pauper  or  a  lunatic 
so  found  by  inquisition,  cannot  be  received  and  detained  as  a  lunatic  in  an 
institution  for  lunatics,  or  as  a  single  patient,  unless  under  a  deception 
Order  made  by  the  judicial  authority,  obtained  upon  a  private  application 
by  Petition,  presented,  if  possible,  by  the  husband  or  wife,  or  by  a  relative 
of  the  alleged  lunatic,  accompanied  by  a  statement  of  particulars  as  when 
an  urgency  order  is  given,  and  two  medical  certificatea.  These  certificates 
must  each  be  made  and  signed  by  a  registered  medical  practitioner,  each 
of  whom  has  personally  examined,  separately  from  the  other,  the  alleged 
lunatic  not  more  than  seven  clear  days  before  the  date  of  the  presentation 
of  the  petition.  In  the  case  of  an  urgency  order,  the  personal  examination 
of  the  alleged  lunatic  must  be  made  not  more  than  two  clear  days  before 
his  or  her  reception.  The  two  (or  seven)  clear  days  do  not  include  the 
day  of  examination  and  of  reception  or  making  of  the  order.  In  all  other 
ca.ses  where  two  medical  certificates  are  required,  the  examination  of  the 
alleged  lunatic  must  be  made  not  more  than  seven  clear  days  before  the 
date  of  the  order  for  reception  made  by  the  judicial  authority. 

The  Judicial  Authority  is  defined  (see  9)  to  be  a  justice  of  the  peace 
specially  appointed  for  the  purpose,  or  a  judge  of  County  Courts,  or  mag- 
istrate, having  respectively^  jurisdiction  in  the  place  where  the  lunatic  is. 
Lists  of  the  judicial  authorities  are  puljlished. 

Upon  the  presentation  of  the  petition  the  judicial  authority  considers 
the  allegations  of  the  petition,  the  statement  of  particulars,  and  the  evi- 
dence of  lunacy  appearing  by  the  medical  certificates,  and  whether  it  is 
necessary  for  him  to  see  and  examine  the  alleged  lunatic  ;  and  if  he  is 
satisfied  that  an  order  may  properly  be  made  forthwith,  he  makes  it.  If 
not  satisfied  he  appoints  a  time,  not  more  than  seven  days  after  the  pre- 
sentation of  the  petition,  for  its  consideration  ;  and  meantime  he  may 
make  inquiries.  He  may  also  visit  the  alleged  lunatic,  if  not  satisfied  with 
the  evidence  of  lunacy  appearing  by  the  medical  certificates.  Here  it  is 
proper  to  remark  that  in  a  medical  certificate  of  the  prescribed  form  the 
medical  practitioner — who  must  be  in  actual  practice — states  that  he  forms 
his  conclusions  (a)  on  facts  indicating  insanity  observed  by  himself  r/^  the 
time  of  examination,  and  (6)  on  facts  communicated  bv  others.  More- 
over, one  of  the  medical  certificates  must,  if  possible,  be  that  of  the  ordinary 
medical  attendant  of  the  alle"'ed  lunatic. 


698  EECEPTION    OF    LUNATICS. 

When  the  petition  is  considered,  this  is  done  in  private,  and  no  one  ex- 
cept the  petitioner,  the  alleged  lunatic  (unless  the  judicial  authority  shall 
in  his  discretion  otherwise  order),  any  one  person  appointed  by  the  lunatic 
for  that  purpose,  and  the  persons  signing-  the  medical  certificates,  is  allowed 
to  be  present  except  with  the  leave  of  the  judicial  authority  ;  and  all  ex- 
cept the  alleged  lunatic  and  his  nominee  are  bound  to  secrecy.  The  judicial 
authority  may  dismiss  the  petition,  giving  his  reasons  to  the  petitioner  in 
writing,  and  send  a  copy  to  the  Commissioners  ;  or  he  may  adjourn  the 
consideration  for  not  more  than  fourteen  days  ;  or  he  m.ay  make  the  de- 
ception Order,  on  the  strength  of  which  the  lunatic  may  be  admitted  into 
an  asylum,  or  be  received  into  a  house  as  a  single  patient. 

The  procedure  in  the  case  of  a  pauper  is  different.  Either  a  medical 
officer  of  a  union  having  knowledge  of  a  pauper  deemed  to  be  a  lunatic 
and  a  proper  person  to  be  sent  to  an  asylum  gives  notice  thereof  to 
the  relieving  officer,  who  when  he  receives  such  notice  or  has  knowledge 
of  an  alleged  pauper  lunatic  living  within  his  district  gives  notice  within 
three  days  to  a  justice  having  jurisdiction  in  the  place  where  the  pauper 
resides;  or,  in  the  case  of  a  wandering  lunatic,  a  constable  or  relieving 
officer  apprehends  him  and  takes  him  before  a  justice.  The  justice  before 
whom  an  alleged  wandering  lunatic  is  brought,  or  who  receives  notice  of 
an  alleged  pauper  lunatic  from  the  relieving  officer,  then  calls  in  a  medical 
practitioner,  who  examines  him,  makes  inquiries,  and  if  he  certifies  to  the 
individual's  insanity  the  justice  makes  an  order  (Order  for  Reception  of 
a  Pavper  Lunatic  or  Lunatic  wandering  at  large),  which  is  accompanied 
by  a  Statement  of  Particulars  signed  by  the  relieving  officer. 

A  person  found  lunatic  by  inquisition  may  also  be  detained  in  an 
asylum  or  received  into  a  house  as  a  single  patient ;  also  a  lunatic  who 
has  been  certified  by  a  medical  man  at  the  instance  of  the  Commissioners. 

We  thus  see  that.lunatics  may  be  admitted  into  an  asylum — 

1..  Under  an  Urgency  OrJer  made  (if  possible)  b_y  a  relative,  a  State-' 
nient  of  Particvlars,  also  signed  (if  possible)  by  a  relative  of  the  lunatic, 
and  one  Medical  Certificate. 

2.  After  the  presentation  of  a  Petition  made  (if  possible)  by  a  relative 
of  the  lunatic,  a  Statement  of  Pa7^ticidars  signed  (if  possible)  by  a  rela- 
tive, two  Medical  Certificates,  and  an  Order  for  Reception  made  by  a 
justice. 

3.  In  the  case  of  a  Pavper  or  a  Wandering  Lunatic,  on  a  Reception 
Order  made  by  a  justice  at  the  instigation  of  a  relieving  officer,  and  a 
Statement  of  Particulars  also  signed  by  the  relieving  officer,  and  one 
Medical  Certificate. 

4.  When  found  lunatic  by  inquisition  (Chancery  Lunatics). 

5.  In  the  case  of  non-paupers,  on  a  Summary  Reception  Order  Avhere 
a  constable  or  relieving  officer  lays  information  before  a  justice  on  oath, 
and  two  Medical  Certificates.  Apparently  no  statement  of  particulars  is 
required  in  this  case. 

6.  When  the  lunatic  has  been  visited  by  the  Commissioners,  and  one 
Medical  Certificate  has  been  obtained  at  their  instance 

Single  patients  may  be  received  when  found  lunatic  under  the  above 
headings  Nos.  1,  2,  and  4,  but  not  those  so  found  under  headings  Nos.  3, 
5,  and  G. 

It  cannot  be  too  clearly  ufiderstood  that  a  lunatic  cannot  be  legally  de- 
tained except  by  judicial  order,  and  in  either  a  licensed  asylum,  a  licensed 
hospital,  a  licensed  house,  or  as  a  single  patient;  and  that  ail  lunatics 
other  than  those  found  lunatic  by  inquisition,  are  under  the  control  of  the 
Commmissioners. 


IDIOTS    AND    IMBECILES.  699 

The  proceedings  in  the  case  of  Chancery  Lunatics  are  much  simplified, 
and  the  cost  of  an  Incpiisition  reduced  l)y  the  recent  statute  above  referred 
to.  A  jury  can  be  dispensed  with  and  the  Inquisition  held  by  the  Mas- 
ters in  Lunacy. 

An  urgency  order  remains  in  force  for  seven  days  from  its  date,  or,  if  a 
reception  order  is  pendin,;';',  then  until  the  petition  is  finally  disposed  of. 
It  is  manifest  that  the  detention  of  a  lunatic  under  an  urgency  order  is 
only  a  preliminary  to  the  regular  procedure  by  petition  and  reception 
order  made  by  a  judicial  authority  on  two  fresh  medical  certificates. 

A  reception  order  is  not  of  force  for  a  longer  period  than  one  year.  It 
must  then  be  renewed  for  two  years,  and  after  that  for  three  years. 

If  the  lunatic  has  not  been  seen  by  the  judicial  authority  before  being 
detained  under  a  reception  order,  he  is  entitled  to  be  seen  by  a  justice,  and 
notice  must  be  given  after  his  reception  that  ho  is  so  entitled,  unless  the 
medical  officer  certifies  that  such  interview  would  be  prejudicial. 

It  is  beyond  the  scope  of  this  work  to  enter  into  the  subsequent  details 
as  to  the  treatment  and  discharge  of  lunatics;  and  for  these  the  reader  is 
referred  to  the  Lunacy  Act,  1890,  a  statute  which  should  be  in  the  hands 
of  every  medical  practitioner  for  reference.  [In  the  American  States  this 
subject  is  regulated  by  the  statutes  of  the  several  States,  and  there  is  no 
general  or  universal  rule.] 

Idiots  and  imbeciles  are  dealt  with  by  a  distinct  enactment,  the  Idiots 
Act,  1886  (49  and  50  Vict.  c.  25).  They  are  received  into  registered  hos- 
pitals and  licensed  institutions  (not  being  asylums  for  lunatics)  under  one 
medical  certificate,  which  must  state  that  the  person  to  be  received  is  an. 
idiot,  or  imbecile,  and  is  capable  of  receiving  benefit  from  the  Inditidion. 
This  must  be  accompanied  by  a  statement  of  particulars.  No  petition  or 
judicial  order  for  reception  is  necessary.  Institutions  for  idiots  and  im- 
beciles are  regulated  and  controlled,  like  lunatic  asylums,  by  the  Commis- 
sioners of  Lunacy. 

A  medical  practitioner  must  not  be  too  ready  to  lend  himself  to  the 
signing  of  certificates  for  the  confinement  of  persons  who  may  be  laboring 
under  harmless  delusions.  In  violent  mania,  or  in  monomania  with  a 
homicidal  or  a  suicidal  propensity,  there  can  be  no  doubt  of  the  propriety 
of  applying  some  degree  of  restraint,  for  here  the  necessity  is  imminent. 
If  a  remarkable  change  has  suddenly  taken  place  in  the  character  of  a  per- 
son ;  if  he  has  become  irritable,  outrageous,  or  threatened  personal  vio- 
lence to  any  one ;  or  if  he  has  recklessly  endangered  the  interests  of  him- 
self and  family — he  is  undoubtedly  a  fit  subject  for  confinement.  The  more 
he  approaches  to  this  condition  the  less  difficulty  w^e  shall  have  in  coming 
to  a  decision,  and  in  a  really  doubtful  instance  there  will  be  no  impro- 
priety in  employing  temporary  restraint;  since,  although  the  person  is 
thereby  deprived  of  liberty,  it  is  better  that  this  should  happen  than  that 
he  or  his  friends  should  incur  the  risk  of  suffering  severely  by  his  insane 
conduct. 

It  is  obvious  from  the  terms  of  the  Act  that  one  person  cannot  sign  a 
certificate  as  a  substitute  for  another,  and  j'et  there  have  been  several  in- 
stances of  its  violation  under  these  circumstances.  In  1855  a  medical 
assistant  was  committed  for  trial  because  he  had  signed  the  name  of  the 
surgeon  with  whom  he  was  living  to  a  certificate  of  insanity  for  the  con- 
finement of  a  pauper  lunatic.  There  was  no  doubt  about  the  insanity  of 
the  person,  and  the  plea  urged  in  defence  was  that  the  surgeon  whose 
name  was  thus  forged  was  in  ill  health  and  had  given  the  assistant  an  au- 
thority to  sign  papers  for  him.  This,  however,  was  no  justification  for 
a  violation  of  the  terms  of  the  Act ;  the  words  of  the  certificate  are  so 


TOO      SPECIFICATION    OF    FACTS    INDICATIVE    OF    INSANITY. 

explicit  on  this  point  that  no  reasonable  person  can  have  any  doubt 
about  their  meaning.  In  Reg.  v.  Ogiivy,  C.  C.  C,  Sept.  1872  (Lancet, 
1812,  ii.  354,  467,  499),  the  defendant  was  fined  fifty  pounds  for  unlaw- 
fully'signing  a  medical  certificate  by  representing  that  he  was  a  registered 
medical  practitioner  when  his  name  was  not  on  the  register.  In  another 
case,  which  occurred  in  1872,  pi-oceedings  were  taken  against  a  medical 
man  under  the  following  circumstances  :  He  signed  a  certificate  for  the 
confinement  of  a  woman  really  a  lunatic,  stating  that  he  had  seen  and 
personally  examined  her  on  Aug  9,  1872,  although  he  had  not  seen  her 
since  March,  1859.  Further,  it  was  proved  that  the  certificate  was  signed 
on  Sept.  10,  but  dated  Aug.  9.  The  medical  man  pleaded  guilty  and  was 
fined.  These  glaring  examples  of  a  departure  from  the  explicit  terms  of 
the  Act  relating  to  lunatics  should  convey  a  caution  to  medical  men  that 
they  cannot  with  impunity  infringe  the  strict  letter  of  the  law. 

As  ignorance  of  the  law  is  not  allowed  to  be  an  excuse  for  its  violation, 
so  a  medical  man,  unless  acquainted  with  all  the  particulars  above  men- 
tioned, may  easily  subject  himself  to  a  prosecution  or  a  civil  action  ;  and 
be  is  not  likely  to  be  spared  the  disgrace  and  mortification  attendant  upon 
either  should  it  happen  that  the  case  is  of  a  doubtful  nature.  The  law 
expressly  requires  from  each  medical  man  a  separate  visit,  a  separate  per- 
sonal examination  of  the  alleged  lunatic,  and  a  separate  medical  certificate 
setting  forth  the  special  fact  or  fads  (whether  observed  by  himself  or 
derived  from  the  information  of  others)  upon  which  his  opinion  is  based. 
Conolly  has  shown  that  there  are  objections  to  the  severity  of  restrictions 
regarding  these  certificates  (Jour,  of  Med.  Sei.,  1861,  p.  127),  but  several 
recent  cases  have  proved  that  they  are  not  even  strong  enough  to  prevent 
sane  persons  from  being  wrongfully  sent  as  lunatics  to  asylums. 

Specification  of  Facts. — It  will  be  observed  that  every  medical  practi- 
tioner signing  a  certificate  of  insanity  is  requested  to  specify  the  facts 
vpon  which  his  opinion  is  formed,  and  whether  such  facts  are  derived 
from  his  own  observation  or  from  the  information  of  any  other  person. 
Medical  men  have  had  some  difficulty  in  performing  this  duty,  i.  e.  in 
assigning  the  fact  or  facts  upon  which  their  judgment  of  the  insanity  of 
a  person  was  based.  (Loud.  Med.  Gaz.,  vol.  xxxvi.  p.  1434;  and  vol. 
xxxvii.  p.  485.)  What  will  constitute  the  description  of  a  fact  to  render 
a  certificate  valid  ?  This  important  question  was  raised  in  the  case  of 
Shuttleworth.  (Queen's  Bench,  Nov.  1847.)  An  application  was  made 
for  the  discharge  of  a  lunatic  on  the  ground  that  the  medical  certificates 
did  not  set  forth  t\\Q  facts  from  which  the  opinion  of  those  who  signed 
them  was  derived.  In  one  the  medical  man  stated  that  the  lunatic 
labored  under  a  variety  of  delusions,  and  that  she  was  dirty  and  inde- 
cent in  the  extreme ;  in  the  other  the  certifier  stated  that  he  had  formed 
his  opinion  from  the  conversation  which  he  had  that  day  had  with  her. 
It  was  contended  that  the  statement  in  the  first  certificate  was  not  so 
much  a  fact  as  a  conclusion  drawn  from  other  facts  which  ought  to  have 
been  mentioned  in  the  certificate  itself.  Lord  Denman  in  giving  the 
judgment  of  the  court  held  that  the  certificates  were  valid — that  it  was 
not^'necessarv  to  have  all  the  delusions  of  an  insane  person  stated  in  a 
certificate.  The  statement  that  the  lunatic  was  dirty  and  indecent  in  the 
extreme  was  prima  facie  sufficient  to  justify  the  imputation  of  insanity, 
even  if  the  certificate  did  not  state  that  the  patient  labored  under  a  variety 
of  delusions.  The  allegation  that  the  opinion  respecting  the  existence  of 
insanitv  was  founded  upon  a  conversation  with  the  alleged  lunatic  was 
also  sufficient  to  render  a  certificate  valid.  (Lond.  Med  Gnz.,  vol.  xxxviii. 
p.  932  ;  also  Law  Times,  Nov,  1846,  p.  145.)     They,  therefore,  refused  to 


CERTIFICATES    OF    INSANITY.  701 

allow  the  discharge  of  the  lunatic.  The  judgment  was  given  by  Lord 
Denman,  and  was  concurred  in  by  those  eminent  judges — Erie,  J.,  Wight- 
man,  J.,  and  Coleridge,  J.  Patteson,  J.,  dissented  to  this  extent:  he 
thought  a  conversation  had  with  the  lunatic  could  not  be  received  as  the 
statement  of  a  fact.  The  judgment  might  have  been  formed  upon  many 
sufficient  facts,  but  the  surgeon  had  not  condescended  to  state  what  those 
facts  were. 

This  question  of  the  sufficiency  of  "a  conversation  to  constitute  a 
'fact'  "  in  drawing  up  a  medical  certificate  was  raised  in  a  case  where 
Batteson,  having  duly  examined  an  alleged  lunatic,  stated  in  his  certifi- 
cate as  a  "  fact"  indicative  of  her  insanity,  "  from  the  conversation  I  have 
had  with  her,"  following  the  decision  in  Shuttleworth's  case,  and  using 
the  same  language.  He  quoted  a  former  edition  of  this  work  as  his' 
authority,  but  the  Commissioners  in  Lunacy  refused  to  admit  this  case  as 
a  precedent,  and  required  that  some  fact  or  facts  apart  from  mere  conversa- 
tion should  be  distinctly  stated.  It  would  therefore  appear  that  in  order 
to  satisfy  the  Commissioners  a  medical  man  must  state  some  "  fact,"  i.  e. 
some  act  or  deed  on  the  part  of  the  alleged  lunatic,  on  which  his  opinion 
is  based.  The  Court  of  Qiieen's  Bench  regarded  a  certificate  based  on 
"  conversation"  only  as  a  substantial  although  not  a  literal  compliance 
with  the  terms  of  the  Act.  Lord  Denman  thought  that  it  would  be  mon- 
strous to  have  all  the  delusions  stated  upon  the  document.  Many  of  them 
were  indecent  and  many  blasphemous.  In  spite  of  this  reasonable  objec- 
tion to  entering  into  the  details  of  a  "  conversation,"  it  is  now  clear  that 
nothing  less  than  this  will  satisfy  the  Commissioners  in  Lunacy.  A 
medical  man,  therefore,  in  drawing  up  a  certificate  should  insert  those 
parts  of  the  conversation  on  which  he  relies,  as  well  as  a  statement  of 
any  fact  or  facts  in  reference  to  habits  or  demeanor  which  in  his  judgment 
may  indicate  unsoundness  of  mind.  "  Facts  indicating  insanity  observed 
by  myself"  are  little  appreciated  or  even  understood  by  many  medical 
men  who  are  legally  empowered  as  registered  members  of  the  profession 
to  sign  these  certificates.  The  facts  are  frequently  stated  in  a  loose  and 
careless  manner,  showing  a  complete  misapprehension  of  their  meaning. 
What  is  really  required  by  the  law  is  a  statement  of  facts  observed  or 
witnessed  by  the  medical  man  himself,  which  would  carry  conviction  to 
the  mind  of  any  non-professional  man  reading  it,  that  the  person  to  whom 
the  statement  referred  was  of  unsound  mind.  A  medical  man  should  in 
all  cases  avoid  giving  as  a  fact  indicating  insanity  any  delusion  which 
might  in  reality  have  some  foundation  in  truth. 

With  respect  to  the  second  requirement  of  the  statute — namely,  "  Facts 
communicated  by  others  " — it  may  be  observed  that,  although  these  do 
not  supersede  the  facts  observed  by  the  medical  man  himself,  they  are  of 
great  importance  in  throwing  light  upon  the  propensities  or  habits  of  the 
patient,  and  thus  serve  as  a  guide  for  treatment.  A  medical  man  must 
take  care  to  draw  a  clear  distinction  between  the  facts  observed  by  him- 
self and  the  facts  communicated  to  him  by  others,  and  avoid  such  vague 
expressions  as  that  he  "  thinks  "  and  "  believes,"  etc. 

As  every  medical  certificate,  although  accepted  by  the  Commissioners  in 
Lunacy,  may  become  at  a  future  time  a  subject  of  close  and  hostile  criti- 
cism in  a  court  of  law,  a  medical  practitioner  should  be  fully  prepared  to 
justify  the  use  of  the  terms  which  he  has  employed.  It  is  therefore  desir- 
able that  he  should  studiously  avoid  any  misstatement  or  exaggeration 
of  the  symptoms.  One  of  the  facts  cited  as  indicative  of  insanity  in  an 
old  lady  was  that  she  kept  a  cockatoo.  In  the  case  of  Davies,  Lord 
Brougham  elicited  from  one  of  the  witnesses,  as  a  fact  upon  which  he 


702  MEDICAL    RESPONSIBILITY. 

relied  to  indicate  insanity,  that,  when  asked  the  question,  the  alleged  luna- 
tic did  not  know  how  much  money  he  had  in  his  pocket.  Another  relied 
upon  the  fact  as  indicative  of  a  weak  mind,  that  he  said  he  preferred  see- 
ing the  people  returning  from  Epsom  races  rather  than  the  racing  on  the 
course.  Yague  and  trivial  facts,  which  do  not  indicate  insanity,  naturally 
tend  to  produce  a  feeling  in  the  minds  of  a  jury  the  ver}^  reverse  of  that 
for  which  the}'  are  brought  forward.  Thus  in  this  case,  although  there 
could  be  no  doubt,  from  what  subsequently  occurred,  that  Mr.  Davies  was 
a  lunatic  and  a  fit  and  proper  person  to  be  placed  under  restraint,  yet  the 
result  of  a  skilful  cross-examination  in  bringing  into  prominence  the  weak- 
ness of  the  facts  on  which  the  medical  witnesses  relied  to  establish  in- 
sanity had  such  an  influence  with  the  jury  that  they  returned  a  verdict  in 
favor  of  the  lunatic,  and  for  a  time  he  was  considered  as  the  unhappy 
victim  of  an  unjust  persecution  on  the  part  of  his  relatives.  A  medical 
man,  certifying  to  the  insanity  of  a  gentleman  who  was  at  that  time  un- 
doubtedly insane,  had  stated,  as  facts  observed  by  himaelf,  that  "his  (the 
patient's)  habits  were  intemperate,  and  that  he  had  squandered  his  prop- 
erty in  mining  speculations."  But  on  cross-examination  he  was  obliged 
to  confess  that  the  only  act  of  intemperance  be  had  actually  observed  was 
the  patient's  drinking  one  glass  of  beer,  and  that  the  squandering  of 
property  was  the  loss  of  what  was  to  him  a  mere  trifle  in  a  mining  specu- 
lation, which  eventually  turned  out  to  be  a  very  good  one.  (Millar's 
Hints  on  Insanit}^  1861,  p.  187.)  Counsel  properly  hold  a  medical  practi- 
tioner stricth^  to  the  common  and  accepted  meaning  of  the  words  he  uses. 
If  strong  points  are  not  forthcoming,  the  proof  of  insanity  must  fail. 
Weak  points  geherally  show  a  weak  case,  and  should  never  be  brought 
forward  or  employed  by  a  prudent  witness. 

A  medical  man  is  not  compelled  to  take  upon  himself  the  responsible 
duty  of  signing  certificates  of  insanity  ;  but  if  he  does  undertake  it,  he 
must  perform  it  with  reasonable  care  and  ordinary  skill.  If  he  certifies 
that  a  person  is  laboring  under  delusions,  he  must  take  care  that  he  under- 
stands the  meaning  of  the  term  and  what  are  the  delusions ;  and  admit- 
ting that  he  is  correct  in  believing  from  his  own  observation  that  they 
exist  in  the  mind  of  the  patient,  it  must  be  remembered  that,  in  order  to 
justify  restraint  or  imprisonment  in  an  asylum,  the  law  looks  always  to 
the  immediate  influence  of  these  delusions  upon  conduct.  In  reference  to 
medical  responsibilitv,  the  following  observations  were  made  bv  a  judge 
in  the  case  of  Hall  v.  Semple  (Q.  B.,  Dec.  1862) :  "  The  true  ground  of 
complaint  is  the  negligence  of  the  defendant  and  the  want  of  due  care  in 
the  discharge  of  the  duty  thrown  upon  him  ;  and  I  think  that  if  a  person 
assumes  the  duty  of  a  medical  man  under  this  statute,  and  signs  a  certifi- 
cate of  insanity  which  is  untrue,  without  making  the  proper  examination 
or  inquiries  which  the  circumstances  of  the  case  would  require  from  a 
medical  man  using  proper  care  and  skill  in  such  a  matter — if  he  states  that 
which  is  untrue,  and  damage  ensues  to  the  party  thereby,  he  is  liable  to 
an  action,  and  it  is  to  that  I  desire  to  direct  your  particular  attention.  In 
])oint  of  law,  if  a  medical  man  assumes  under  this  statute  the  duty  of 
siirning  a  certificate,  without  making  that  due  and  proper  examination 
which  under  such  circumstances  he  ought  to  make,  not  in  the  exercise  of 
the  oxtremest  possible  care,  but  of  ordinary  care,  so  that  he  is  guilty  of 
culpable  negligence  and  damage  ensue,  then  an  action  will  lie  against  him, 
althou;ih  there  may  have  been  no  imyn'oper  motive,  and  the  certificate  may 
not  1)0  false  to  his  knowledu-e."  In  this  case  the  jury  found  a  verdict  fur 
the  plaintiff — that  the  certificate  was  untrue  in  effect,  and  that  it  had  been 
signed  without  proper  examination  and  inquiries  and  without  probaljle 


DISCHARGE    OF    LUXATICS.  703 

cause.  This,  and  the  more  recent  actions  of  Mrs.  Weldon  against  Semple 
and  Winslovv,  convey  a  severe  caution  to  members  of  the  medical  profes- 
sion ;  and  also  these  latter  actions  convey  tlie  further  caution  that  a  medi-- 
cal  man  should  not  sign  a  certificate  at  the  request  of  the  proprietor  or 
superintendent  of  the  asylum  into  which  the  supposed  lunatic  is  to  be 
admitted,  nor  receive  a  fee  of  unusual  amount  for  signing  a  certificate. 

Discharge  of  Lunatics.- — In  forming  an  opinion  relative  to  the  propriety 
of  discharging  a  person  who  has  once  been  confined  as  a  lunatic  in  an  asy- 
lum, it  is  proper  to  examine  the  particulars  of  his  case  with  the  same  cau- 
tion as  if  the  object  were  to  confine  him  for  the  first  time.  Experience 
shows,  in  i-eference  to  the  criminal  lunatics  confined  under  State  supervi- 
sion, that  there  are  strong  reasons  for  their  detention.  In  18T7,  two  men 
were  readmitted,  after  their  discharge  as  cured,  on  account  of  their  having 
repeated  the  offences  of  which  they  had  been  previously  convicted.  The 
question  of  liberation  is  commonly  restricted,  like  that  of  restraint,  to 
cases  of  mania  and  monomania.  It  may  so  happen  that  the  person  has  a 
lucid  interval  at  the  time  of  examination,  in  which  case  it  will  be  necessary 
to  make  more  than  one  visit.  One  who  has  been  guilty  of  a  heinous 
crime  like  murder  should  never  on  any  pretence  be  discharged.  There 
are  often  long  lucid  intervals  in  homicidal  mania,  and  it  is  impossible  to 
be  certain  that  the  disease  is  entirely  removed.  Instances  have  occurred 
in  which  persons  who  had  been  confined  on  account  of  acts  of  murder,  and 
liberated  on  apparent  recover}^,  have  soon  after  their  liberation  murdered 
a  wife  or  child,  and  have  been  again  tried  and  sent  to  an  asylum.  Yet  it 
appears  to  be  the  custom  at  Broadmoor  to  discharge,  on  their  apparent 
recovery,  patients  who  have  been  guilty  of  murder. 

A  quiet  and  orderly  manner  maintained  for  many  weeks  or  months  may 
suffice  to  throw  both  physician  and  attendant  off  their  guard.  Orange 
relates  a>  case  in  which  a  man  was  tried  and  convicted  of  murder  in  1868. 
He  became  insane  and  was  admitted  into  Broadmoor  in  1869.  For  eigh- 
teen months  he  conducted  himself  with  such  propriety  that  he  was  allowed 
to  go  for  walks  with  his  attendant.  One  day,  while  thus  walking,  appa- 
rently quite  restored,  he  asked  his  attendant  a  question  about  some  rabbit- 
burrows  near  the  path.  The  attendant  stooped  down  to  examine  one  of 
tiiem,  when,  in  an  instant,  he  was  felled  to  the  ground  by  a  heavy  blow 
on  the  back  of  his  head.  The  lunatic  then  attempted  to  strangle  him,  and 
ultimately  escaped. 

If  the  lunatic  has  manifested  the  least  disposition  to  suicide,  we  should 
be  extremely  cautious  in  liberating  him  ;  for  suicidal  mania  is  often  art- 
fully concealed  under  a  cheerful  exterior.  We  cannot  always  test  the  pro- 
priety of  granting  liberation  by  the  lightness  of  the  offence  for  which  a 
criminal  lunatic  has  been  confined.  The  circumstances  under  which  the 
most  trifling  off"ence  has  been  committed  may  show  that  the  mind  is  w-holly 
unsettled  with  regard  to  moral  responsibility;  and  such  lunatics  can  never 
be  trusted,  even  when  there  is  a  great  improvement  in  their  language  and 
deportment.  In  this  respect,  the  case  of  Dodwell  (C.  C.  C,  March,"  1878) 
is  of  some  interest.  This  man  discharged  a  pistol,  in  open  court,  at  the 
Master  of  the  Rolls.  The  motive  which  he  assigned  for  the  act  was  to 
draw  attention  to  his  case  (a  Chancery  suit),  and  to  have  it  brought  fully 
before  the  public.  He  was  tried  for  the  offence  and  acquitted  by  the  jury 
on  the  ground  of  insanity.  The  result  was  that  he  was  consigned  as  a 
lunatic  to  the  Criminal  Asylum  at  Broadmoor.  The  court  and  jury 
thought  that  the  act  of  the  accused  showed  a  total  absence  of  self-control 
and  that  the  motive  assigned  was   irrational   and  not   consistent  w'th 


704  NULLITY    OF    MARRIAGE. 

soundness  of  mind.  It  was  not  considered  necessary  at  the  trial  to  require 
medical  evidence  of  the  state  of  mind  of  the  prisoner.  Like  all  lunatics, 
he  stron.u]y  denied  that  he  was  insane.  Soon  after  his  acquittal  and  con- 
finement in  Broadmoor,  Dodwell  was  seen  on  the  part  of  his  friends  by 
two  physicians.  Ttieir  opinion  was  that  he  was  quite  sane  and  ouf^ht  to 
be  di.scbarged;  in  fact,  that  he  was  a  sane  man,  "  incarcerated  in  a  living- 
tomb."  The  interests  of  the  public  do  not  appear  to  have  been  repre- 
sented on  this  occasion.  The  prisioner  Avas  subsequently  visited  and 
examined  by  two  other  physicians,  under  an  order  from  the  Secretary  of 
State,  and  three  months  afterwards  by  two  independent  medical  men  ap- 
pointed by  the  Commissioners  in  Lunacy.  The  result  of  their  interviews 
with  the  convict  was  that  he  was  considered  to  be  decidedly  insane  and 
that  it  would  be  unsafe  to  allow  him  to  leave  the  prison. 

Nullity  of  Marrmge  on  Account  of  Lvvacy. — It  will  be  readily  seen 
that  the  sexual  pervej'sion  inseparable  from  various  forms  of  insanity  may 
lead  to  a  union  perhaps  with  some  one  far  beneath  the  patient,  and  the 
influence  of  nymphomania  leads  to  impulsive  acts  which  the  person,  who 
perhaps  is  an  hysterical  girl,  does  not  stop  to  consider.  The  celebrated 
English  case  of  Miss  Bagster  is  an  example  of  this  kind.  .Miss  Bagster 
was  proved  by  the  evidence  to  be  a  frivolous  and  weak-minded  girl,  whose 
education  had  been  much  neglected.  She  Avas  a  lady  of  fortune  and  ran 
away  with  and  was  married  to  a  Mr.  Newton,  An  application  was  made 
by  her  family  to  dissolve  the  marriage  on  the  ground  that  she  was  of  un- 
sound mind.  Amongst  other  facts  urged  before  the  Commission  as  a  proof 
of  the  allegation,  it  was  mentioned  that  she  was  occasionally  violent  and 
self-willed,  that  she  was  passionate  as  a  child  and  that  even  in  maturer  years 
she  had  little  or  no  self-control ;  that  she  was  ignorant  of  arithmetic  and 
therefore  incapable  of  taking  care  of  her  property  ;  that  she  had  some 
erotic  tendencies,  which  were  evinced  by  her  want  of  womanh^  delicacy 
and  by  her  having  engaged  herself  Avith  a  view  to  marriage  to  several 
individuals.  On  her  examination  before  the  Commissioners,  her  answers 
were  intelligent  and  her  conduct  in  no  way  different  from  that  of  ordinary 
individuals."  Seven  medical  witnesses  were  summoned  to  support  the 
Commission,  and  each  of  them  deposed  that  she  was  of  unsound  mind. 
The  Commissioners,  however,  bad  recourse  to  Morrison  and  Haslam,  who 
visited  her  and  who  came  to  the  conclusion  that  she  was  neither  imbecile 
nor  idiotic,  and  that  her  inability  to  manage  her  affairs  arose  from  igno- 
rance. She  was  aware  of  her  deficiencies,  deplored  her  ignorance  of 
arithmetic,  and  explained  it  on  the  ground  that  her  grandfather  had  been 
too  ready  to  send  excuses  for  idleness  when  she  was  at  school.  Her  con- 
versation trreatly  impressed  Haslam  and  Morrison  with  a  belief  in  her 
sanity.  The  jury,  by  a  majority  of  twenty  to  two,  returned  a  verdict 
that  Miss  Bagster  had  been  of  unsound  mind  since  November,  1830,  and 
that  the  marriage  was  consequent!}^  dissolved. 

In  the  Durham  divorce  suit  for  nullity  (Durham  v.  Durham,  otherwise 
Milner,  Divorce  Ct.,  Feb.  1S85),  the  plaintiff,  the  Earl  of  Durham,  failed 
to  obtain  a  dis.solution  of  his  marriage  with  Miss  Ethel  Milner  on  the 
ground  of  insanity ;  it  not  having  been  proved  to  the  satisfaction  of  the 
judge  that  Lady  Durham  was  insane  on  the  date  of  her  marriage.  A 
similar  suit  (Cannon  v.  Cannon)  heard  about  the  same  time,  the  parties 
to  it  occupying  a  humbler  station  in  life,  also  failed,  though  here  the  wnfe 
was  clearly  insane  a  few  days  subsequent  to  the  marriage. 

In  Hnn'ter  v.  Hunter,  otherwise  Edney,  the  marriage  was  dissolved  on 
the  ground  that  the  l)ride  was  insane  at  the  time  of  her  marriage,  and  in- 
capable of  under.standing  the  contract,     (See  Medico-Leg.  Jour.,  ii.  p.  7L) 


TESTIMONIAL  CAPACITY,  705 


CHAPTER   LXIV. 

LUNATICS     AS     WITNESSES. INTERDICTION. COMMISSIONS      IN     LUNACY. EXAMINATION     OF 

ALLEGED    LUNATICS. MEDICAL    AND    LEGAL    TESTS     OF    COMPETENCY. — CONFLICT     OF     EVI- 
DENCE   AND    OPINION. 

Lunatics  as  Witnesses. — In  regard  to  the  testimonial  capacity  of  luna- 
tics, it  may  now  be  considered  as  settled  that  a  lunatic  who  labors  under 
delusions,  but  who  in  the  judgment  of  a  medical  practitioner  is  capable  of 
giving  a  fair  account  of  any  transaction  that  happened  before  his  eyes,  and 
who  appears  to  understand  the  obligation  of  an  oath,  may  be  called  as  a  wit- 
ness, (Reg.  V.  Hill,  Denison's  Crown  Cases,  2,  p.  254.)  The  rule  first 
laid  down  by  Parke,  B.,  is  in  accordance  with  this  view:  it  is  for  the 
judge  to  say  whether  the  evidence  of  the  witness  is  admissible,  and  then 
his  credibility  is  a  question  for  the  jury. 

Lunatics  have  occasionally  brought  actions  for  damages  involving 
charges  of  assault  against  those  in  whose  establishments  they  may  have 
been  confined.  A  trial  (Nunn  v.  Hemming,  Exch.  Div.,  Feb.  ]8Y9)  shows 
how  such  cases  are  dealt  with,  and  proves  that,  unless  the  testimony  of  a 
lunatic  is  corroborated,  it  will  not  be  accepted  by  a  jury.  The  plaintiff 
claimed  damages  from  the  defendant  for  an  assault  while  under  his  care 
as  a  lunatic  patient.  He  had  made  an  attempt  to  escape,  was  brought 
back  to  the  asylum,  and  was,  according  to  his  statement,  violently  plunged 
into  a  cold  bath  and  nearly  drowned.  No  complaint  was  made  of  this 
treatment  by  him  to  the  Commissioners  until  three  years  after  the  occur- 
rence. In  letters  to  his  wife  shortly  after  the  alleged  maltreatment  he 
had  not  mentioned  it.  The  story  of  the  plaintiff  was  directly  contradicted 
by  every  living  man  who  could  have  witnessed  the  scene  if  it  had  occurred, 
and  there  was  no  confirmatory  or  corroborative  evidence.  On  the  other 
hand,  seven  medical  men  had  testified  that  the  plaintiff'  at  this  time  and 
subsequently  had  labored  under  delusions,  and  had  attempted  suicide. 
The  plaintiff  admitted  in  court  that  he  had  swallowed  his  three  shirt-studs 
because  he  thought  that,  being  gold,  they  would  cure  a  pain  in  the  stomach. 
His  counsel  contended  that  his  statement  was  to  be  believed,  and  those 
who  testified  against  him  he  treated  as  perjured  v/itnesses.  His  conten- 
tion was,  "  Get  rid  of  the  plaintiff's  delusion,  and  the  facts  are  proved  ;" 
but  this  was  precisely  what  could  not  be  done,  and  the  jury  returned  a 
verdict  for  the  defendant.  Any  other  conclusion  would  have  been  against 
justice  and  common  sense.  This  case  shows  that  the  uncorroborated  tes- 
timony of  a  lunatic  laboring  under  insane  delusions  will  not  be  accepted 
as  evidence.  Section  3.30  of  the  Lunacy  Act,  1890,  is  intended  to  protect 
medical  practitioners  and  others,  when  acting  in  good  faith  and  with  reason- 
able care,  from  actions  at  law  brought  by  lunatics. 

Interdiction. — By  interdiction  we  are  to  understand  the  depriving  of  a 
person  laboring  under  mental  disorder  of  his  civil  rights;  in  other  words, 
preventing  him  from  exercising  any  control  or  management  over  his 
aff"airs.  It  may  be  with  or  without  restraint  or  confinement  in  an  asylum, 
for  one  condition  does  not  necessarily  imply  the  other,  although  there  is 
a  popular  idea  to  the  contrary.  In  re  Smith  (June,  1862),  an  order  for 
a  jurv  was  issued  to  trv  the  question  of  sanity  or  insanity  and  in  affirm- 
45 


706  EXAMINATION    OF    ALLEGED    LUNATICS. 

ino-  tbe  order,  Knight  Bruce,  L.  J.,  made  the  following  statement:  "It 
is  desirable  to  remove  the  idea,  but  too  generally  entertained  by  persons 
in  different  stations  of  life,  that  the  finding  by  a  jury  that  a  person  is  of 
unsound  mind  necessarily  involves  an  interference  with  his  personal  free- 
dom :  it  does  not.  The  court  places  no  further  restraint  upon  a  lunatic 
than  is  necessary  for  his  protection,  and  I  would  refer  to  the  fact  that  there 
are  several  lunatics  living  under  the  protection  of  the  court  who  reside  in 
their  own  houses  with  large  establishments." 

When  a  person,  from  mental  incompetency,  is  liable  to  be  imposed  upon 
bv  others,  or  is  guilty  of  foolish  and  extravagant  acts,  whereby  his 
property  is  wasted,  a  commission  of  inquiry  may  be  constituted  under 
the  Great  Seal ;  and  the  inquiry  may  be  carried  out  by  the  Masters,  either 
alone  or  with  other  appointed  persons ;  or  an  inquisition  may-be  held  with 
or  without  a  jury  to  determine  the  competency  or  incompetency  of  an 
alleged  lunatic.  The  object  of  the  commission  is  to  determine  whether 
the  incapacity  to  manage  affairs  is  owing  to  some  mental  defect  or  dis- 
order, and  not  merely  to  want  of  education  or  bodily  infirmity — otherwise 
all  wealthy  minors  and  infirm  persons  might  be  deprived  of  the  control  of 
their  property.  Formerly  commissions  were  not  issued  unless  it  was 
evident  that  lunacy  or  idiocy  existed — for  weakness  of  mind  or  imbecility 
was  not  considered  sufficient  to  justify  legal  interference.  This  is  no 
longer  the  case,  unsoundness  of  mind  with  incapacity  of  managing  himself 
and  his  affairs  being  all  that  the  law  requires  to  be  established.  Thus, 
then,  whether  the  case  be  one  of  mania  or  dementia  is  not  now  the  ques- 
tion, but  whether  the  party  be  compos  ornon  compos  mentis  ;  if  the  latter, 
whether  it  be  to  a  degree  to  prevent  him  from  controlling  his  property 
with  careful  and  provident  management.  Some  years  ago,  a  person  who 
had  a  delusion  on  a  particular  subject,  although  not  affecting  his  social 
duties,  was  deemed  a  fit  subject  for  a  commission,  and  deprived  of  bis 
civil  rights  merely  because  his  mental  disorder  would  fall  under  the  defini- 
tion of  lunac3^  i3n  the  other  hand,  one  who  had  no  delusion  but  great 
mental  weakness,  such  as  to  incapacitate  him  for  properly  managing  his 
affairs,  was  not  deemed  a  fit  subject  for  a  commission  ;  since  weakness  of 
mind  and  insanity  were  considered  to  be  two  entirely  different  states — the 
latter  alone  requiring  interference,  although  the  injurious  results  might  be 
the  same  in  both  cases. 

Examination  of  Alleged  Lunatics. — To  determine  whether  a  person 
is  or  is  not  a  fit  subject  for  interdiction  or  deprivation  of  civil  rights,  it 
is  necessary  to  bear  in  mind  that  it  is  not  enough  to  show  that  there 
is  delusion,  as  in  the  lighter  cases  of  monomania  ;  but  we  are  bound  to 
ascertain  how  far  the  delusion  affects  the  judgment  of  the  person,  so  as 
to  prevent  him,  like  other  men,  from  managing  his  affairs  with  provident 
care  and  propriety.  In  many  instances,  however,  some  proof  of  delusion 
only  is  sought  for  ;  and,  if  this  be  procured,  it  is  hastily  inferred  that  the 
person  must  be  entirely  incompetent  to  manage  his  property.  The  most 
difficult  cases  are  those  which  involve  questions  of  imbecility.  In  con- 
ducting the  defence  of  the  Windham  case  (Dec.  1861)  Cairns  was  allowed 
by  his  medical  advisers  to  make  the  following  strange  statement:  "In  a 
case  of  insanity  accompanied  by  delusion,  the  mode  of  investigating  it 
so  as  to  arrive  at  the  truth  is  a  matter  of  great  difficulty  and  doubt ;  but 
in  a  case  of  imbecility,  where  there  is  either  no  mind  at  all  or  next  to 
none,  the  task  of  coming  to  a  right  and  just  decision  is  comparatively 
easy."  Such  a  statement  is  the  reverse  of  the  truth,  and  must  have  been 
made  under  some  hazy  notion  that  the  state  of  imbecility  was  identical 
with  that  of  idiocy.     One  of  his  own  witnesses  (Sutherland),  in  a  subse- 


EXAMINATION    OF    ALLEGED    LUNATICS.  707 

quent  stage  of  the  proceeding's,  corrected  this  error,  by  the  admission,  in 
cross-examination,  that  "  drawing  the  line  between  soundness  and  unsound- 
ness of  mind  in  a  case  of  imbecility  is  one  of  the  most  difficult  questions 
of  medical  science." 

In  conducting  the  examination  of  an  alleged  lunatic  we  should  compare 
his  mind  as  it  is  with  what  it  is  proved  to  have  been  ;  and  if  it  be  a  case 
of  supposed  imbecility  a  proper  regard  must  be  had  to  age,  society,  edu- 
cation, and  general  conduct.  We  should  also  consider  whether  the  per- 
son has  been  treated  by  his  friends  and  relations  as  a  lunatic  or  imbecile 
prior  to  the  issuing  of  the  Commission.  A  young  person  whose  educa- 
tion has  been  much  neglected,  and  who  has  never  been  entrusted  with  the 
care  of  money,  cannot  be  expected  to  have  much  knowledge  of  the  method 
of  managing  a  large  property.  Questions  are  sometimes  put  on  the  moral 
responsibility  of  man  and  the  attributes  of  God  to  one  who,  perhaps, 
never  heard  of  ethics  or  metaph3rsics.  Again,  mathematical  and  arith- 
metical questions,  which  would  embarrass  many  persons  who  are  sane 
and  competent,  are  sometimes  put  on  these  occasions.  In  one  instance  a 
physician  gave  evidence  on  a  Commission  that  he  found  the  alleged  im- 
becile could  not  work  the  first  proposition  in  Euclid;  but  this  person  ad- 
mitted that  ho  had  always  disliked  mathematics.  In  another  case  one  ex- 
aminer asked  the  alleged  imbecile,  who  said  he  had  1200^.  in  the  bank,  and 
received  201.  for  interest, — How  much  was  that  per  cent.  ?  He  said  he  could 
not  tell :  he  was  no  good  hand  at  arithmetic.  The  counsel  who  appeared 
against  the  Commission  afterwards  put  the  same  arithmetical  question  to 
one  of  the  medical  witnesses  who  had  deposed  to  the  imbecility  of  the  party  ; 
and  this  witness,  an  educated  man,  confessed  himself  quite  unable  to 
answer  it — a  practical  illustration  of  the  impropriety  of  pronouncing  a 
person  to  be  imbecile  or  incompetent  merely  because  he  is  ignorant  of 
that  which  he  has  never  been  taught.  (Case  of  David  Yoolow.)  Unless 
the  questions  are  confined  to  those  subjects  which  the  person  has  had 
either  the  opportunity  or  inclination  to  learn,  a  medical  witness  will 
always  incur  the  risk  of  confounding  mere  ignorance  with  imbecility. 

One  of  the  best  tests  of  mental  capacity  will  be  found  in  determining 
the  degree  to  which,  with  ordinary  opportunities,  a  person  has  shown 
himself  capable  of  being  instructed ;  but  too  high  a  standard  must  not  be 
assumed  as  a  test  of  capacity.  The  mind  of  an  alleged  imbecile  should 
not  be  compared  with  the  most  perfect  mind,  but  with  that  of  another 
person  of  average  capacity,  of  the  same  age  and  station  in  society,  and 
who  has  enjoyed  like  opportunities  of  instruction.  It  would  be  difficult 
to  find  two  sane  persons  who  were  exactly  equal  in  mental  power ;  in 
some,  one  faculty  is  prominently  developed  ;  in  others,  another.  All  that 
we  have  to  look  for  in  these  cases  of  alleged  unsoundness  is  an  average 
degree  of  intellectual  development,  so  as  to  qualify  the  person  for  per- 
forming the  duties  of  his  station.  To  win  the  confidence  of  an  alleged 
lunatic  for  the  purpose  of  examination,  we  should  not  treat  his  observa- 
tions or  delusions  with  levity,  but  rather  seriously  sympathize  with  him 
in  his  troubles;  we  should  listen  attentively  to  all  he  has  to  say,  for  his 
suspicions  will  be  excited  by  many  questions  being  put  to  him.  If  we 
cannot  agree  with  his  conclusions,  we  should  not  contradict  him  abruptly, 
but  endeavor  to  draw  him  out  by  asking  for  some  corroborative  evidence 
of  his  statements.  Before  visiting  the  patient  we  should  make  ourselves 
thoroughly  acquainted  with  every  particular  connected  with  his  history 
and  condition,  and  treat  him  as  much  like  a  sane  person  as  possible.  The 
insane  are  exceedingly  suspicious,  and  quick  to  detect  any  deceit  prac- 
tised on  them.     They  are  also  jealous  of  the  intrusion  of  strangers,  and, 


7C8  CASES    OF    IMBECILITY. 

unless  great  tact  is  employed,  will  look  upon  a  medical  man  as  an  enemy. 
The  patient  should  be  informed  that  his  perceptions  are  merely  the  result 
of  natural  disease  ;  it  is  useless  to  tell  him  that  he  is  under  a  delusion 
when  his  perceptions,  although  sometimes  exaggerated,  are  too  real  to  be 
doubted. 

The  conflicting  medical  evidence  given  on  Commissions  in  Lunacy  is  in 
great  part  to  be  ascribed  to  the  fact  that  the  whole  of  the  mind  of  the 
person  is  not  fairly  examined.  One  physician  tests  one  faculty  ;  another, 
another  ;  each  has  his  own  theory  of  insanity,  and  each  his  own  standard 
of  competency.  The  witnesses  in  support  of  the  Commission  do  not  go 
so  much  to  test  the  actual  state  of  the  mind,  of  the  person  as  to  discover 
what  they  deem  proofs  of  insanity  ;  those  against  the  Commission  take 
an  opi)osite  course — they  look  only  for  some  proofs  of  soundness.  It  can- 
not, therefore,  happen  otherwise  than  that  different  conclusions  should  be 
drawn  under  such  different  modes  of  investigation.  There  is  another 
point  which  requires  attention  in  these  cases.  Persons  laboring  under  a 
slight  degree  of  inibecility  are  very  soon  irritated  ;  they  are  easily  per- 
suaded that  they  are  ill  used  and  persecuted  ;  and  when  they  happen  to 
be  questioned  by  parties  who  are  represented  as  their  enemies  they  lose 
their  self-command,  and  are  no  longer  able  to  answer  questions  which 
under  their  ordinary  state  of  mind  they  would  reply  to  with  perfect  ac- 
curacy. A  defective  memory  must  not  be  hastily  set  down  as  a  proof  of 
legal  unsoundness.  This  is  more  or  less  the  natural  lesult  of  age.  A 
man  mav  not  have  a  good  memory,  and  yet  have  a  mind  sound  enough 
for  the  management  of  his  affairs.  A  defective  memory  in  an  aged  per- 
son, taken  alone,  proves  nothing. 

A  medical  witness  must  not  allow  himself  to  be  embarrassed  by  medical 
or  legal  definitions  of  insanity.  The  malady  may  not  assume  the  form  of 
lunacy  or  idiocy,  in  a  strictly  legal  view — nor  of  mania,  melancholia,  de- 
mentia, or  idiocy,  in  a  strictly  medical  view ;  but  still  may  be  a  case  of 
iiiich  mental  disorder  as  to  create  an  incapacity  for  managing  affairs. 
This  is  the  point  to  which  a  medical  examiner  has  to  direct  his  attention. 
Cases  of  imbecility  present  the  greatest  difficulty,  and  create  the  greatest 
conflict  of  opinion  among  medical  witnesses.  Imbecility  strictly  implies 
a  weak  or  feeble  mind,  and  this  term  is  properly  applied  to  one  who  has 
an  intellect  below  par  or  below  the  normal  average.  The  vagueness  of 
these  terms  shows  how  difficult  it  is  to  draw  a  clear  distinction  between 
legal  sanity  and  that  degree  of  mental  weakness  implied  by  imbecility 
which  would  justify  interdiction.  Insanity,  in  the  common  acceptation  of 
the  term,  cannot  be  proved  in  these  cases:  there  will  be  no  evidence  of 
delusion,  and  there  may  be  such  an  amount  of  self-control  as  to  enable  a 
person  to  maintain  a  rational  conversation.  Memory,  judgment,  and 
other  faculties,  although  weak,  are  still  present  in  a  greater  or  less  degree  ; 
and  from  one  or  two  interviews  only  an  examiner  might  be  disposed  to 
pronounce  the  person  of  sound  mind  and  competent  to  manage  his  own 
affairs.  There  is  a  wide  field  for  argument  here  ;  for  it  may  be  said  with 
some  truth  in  a  defence,  "  that  the  doctors  cannot  put  their  fingers  on  a 
single  point  indicative  of  insanity."  In  short,  each  fact  specified  by  them 
may  be  frittered  away  with  the  remark  that  every  one  must  have  known 
some  person  who  had  either  a  bad  memory  or  a  weak  judgment ;  who 
squandered  money,  who  wasted  it  on  unworthy  objects,  who  hoarded  it 
and  refused  to  pay  just  debts,  or  who  lost  it  in  foolish  speculations,  etc. 
All  this  may  be  true,  and  yet  the  person  in  question  may  be  legally  of 
unsound  mind  and  properly  interdicted.  As  Pagan  justly  remarks,  there 
is  a   facility  of  disposition  in  an  imbecile  or  weak-minded  person,  which 


PROOFS    OF    UNSOUNDNESS    OF    MIND.  709 

laj^s  him  open  to  be  imposed  upon  by  the  artful  and  designing ;  and  our 
conclusion  regarding  his  competency  must  therefore  be  the  result  of  a 
just  appreciation  of  his  general  knowledge  of  affairs  derived  from  an  ex- 
amination of  all  his  faculties.  We  have  to  consider  how  far  his  imperfect 
mind  would  prevent  him  from  attending  to  his  own  interests,  not  in  a 
manner  which  would  insure  their  most  profitable  application,  but  in  such 
a  way  as  would  prevent  his  affairs  from  being  involved  in  ruin.  His 
knowledge  and  understanding  may  be  so  imperfect  that  his  property 
would  necessarily  run  to  waste  under  his  unassisted  control.  When  it  is 
proved  that  there  has  been  habitual  submission  to  the  dictation  of  others, 
either  from  a  long  habit  of  being  controlled,  from  indifference  or  fear — 
when  a  man  has  allowed  himself  to  be  disobeyed  or  neglected  by  his  ser- 
vants, and  to  be  openly  cheated  by  tradesmen — these  circumstances  fur- 
nish evidence  of  weakness  of  mind  and  a  justification  of  the  opinion  that 
there  should  be  interdiction.  On  the  other  hand,  if  a  person  when  left  lo 
himself  has  managed  his  affairs  with  reasonable  care  and  propriety,  and 
has  acted  independently  of  others,  there  can  be  no  stronger  proof  of  his 
legal  competency. 

The  testamentary  capacity  of  imbeciles  may  be  tried  by  the  same  rules. 
A  man  who  is  of  such  an  easy  disposition  as  to  be  improperly  influenced 
in  the  use  of  his  property  while  living,  may  be  equally  influenced  by  fear 
or  control  to  make  an  improper  disposition  of  it  by  his  will;  but  in  this 
case  the  terms  of  the  will,  if  drawn  up  by  himself,  will  allow  a  fair  judg- 
ment to  be  formed  of  the  mental  soundness  of  the  testator.  There  is  on 
these  occasions  a  method  of  testing  the  state  of  mind  which  has  been  sug- 
gested by  Conolly — namely,  by  inducing  the  patient  to  express  his 
thoughts  in  writing,  as  in  a  letter  addressed  either  to  his  physician  or  to 
some  confidential  friend.  This  plan  would  probably  often  succeed  in 
showing  the  existence  of  a  delusion,  when  an  oral  examination  would 
wholly  fail ;  the  patient  would  not  be  led  to  suspect  that  he  was  being 
subjected  to  an  examination  for  a  hostile  purpose.  The  current  of  his 
thoughts  would  be  uninfluenced  by  the  suspicion  that  the  act  of  writing 
was  to  test  the  state  of  his  mind  ;  and  as  no  man  can  long  write  in  a  con- 
nected manner  who  does  not  think  collectedly,  so  we  may  expect  to  find 
ample  evidence  whether  a  delusion  really  exists  in  his  mind  or  not.  There 
are  cases  recorded  in  which  the  evidence  of  delusion  has  been  derived  from 
the  terms  of  a  will  or  deed  written  or  dictated  by  the  lunatic  himself, 
when  there  was  great  difficulty  in  obtaining  proof  by  an  oral  examination. 

In  idiocy  there  is  no  capacity  for  writing.  In  dementia,  as  there  is  no 
memory,  it  commonly  happens  that  the  same  word  is  written  over  and 
over  again.  No  person  in  a  state  of  dementia  can  write  a  connected  sen- 
tence, because,  before  the  last  part  of  the  sentence  is  completed,  the  first  is 
forgotten.  In  imbecility  we  may  meet  with  every  variety  of  mental  de- 
fect, but  the  state  of  the  mind  is  generally  well  shown  by  the  expression 
of  the  thoughts  in  writing.  This  method,  it  must  be  remembered,  cannot 
show  whether  or  not  a  person  is  capable  of  managing  his  affairs;  it  is  a 
mere  index  of  a  certain  state  of  mind,  and  must  be  coupled  with  general 
habits  and  conduct,  before  any  conclusion  is  drawn  from  it  relative  to  the 
propriety  of  interdiction.  It  will  often  serve  to  detect  the  existence  of  a 
delusion  when  other  means  fail.  Winslow  attached  some  importance  to 
handwriting  as  foreshadowing  the  occurrence  of  general  paralysis  with 
softening  of  the  brain.  This,  however,  refers  not  so  much  to  composition 
or  style  as  to  correct  writing  and  spelling.  The  reader  will  find  a  com- 
plete essay  on  the  writings  of  the  insane,  and  the  medico-legal  conclusions 
to  which  they  lead,  by  Marce,  in  the  Ann.  d'Hyg.,  1864,  t.   1,  p.  379. 


710  PROOFS    OF    UNSOUNDNESS    OF    MIND. 

When  a  verdict  of  insanity  is  returned  under  a  Commission,  it  must 
always  represent  the  person  to  be  of  unsound  mind,  and  by  reason  of  that 
unsoundness  to  be  incompetent  to  manage  his  ati'airs.  A  date  must  be 
fixed  at  wliich  the  insanity  first  appeared,  and  this  date  should  always  be 
anterior  to  the  issuing-  of  the  Conjmission.  If  there  are  lucid  intervals, 
the  space  of  time  occupied  by  these  should  also  be  defined. 

Among  cases  well  calculated  to  show  the  conflict  of  medical  evidence  on 
Commissions  in  Lunacy,  is  that  of  W.  F.  Windhani  (Doc.  1861).  Fifteen 
of  the  relatives  of  this  gentleman  petitioned  for  an  inquiry  into  his  state 
of  mind,  on  the  ground  that  he  labored  under  congenital  deficiency  of  in- 
tellect (imbecility),  and  this  view  was  supported  by  strong  medical 
opinions  ;  on  the  other  side,  it  was  alleged  that  the  mental  condition  of 
Mr.  Windham,  if  below  the  normal  standard,  was  merely  the  result  of  a 
neglected  education.  The  inquiry  lasted  thirty-three  days,  during  which 
140  witnesses  were  examined — namely,  fifty  on  the  part  of  the  petitioners, 
and  ninety  in  favor  of  Mr.  Windham,  at  a  cost  of  about  30,000/.  There 
was  no  proof  of  the  want  of  opportunity  of  education,  but  strong  reason 
to  believe  that  the  alleged  imbecile  had  not,  like  other  boys  of  his  age, 
made  use  of  the  advantages  which  he  had  enjoyed.  He  had  been  sent  to 
Eton,  but  had  derived  little  benefit  there.  It  seems  to  have  been  admitted 
that,  as  a  boy,  he  was  wholly  unlike  other  boys,  and  when  he  attained  his 
majority,  in  Aug.  1861,  his  conduct  was  extravagant,  wild,  and  quite  in- 
consistent with  his  social  position.  At  the  same  time,  he  was  not  entirely 
deficient  in  business  matters  ;  for  it  was  proved  that  his  uncle,  one  of  the 
petitioners,  had  shortly  before  negotiated  with  him  for  the  sale  of  a  piece 
of  land  of  the  value  of  1000/.,  thereby  admitting  his  capacity  to  transact 
business.  The  evidence  received  on  this  occasion  was  allowed  to  extend 
to  the  whole  of  his  life  ;  and  it  may  be  observed  that  in  cases  of  alleged 
imbecility  it  is  not  possible,  without  doing  injustice,  to  prevent  the  re- 
ception of  evidence  from  a  long  antecedent  date.  The  result  of  this  inquiry 
Avas  that  the  jury,  by  a  majority  of  fifteen  to  eight,  returned  the  following 
verdict :  "  That  Mr.  Windham  is  of  sound  mind,  and  capable  of  taking- 
care  of  himself  and  his  affairs."  After  the  verdict  had  been  returned  pro- 
nouncing him  sane  and  competent,  he  was  guilty  of  many  extravagant 
acts,  exhausted  a  splendid  fortune,  and  became  a  bankrupt ;  showing  that, 
whatever  legal  soundness  of  mind  he  might  possess,  he  practically  did  not 
evince  the  capacity  of  taking  care  of  his  affairs. 

A  large  section  of  the  public  joined  in  the  view  prominently  put  forward 
at  this  inquiry  by  his  counsel,  that  this  unfortunate  young  man  had  been 
made  the  victim  of  a  charge  the  most  cruel,  unjust,  and  unjustifiable.  In- 
sanity, it  was  urged,  in  the  ordinary  acceptation  of  the  word,  did  not  exist 
in  his  case.  There  were  no  illusions,  hallucinations,  or  insane  delusions; 
but  as  these  are  never  met  with  in  the  form  of  unsoundness  imputed  to 
Mr.  Windham,  namely,  imbecility,  their  absence  proved  nothing  for  or 
against  the  existence  of  imbecility  or  weakness  of  mind.  But  what  test 
is  there  for  imbecility  except  conduct  and  conversation?  There  was  no 
incoherency  of  language,  but  there  was  strong  evidence  of  habits  such  as 
we  do  not  meet  with  among  men  of  really  reasonable  minds  ;  but  opinions 
were  divided  on  the  question  whether  these  indicated  unsoundness  of 
mind,  or  a  mixture  of  eccentricity  and  moral  depravity  from  deficient  edu- 
cation. A  majority  of  the  jury  took  the  latter  view;  and  Lord  Chelms- 
ford, in  commenting  upon  this  verdict  in  the  House  of  Lords,  said,  "  The 
law  as  laid  down  by  Lord  Lyndhurst  applied  to  cases  short  of  insanity, 
but  they  must  be  cases  of  unsoundness  of  mind ;  and  mere  extravagance 
or  follies,  which  indicated  imbecility,  would  not  be  sufficient  unless  the 


CIVIL    RESPONSIBILITV    OF    LUNATICS.  711 

iin])ocility  amounted  to  unsoundness  of  mind."  The  legal  test  of  the 
existence  of  this  state  of  mind,  we  are  told  by  high  authority,  is  "con- 
duct." A  lawyer  means  by  "madness"-  conduct  of  a  certain  character, 
while  a  physician  means  by  it,  "a  certain  disease,  one  of  the  eflects  of 
which  is  to  produce  such  conduct."  (Stephen's  Crim.  Law  of  England, 
p.  87.)  The  whole  evidence  against  Mr.  Windham  bore  upon  conduct, 
and  from  the  verdict  we  learn  what  sort  of  conduct  does  not  constitute 
unsoundness  in  a  legal  sense.  Thus  the  marrying  of  a  woman  of  disrepu- 
table character,  the  squandering  upon  her  of  14,000/.  in  jewellery,  and 
settling  upon  her,  without  any  reasonable  grounds,  SOOl.  per  annum,  with 
other  extravagant  acts  of  a  similar  kind,  do  not  constitute  "conduct  of  a 
certain  character"  sufficient  to  render  a  man  non  compos  mentis  in  the  eye 
of  the  law;  but  if  these  acts  evince  soundness  of  mind  and  a  competency 
to  manage  affairs,  what  are  the  acts  which  indicate  unsoundness  or  incom- 
}tetency  ?  On  the  other  hand,  w'e  are  told  that  the  physician  looks  to  the 
existence  of  a  certain  disease  ;  but  a  physician  can  know  nothing  about 
the  existence  of  disease  of  the  brain  during  life  in  any  case  of  imbecility, 
except  in  so  far  as  its  effects  may  be  manifested  by  conduct.  We  there- 
fore come  round  to  the  legal  test  of  "conduct,"  which  in  Mr.  Windham's 
case  was  considered  to  be  quite  consistent  with  the  provident  manage- 
ment of  a  large  estate  and  a  splendid  fortune.  That  the  legal  test  was 
here  a  failure  in  affording  protection  from  wastefulness  is  proved  by  the 
result — -the  loss  of  the  whole  property  from  reckless  extravagance. 

So  strong  was  the  public  feeling  in  reference  to  medical  evidence  after 
this  inquiry,  that  the  Lord  Chancellor  actually  proposed  to  exclude  it  alto- 
gether in  Commissions  in  Lunacy,  except  in  so  far  as  it  was  based  on 
facts  within  the  personal  knowledge  of  the  witnesses.  It  was  suggested 
that  the  general  scientific  conclusions  of  experts  should  not  be  receiv^ed  as 
evidence.  The  proposition,  which  would  have  been  most  injurious  to  the 
interests  of  the  insane  as  well  as  of  the  sane,  did  not  meet  with  a  favor- 
able reception. 

The  medical  attendant  of  ever}^  person  found  lunatic  by  inquisition  has 
every  five  years  to  send  to  the  Masters  a  report  as  to  the  mental  and 
bodily  condition  of  the  patient,  and  a  certificate  if  he  is  still  of  unsound 
mind  and  a  proper  person  to  be  detained. 


CHAPTER   LXY. 

CIVIL  RESPONSIBILITY. TESTAMENTARY  CAPACITY. WILLS  MADE  BY  THE    INSANE. TEST  OP 

CAPACITY. EVIDENCE    OF  DELUSION. ECCENTRICITY. 

Testamentary  Capacity.  Wills  made  by  the  Insane  — Questions  in- 
volving the  testamentary  capacity  of  persons  are  of  frequent  occurrence, 
and  medical  evidence  is  commonly  required  for  their  solution.  When 
property  is  bequeathed  by  a  testator  out  of  the  usual  order  of  succession, 
it  may  be  alleged  by  the  relatives  that  he  was  incompetent  to  understand 
the  nature  of  the  deed — either  from  insanity,  the  imbecility  of  age,  or  that 
natural  failing  of  the  mind  which  is  so  often  observed  to  occur  from  dis- 
ease or  on  the  approach  of  death.  A  disposing  mind  is  what  the  law 
requires  to  render  a  will  valid,  and  this  does  not  rest  so  much  upon  the 


713  TESTAMENTARY    CAPACITY. 

question  of  sanity  or  insanity,  as  upon  the  proof  of  competency  or  incom- 
petency in  the  testator.  The  best  test  of  capacity  for  this  act  is  that  a 
man,  at  the  time  of  signing  the  will,  should  know  the  nature  and  amount 
of  his  property  and  the  just  claims  of  those  who  are  nearly  related  to 
him.  It  has  been  truly  said  that  the  evidence  of  the  medical  attendant  on 
the  state  of  the  testator's  mind  at  the  time  of  the  execution  of  the  will,  is 
worth  more  than  the  opinions  of  experts  or  of  witnesses  who  may  have 
seen  the  testator  at  other  times  and  under  other  circumstances.  (Med. 
Times  and  Gaz.,  1871,  ii.  p.  203  )  A  medical  man  is  frequently  of  neces- 
sity a  witness  to  a  will,  and  he  should  always  remember  that  when  he 
signs  his  name  to  it  as  a  witness  he  is  practically  testifying  to  the  compe- 
tenc}^  of  the  testator  to  make  it. 

Bodily  disease  or  incapacity  does  not  affect  the  validity  of  a  will  unless 
the  mind  is  directly  or  indirectly  disturbed  by  it.  A  man's  mind,  under 
these  circumstances,  may  not  be  so  strong  as  in  robust  health,  but  still  it 
may  retain  a  disposing  power.  In  Harwood  v.  Baker  (Privy  Coun.,  1841 ), 
a  will  was  pronounced  to  be  invalid  owing  to  the  general  state  of  bodily 
disease  in  which  the  testator  w^as  at  the  time  of  making  it.  He  was  labor- 
ing under  erysipelas  and  fever,  and  these  diseases  had  produced  a  degree 
ofdrowsiness  and  stupor  w'hich  rendered  him  incompetent  to  act.  In  the 
case  of  Day  (1838),  epilepsy,  was  alleged  to  have  affected  the  mind;  and 
in  the  case^of  Blewitt  (1833),  paralysis  was  adduced  as  a  ground  of  in- 
competency. In  all  cases  of  this  kind  th'e  law  looks  exclusively  to  the 
actual  effect  of  the  bodily  disease  upon  the  mmd  at  the  time  the  will  was 
made  ;  and  this  is  commonly  a  question  to  be  determined  by  a  jury  from 
the  testimony  of  the  usual  medical  attendant  of  the  deceased,  as  well  as 
from  the  evidence  of  medical  experts. 

Test  of  Cojyacity. — A  person  is  considered  to  be  of  a  sane  and  disposing 
mind  who  knows  the  nature  of  the  act  which  he  is  performing,  and  is  fully 
aware  of  its  consequences.  From  some  decisions  that  have  been  given  it 
Avould  appear  that  a  state  of  mind  for  which  a  person  might  be  placed 
under  interdiction  or  deprived  of  the  management  of  his  affairs  W'ould  not 
render  him  incompetent  to  the  making  of  a  will.  The  validity  of  the  will 
of  a  lunatic  was  once  allowed,  although  made  while  he  was  actually  con- 
fined in  an  asylum,  because  the  act  was  rational,  and  it  was  such  as  the 
lunatic  had  announced  his  intention  of  making  some  years  prior  to  the 
attack  of  insanity.  (Coghlan's  case  ;  see  Re  Garden,  Law  Times,  July 
6,  1844,  p.  258;  also  the  case  of  Cartwright,  Mayo  on  Med.  Tes.,  p.  44.) 
In  Nichols  and  Freeman  v.  Binns  (Frob.  Ct.,  Aug.  1858),  the  question 
was  W'hether  the  wnll  of  a  Mr.  Parkinson,  made  in  a  lunatic  asylum  near 
Norwich,  was  executed  during  a  lucid  interval.  The  jury  found  a  verdict 
in  favor  of  the  will.  In  Parker  v.  Lord  (1876),  the  testator.  Lord,  a 
surgeon,  was  afflicted  with  insanity  in  Jan.  1875.  It  was  proved  that  he 
had  lucid  intervals.  He  executed  his  will  in  the  following  February.  The 
court  pronounced  for  the  wnll,  in  which  there  was  a  reasonable  disposition 
of  his  property,  on  the  ground  that  it  had  been  executed  during  a  lucid 
interval. 

The  insanity  of  a  person,  when  not  already  found  insane  under  a  Com- 
mission,  must  not  in  these  cases  rest  upon  presumption  or  probability, 
but  be  established  by  positive  proof.  The  act  of  suicide  is  often  hastily 
assumed  to  be  evidence  of  insanity;  but  it  would  not  be  allowed  as  a 
proof  of  this  state,  even  when  a  testator  had  destroyed  himself  shortly 
after  the  execution  of  his  will.  A  case  has  been  decided  where  the  testator 
committed  suicide  three  days  after  having  given  instructions  for  his  will; 
but  the  act  was  not  admitted  as  a  proof  or  even  as  a  presumption  of  in- 


DELUSION    IN    THE    DEED.  713 

sanity  at  the  time,  and  the  will  was  pronounced  to  be  valid.  In  another 
case,  Edwards  v.  Edwards  (Frero^^  Ct.,  Feb.  1854),  it  was  proved  that 
the  testator  had  coniniitted  suicide  three  days  after  the  execution  of  his 
will,  and  there  was  some  evidence  of  eccentric  habits  almost  amouutin/^to 
insanity;  but  the  will  was  found  valid.  In  White  v.  Halford  (Frob.  Ct., 
Feb.  1874),  a  will  was  contested  on  the  ground  that  the  testator  had 
thrown  himself  out  of  his  bedroom  window  and  had  inflicted  some  severe 
injuries  on  himself  a  niyht  or  two  before  the  will  was  made.  He  repeated 
these  attempts  on  himself,  and  eventually  died  in  a  lunatic  asylum.  The 
jury  found  in  favor  of  the  will.  -There  was  no  proof  that  the  testator  was 
laborini?  under  any  delusion  when  it  was  made.  Suicide  alone  is  not 
deemed  to  be  such  a  proof  of  the  existence  of  insanity  as  to  render  a  will 
invalid. 

Delusion  in  the  Deed. — The  validity  of  deeds  executed  by  persons 
affected  with  primary  delusional  insanity  (monomania)  is  often  a  subject 
of  dispute.  The  practice  of  the  law  indicates  that  the  mere  existence  of  a 
delusion  in  the  mind  of  a  person  does  not  necessarily  vitiate  a  deed,  unless 
the  delusion  form  the  g-roundwork  of  it,  or  unless  the  most  decisive  evi- 
dence be  given  that,  at  the  time  of  executing  the  deed,  the  testator's  mind 
was  influenced  by  it.  Strong  evidence  is  often  derivable  from  the  act 
itself,  especially  when  a  testator  has  drawn  up  the  will  of  his  own  accord. 
In  the  case  of  Barton  (1840),  the  Ecclesiastical  Court  was  chiefly  guided 
in  its  decision  by  the  nature  of  the  instrument.  The  testator,  it  appeared, 
labored  under  the  delusion  that  he  could  dispose  of  his  own  property  to 
himself,  and  make  himself  his  own  legatee  and  executor.  This  he  had 
accordingly  done.  The  will  was  pronounced  to  be  invalid.  But  a  will 
may  be  manifestly  unjust  to  the  surviving  relatives  of  a  testator,  and  it 
may  display  some  of  the  extraordinary  opinions  of  the  individual;  yet  it 
will  not  necessarily  be  void,  unless  the  testamentary  dispositions  clearly 
indicate  that  they  have  been  made  under  the  influence  of  a  decision,  and, 
as  has  been  already  remarked,  what  relatives  assert  to  be  delusions  are 
often  actual  facts.  Some  injustice  may  possibly  be  done  by  the  rigorous 
adoption  of  this  principle,  since  delusion  may  certainly  enter  into  a  man's 
act,  whether  civil  or  criminal,  and  it  may  not  be  always  in  our  power  to 
discover  it ;  but,  after  all,  this  is  perhaps  the  most  equitable  mode  of  con- 
struing the  last  wishes  of  the  dead.  The  proof  of  the  existence  of  delu- 
sion may  be  very  close  upon  the  date  of  the  will,  as  in  Sewell  v.  Wells 
(Prob.  Ct.,  June,  1877),  and  yet  the  will  may  be  held  to  be  valid.  The 
testator  made  his  will  on  March  10,  1875.  It  was  admitted  on  both  sides 
that  he  was  insane  in  May,  1875,  and  there  was  evidence  that  he  was 
laboring  under  delusions  regarding  himself  and  his  property  on  March  15, 
i.e.  five  days  after  the  date  of  the  will.  The  jury  found  that  there  was 
no  delusion  when  he  made  the  will.  Delusions  may  exist  without  beino- 
in  all  cases  manifest  or  discoverable.  Fersons  who  have  committed  suicide, 
or  who  have  destroyed  their  own  property,  or  done  any  other  act  from 
which  unsoundness  of  mind  might  be  inferred,  might  be  enabled  to  con- 
ceal the  delusions  under  which  they  labored  down  to  the  last  moment  of 
their  lives. 

According  to  Nichol,  it  is  not  necessary  in  civil  suits  to  connect  the 
morbid  imagination  with  the  act  itself;  if  the  mind  is  proved  to  be  un- 
sound the  act  is  void.  In  Roberts  v.  Kerslake  (Warwick  Aut.  Ass., 
1854),  Lord  Wensleydale  held  that  to  vitiate  a  will  if  it  be  a  case  of 
delirium  the  act  must  be  traced  to  delirious  delusion,  but  if  be  a  case  of 
lunacy  it  need  not  be  traced  to  a  delusion.  In  Sharpe  v.  Macauley  (Win- 
chester Aut.  Ass.,  1856),  Martin,  B.,  advised  the  jury  in  coming  to  a 


714  ECCENTRICITY    IN    WILLS. 

conclusion  on  tbe  question  whether  the  testator  had  a  "  sound  and  dis- 
posing mind"  to  loolv,  not  to  the  opinions  of  others,  but  to  the  man's  own 
acts  as  well  as  his  correspondence.  A  disposing  mind  implied  that  a  man 
understood  the  nature  of  his  property,  the  use  and  benefits  arising  from 
it,  and  had  sense  and  discretion  to  select  persons  to  enjoy  it  after  his  death. 
A  man  may  have  labored  under  delusions  and  have  been  confined  as  a 
lunatic,  yet  at  the  date  of  his  will  he  may  have  been  sane  and  have  had 
a  disposing  power.  The  main  question,  therefore,  is:  Was  the  testator 
of  sane  mind  when  the  will  was  executed?  This  may  be  deduced  from 
direct  evidence  of  his  condition  as  well  as  from  the  provisions  of  the  will 
itself. 

Eccentricity  in  Wills. — The  evidence  in  these  cases  sometimes  amounts 
to  proof  of  eccentricity  only  on  the  part  of  the  testator  or  in  the  deed 
itself;  but  a  clear  distinction  must  be  here  drawn.  The  will  of  an  eccen- 
tric man  is  such  as  might  always  have  been  expected  from  him  ;  the  will 
of  one  laboring  under  insanity  (delusion)  is  different  from  that  which  he 
would  have  made  in  an  unaffected  state — the  instrument  is  wholly  different 
from  what  it  would  once  have  been.  The  insane  are  eccentric  in  their 
ideas,  their  language,  or  their  conduct;  but  the  merely  eccentric  have  but 
a  voluntary  resemblance  to  the  insane  in  these  respects.  (Jamieson's 
Lect.,  Lon.  Med.  Gaz.,  vol.  xlvi.  p.  180.)  They  can  if  they  please  alter 
their  conduct  and  act  like  other  persons  neither  eccentric  nor  insane.  In 
a  case  in  the  Probate  Court,  Hannen,  J.,  observed  that  it  was  impossible 
to  define  exactly  the  distinction  between  eccentricity  and  insanit}^  or  to 
draAV  the  exact  line  between  sanity  and  insanity,  but  for  practical  pur- 
poses we  are  able  to  say  in  a  particular  instance  whether  a  man  is  sane 
or  insane.  The  acts  of  eccentricity  may  be  harmless,  and  the  evidence 
may  show  that  up  to  the  time  of  death  the  testator  may  have  been  treated 
as  a  person  of  sound  mind.  In  Burdett  v.  Thompson  (Prob.  Ct.,  Jul}^, 
1873),  the  will  of  a  testatrix  was  disputed  because  in  a  codicil  she  had 
ordered  the  doors  and  windows  of  her  house  to  be  bricked  up  and  the 
house  locked  up  with  the  furniture  and  contents  for  a  period  of  twenty 
years.  Further,  that  her  pony,  pigeons,  dogs,  and  poultry  were  to  be 
shot  after  her  death.  It  was  proved  that  she  was  a  shrewd  and  intelligent 
woman,  and  managed  her  own  affairs  down  to  the  time  of  her  death.  On 
the  other  hand,  it  was  contended  that  these  acts  were  an  indication  of 
mental  disease.  Hannen,  J.,  said  it  was  impossible  to  lay  down  any 
abstract  proposition  as  to  what  constituted  unsoundness  of  mind.  No 
person's  mind  could  be  said  to  be  perfectly  sound,  just  aS'  no  person's 
body  could  be  said  to  be  perfectly  sound  ;  but  the  question  in  these  cases 
was  whether  there  was  such  a  degree  of  unsoundness  as  to  interfere  with 
those  faculties  which  required  to  be  brought  into  action  in  making  a  will. 
The  jury  were  not  able  to  agree  upon  this  question  and  were  discharged. 

Wills  are  sometimes  contested  more  on  the  ground  of  eccentricity  than 
of  insane  delusion;  but  if  eccentricity  only  be  ])roved  a  court  will  not 
interfere.  In  the  case  of  Morgan  v.  Boys  ( 1838),  it  was  proved  that  the 
testator  by  his  will  had  left  a  large  fortune  to  his  housekeeper.  The  will 
was  disputed  on  the  ground  that  it  bore  intrinsic  evidence  of  the  deceased 
not  having  been  in  a  sane  state  of  mind  at  the  time  of  making  it.  After 
having  bequeathed  his  property  to  a  stranger,  the  testator  directed  that 
his  executors  should  "  cause  some  parts  of  his  bowels  to  be  converted  into 
fiddle-strings,  that  others  should  be  sublimed  into  smelling-salts,  and  that 
the  remainder  of  his  body  should  be  vitrified  into  lenses  for  optical  pur- 
poses." He  further  added  in  a  letter  attached  to  his  will:  "The  world 
may  think  this  to  be  done  in  a  spirit  of  singularity  or  whim,  but  I  have 


WILLS    IN    EXTREMIS.  715 

a  mortal  aversion  to  funeral  pomp,  and  I  wish  my  body  to  be  converted 
into  purposes  useful  to  mankind."  It  was  shown  that  the  deceased  had 
conducted  his  affairs  with  great  shrewdness  and  ability  ;  that  he  not  only 
did  not  labor  under  iml)ecility,  but  that  he  had  been  always  treated  durino- 
life  as  a  person  of  indisputable  capacity  Ijy  those  with  whom  he  had  to 
deal.  Jenuer  in  giving- judgment  held  that  insanity  was  not  proved;  the 
facts  merely  amounted  to  eccentricity,  and  on  this  ground  be  pronounced 
for  the  validity  of  the  will.  The  best  rule  to  guide  the  court  was  the 
conduct  of  persons  towards  the  deceased;  and  the  acts  of  his  relatives 
evinced  no  distrust  of  his  sanity  or  capacity  while  he  was  living.  The 
deceased  had  always  been  noted  for  his  eccentric  habits,  and  he  bad 
actually  consulted  a  physician  upon  the  possibility  of  his  body  being 
devoted  to  chemical  experiments  after  death.  In  the  case  of  Mudway  v. 
Croft  (Prerog.  Ct.,  Aug.  1843),  a  Avill  contested  on  the  ground  of  in- 
sanity but  defended  on  the  plea  of  eccentricity,  Fust  said:  "It  is  the 
prolonged  departure,  without  an  adequate  external  cause,  from  the  state 
of  feeling  and  modes  of  thinking  usual  to  the  individual  when  in  health, 
this  is  the  true  feature  of  disorder  of  the  mind." 

Wills  in  Senile  Dementia. — Wills  made  in  incipient  dementia  arising 
from  extreme  age  (senile  imbecility)  are  often  disputed,  either  on  the 
ground  of  mental  deficiency,  or  of  the  testator,  owing  to  weakness  of  mind, 
having  been  subjected  to  control  and  influence  on  the  part  of  interested 
persons.  If  a  medical  man  be  present  when  a  will  is  executed,  he  may 
satisfy  himself  of  the  state  of  mind  of  a  testator,  by  requiring  him  to  re- 
peat from  memory  the  mode  in  which  he  has  disposed  of  the  bulk  of  his 
property.  A  medical  man  has  sometimes  placed  himself  in  a  serious 
position  by  becoming  a  witness  to  a  will  without  first  assuring  himself  of 
the  actual  mental  condition  of  the  person  making  it  (case  of  the  Duchess 
of  Manchester,  1854).  It  would  alwavs  be  a  good  ground  of  justification 
if.  at  the  request  of  the  witness,  the  testator  is  made  to  repeat  substantially 
the  leading  provisions  of  his  will  from  memory.  If  a  dying  or  sick  per- 
son cannot  do  this  without  prompting  or  suggestion,  there  is  reason  to 
believe  that  he  has  not  a  sane  and  disposing  mind.  It  has  been  observed 
on  some  occasions,  when  the  mind  has  been  weakened  by  disease  or  in- 
firmity from  age,  that  it  has  suddenly  cleared  up  before"  death,  and  the 
person  has  unexpectedly  shown  a  disposing  capacity.  (Ann.  d'Hyg., 
1831,  p.  360.)  In  Durnell  v.  Corfield  (Prerog.  Ct.,  July,  1844),  a  case  in 
which  an  old  man  of  weakened  capacity  had  made  a  will  in  favor  of  his 
medical  attendant,  Lushington  held  that,  to  render  it  valid,  there  must  be 
the  clearest  proof,  not  only  of  the  factum  of  the  instrument,  but  of  the 
testator's  knowledge  of  its  contents.  (Law  Times,  July  27,  1844.)  In 
West  V.  Sylvester  (Xov.  1804),  Wilde,  J.,  in  pronouncing  judgment 
against  a  will  propounded  as  that  of  the  deceased,  an  aged  lady,  said,  "At 
the  time  she  executed  the  will,  although  for  many  purposes  she  might  be 
said  to  be  in  her  right  senses,  she  was  nevertheless  suffering  from  that 
failure  and  decrepitude  of  memory  which  prevented  her  from  having  pre- 
sent to  her  mind  the  proper  objects  of  her  bounty,  and  selecting  "those 
whom  she  wished  to  partake  of  it." 

TI7//s  in  Extremis. — Wills  made  by  persons  whose  capacity  during  life 
has  been  never  doubted,  while  lying  at  the  point  of  death  or,  as  it  is 
termed,  in  extremis,  are  justly  regarded  with  suspicion,  and  may  be  set 
aside  according  to  the  medical  circumstances  proved.  Many  diseases, 
especially  those  which  affect  the  brain  or  nervous  system,  directly  or  in- 
directly, are  likely  to  produce  a  dulness  or  confusion  of  intellect,  under 
which   a  proper  disposing  power  is  lost.     Delirium  sometimes  precedes 


716  HABITUAL    INTEMPERANCE. 

death,  in  which  case  a  will  executed  by  a  d3nng  person  thus  afifected  would 
be  pronounced  invalid. 

In  examining  the  capacity  of  a  person  under  these  circumstances,  we 
should  avoid  putting'  leading  questions — namely,  those  which  suggest  the 
answers  "  yes"  or  "no,"  Thus,  a  dying  man  may  hear  a  document  read 
over,  and  affirm,  in  answer  to  such  a  question,  that  it  is  in  accordance 
with  his  wishes,  but  without  understanding  its  purport.  This  is  not  sat- 
isl'actor}"  evidence  of  his  having  a  disposing  mind  ;  we  should  see  that  he 
is  able  to  dictate  the  provisions  of  the  document,  and  to  repeat  them  sub- 
stantially from  memory  when  required.  If  he  can  do  this  accurately, 
there  can  be  no  doubt  of  his  possessing  complete  testamentary  capacity. 
But  it  may  be  objected  that  many  dying  men  cannot  be  supposed  capable 
of  such  an  exertion  of  memory  ;  the  answer  is  then  ver}^  simple  ;  it  is 
better  that  the  person  should  die  without  a  will,  and  his  property  be  dis- 
tributed according  to  the  law  of  intestacy,  than  that,  through  any  failing 
of  his  mind,  he  should  unknowingly  cut  off  the  rights  of  those  who  have 
the  strongest  claims  upon  him. 

Habitual  Intemperance. — A  man  may  be  of  drunken  habits,  and  yet 
not  incapacitated  for  making  a  will.  In  Smith  v.  Austen  (Prob.  Ct., 
Nov.  1875),  Hannen,  J.,  pronounced  in  favor  of  the  will  of  a  man  who 
was  proved  to  have  been  of  exceedingly  drunken  habits.  The  question 
was  whether  his  mental  faculties  had  been  thereby  enfeebled  so  as  to 
render  him  incapable  of  exercising  his  judgment.  There  was  no  proof  of 
this,  and  during  life  he  had  not  been  treated  by  anybody  as  incapable  of 
managing  his  affairs. 

Effect  of  Narcotics. — The  habitual  use  of  opium  or  other  narcotics  may 
give  rise  to  a  question  respecting  testamentary  capacity.  We  were  con- 
sulted in  a  case  of  this  kind,  in  which  the  testator  had  been  in  the  habit  of 
taking  morphine,  until,  according  to  our  informant,  the  dose  had  reached 
fifteen  grains  a  day.  He  made  a  will  fairly  disposing  of  his  property 
among  his  children.  Nine  days  afterwards  he  made  another  will,  entirely 
revoking  the  previous  one,  leaving  his  property  to  a  younger  son,  who 
was  alleged  to  have  exerted  an  undue  influence.  The  will  was  declared 
valid. 

The  long  use  of  narcotics,  in  large  doses,  may  weaken  the  powers  of 
the  mind,  and  render  a  man  more  easily  amenable  to  improper  influence  ; 
but  the  question  will  be  in  this  case,  as  with  drunkards,  whether  the  habit 
has  permanently  enfeebled  the  mind  so  as  to  prevent  a  man  from  exer- 
cising a  reasonable  disposition  of  his  property.  The  proof  of  this  will 
rests  with  those  who  would  benefit  by  the  allegation. 

Restriction  of  Medical  Opinions. — In  an  important  case  (Bainbrigge 
V.  Bainbrigge,  Oxford  Sum.  Ass.,  1850),  tried  before  Lord  Campbell,  in 
which  the  testamentary  capacity  of  a  man  was  disputed,  it  was  held  that 
a  medical  witness,  although  conversant  with  cases  of  insanity,  cannot  be 
asked  his  opinion  as  to  the  insanity  of  a  testator  founded  upon  evidence 
given  at  the  trial  in  his  hearing.  (4  Cox,  Crim.  Cases,  454  ;  see  also  on 
tliis  subject,  Lond.  Med.  Gaz.,  vol.  xlvi.  p.  240.)  In  the  case  of  the 
Duchess  of  Manchester,  however,  the  opinions  of  Sutherland,  Mayo,  and 
Conolly  on  the  competency  of  the  testatrix  to  make  a  will  were  received 
l)v  the  court,  although  based  only  upon  the  evidence  given  at  the  trial. 
The  above  decision  may,  indeed,  now  be  considered  as  entirely  set  aside. 


THE  PLEA  OR  DEFENCE  OF  INSANITY.  717 


CHAPTER    LXYI. 

THE    PLEA    OR    DEFENCE  OF    INSANITY. CIRCUMSTANCES    UNDER   WHICH    IT    IS    ADMISSIBLE. 

HOMICIDAL  INSANITY. MORAL  INSANITY.  —  SYMPTOMS. LEGAL  TESTS. MEDICAL  TESTS. 

DELUSION. TESTS  OF  IRRESPONSIBILITY. MEDICAL  EVIDENCE. 

The  Plea  or  Defence  of  Insanity. — Responsibility  here  signifies  noth- 
ing more  than  liability  to  punishment  for  crime,  and  a  criminal  act  implies 
tlie  existence  of  intention,  will,  and  malice.  (Stephen.)  When  insanity 
has  reached  a  certain  stage  or  degree,  an  act  may  be  perpetrated  without 
malice ;  and  in  this  sen.<e  the  person  is  considered  to  be  irresponsible  in 
law.  This  is  a  question  of  fact,  to  be  determined  by  a  jury  from  the 
whole  evidence  set  before  them  ;  and  the  proof  rests  with  those  who  make 
the  allegation  that  the  act  in  question,  whether  murder  or  arson,  was  not 
done  wilfully  and  maliciously.  "The  sanity  of  a  man's  conduct,"  ob- 
serves Stephen,  J.,  "involve^i  the  presence  of  intention  and  will  on  all 
ordinary  occasions ;  and  if  the  act  is  one  of  those  which  the  law  forbids,  it 
is  presumed  to  be  malicious  and  wicked."  (Crim.  Law  of  England,  p. 
89.)  This  subject  is  of  considerable  importance  in  a  medico-legal  view; 
for  should  a  plea  of  insanity  be  improperly  admitted  in  any  criminal  ease, 
then  punishment  is  made  to  fall  unequally  on  offenders  ;  and  if,  on  the 
other  hand,  it  be  improperly  rejected,  punishment  is  administered  with 
undue  severity,  and  loses  its  deterrent  influence.  The  rule  of  law  is  that 
no  man  is  responsil)le  like  a  sane  person  for  any  act  committed  by  him 
while  in  a  state  of  insanity  ;  but  the  existence  of  mental  disease  does  not 
necessarily  exempt  a  person  from  criminal  responsibility.  (Reg.  v.  Bur- 
ton, Maidstone  Lent  Ass.,  1862.)  Many  a  man  whose  mind  is  unsound 
knows  perfectly  well  that  he  is  doing  wrong;  and  so  long  as  he  knows 
that,  he  is  subject  to  the  criminal  law.  The  plea  of  insanity  may  be 
raised  for  the  smallest  offence  up  to  the  highest  crime — murder  ;  but  it  is 
rarely  made  a  defence  in  smaller  offences,  because  the  confinement  to 
which  an  accused  person,  if  found  insane,  would  necessarily  be  subjected, 
would  often  be  a  heavier  punishment  than  that  which  the  law  actually 
prescribes  for  the  offence  which  he  may  have  committed.  In  a  case  of 
felonious  assault,  it  was  urged  by  counsel  in  defence  that  the  prisoner  was 
insane  ;  but  the  evidence  on  this  point  was  not  b}^  any  means  conclusive — 
when  it  was  intimated  by  the  court  that,  if  this  plea  were  admitted,  the 
party  would  probably  undergo  a  much  longer  imprisonment  than  if  on 
conviction  he  received  the  legal  punishment  for  the  offence.  (Reg.  v. 
Reynolds,  Bodmin  Aut.  Ass.,  1843.)  The  judge  is  reported  to  have  said 
that  there  was  no  proof  of  insanity.  If  the  prisoner  was  pronounced  in- 
sane, he  might  be  imprisoned  for  life,  and  therefore  he  did  not  think  that 
that  finding  would  benefit  him.  A  verdict  of  guiltj^  was  returned,  and  the 
man  was  sentenced  to  eighteen  months'  imprisonment.  This  case  shows 
that  a  defence  of  this  kind  may  be  sometimes  indiscreetly  put  forward. 
Such  a  mode  of  dealing  with  the  plea  of  insanity,  i.  e.  of  making  it  a  ques- 
tion of  expediency  dependent  on  the  amount  of  punishment  for  the  offence, 
must  be  pronounced  indefensible. 

The  discharge  of  persons  who  have  perpetrated  a  criminal  act  or  hei- 
nous crime,  but  have  been  acquitted  on  the  ground  of  insanity  and  con- 


718  DEGREES    OF    CEIMIXAL    RESPONSIBILITY. 

fined  during  her  Majesty's  pleasure,  is  a  very  serious  matter,  and  one  in 
v.hich  the  safety  of  the  public  is  deeply  concerned.  Some  medical  men 
appear  to  think  that  the  interest  of  the  prisoner  alone  is  to  be  considered  ; 
but  this  would  lead  to  the  discharge  of  many  dangerous  lunatics.  (Dod- 
■u-ell's  case,  ante,  p.  703.) 

Murder,  incendiarism,  and  theft  are  the  crimes  for  which  the  plea  of 
insanity  is  commonly  raised  ;  and  it  has  been  generally  confined  in  this 
country  to  those  cases  in  which  persons  have  been  charged  with  murder 
or  attempts  at  murder.  Murder  may  be  perpetrated  by  one  who  is  obvi- 
ously laboring  under  delirium  or  violent  mania,  or  by  an  idiot  or  imbecile. 
Apart  from  the  circumstances  connected  with  the  criminal  act,  there  may 
be  clear  evidence  of  such  a  disordered  state  of  mind  in  the  person,  as  at 
once  to  exonerate  him  from  that  amount  of  responsibility  which  is  exacted 
from  one  who  is  sane.  The  appearance  of  the  accused,  or  the  testimony 
of  a  medical  man,  renders  it  unnecessary  to  go  into  the  evidence,  and  a 
verdict  is  returned  accordingly.  The  cases  of  difficulty  are  those  in  which 
insanity  presents  it.self  in  a  doubtful  aspect,  as  in  mania  complicated  with 
epilepsy,  or  in  some  forms  of  imbecility.  The  mental  disorder  may  be  of 
so  slight  a  nature  as  not  to  justify  an  acquittal  for  murder.  In  order  to 
exculpate  a  person,  it  must  be  proved  that  insanity  in  a  certain  degree  ex- 
isted at  the  time  of  the  perpetration  of  the  act.  Whether  the  prisoner  is 
or  is  not  insane  when  placed  on  his  trial,  has  been  sometimes  held  to  be 
immaterial  in  reference  to  the  question  of  responsibility.  In  the  case  of 
Murray  (High  Ct.  of  Just.,  Edin.,  Kov.  1858),  it  was  proved  that  the 
accused  recovered  his  sanity  eight  hours  after  he  had  killed  the  deceased  ; 
but  he  was  acquitted  on  the  ground  of  insanit}"  at  the  time  of  committing 
the  act.  [The  Act  of  Parliament  of  August,  1883,  provides  and  the  En- 
glish Judges  charjre,  that  if  the  accused  was  insane  at  the  time  the  act  was 
committed,  that  the  jury  should  so  find  :  vid.  Judge  Day's  charge  in  case 
of  Gouedstan,  Med.  Leg.  Jour.,  vol.  2,  p.  343.] 

The  proved  existence  of  mental  disease  does  not  necessarily  exempt  a 
person  from  criminal  responsibility.  Even  the  existence  of  a  morbid  de- 
lusion cannot  always  be  allowed  to  screen  a  criminal  from  the  conse- 
quences of  his  own  acts ;  while,  on  the  other  hand,  there  are  instances  in 
which  a  plea  of  insanity  may  be  properly  allowed,  although  no  delusion 
can  be  proved.  Each  case  must  be  taken  with  all  its  surrounding  circum- 
stances. 

The  great  difference  of  opinion  which  exists  between  physicians  and 
jurists  in  reference  to  this  plea  appears  to  consist  in  this:  most  jurists 
contend  that  no  degree  of  insanitv  should  exempt  from  punishment  for 
crime,  unless  it  has  reached  that  point  that  the  person  is  utterly  uncon- 
scious of  the  difference  hetxoeen  right  and  wrong  at  the  time  of  commit- 
ting the  alleged  crime.  Physicians,  on  the  other  hand,  affirm  that  this  is 
not  a  proper  test  of  the  existence  of  that  degree  of  insanity  which  should 
exempt  a  man  from  punishment  for  his  acts;  that  those  who  are  laboring 
under  confirmed  insanity,  and  who  have  been  properly  confined  in  asylums 
for  years,  are  fully  conscious  of  the  difference  between  right  and  wrong, 
and  are  quite  able  to  appreciate  the  illegality  as  well  as  the  consequences 
of  their  acts.  Again,  those  who  have  patiently  watched  the  insane  for 
3'ears  agree  that  the  legal  test  of  utter  unconsciousness  of  right  and  wrong 
in  the  performance  of  acts  would  in  reality  apply  only  to  persons  who 
were  suffering  from  delirium,  from  furious  paroxysms  of  mania,  or  from 
confirmed  idiocy;  and  that  if  the  rule  suggested — that  a  person,  in  order 
to  be  acquitted  on  the  ground  of  insanity,  should  be  first  proved  to  be  as 
unconscious  of  his  act  as  a  baby  (Warren) — were  strictly  carried  out, 


INSANITY    IN    A    MEDICAL    AND    LEGAL    SENSE.  719 

there  is  scarcely  a  lunatic  inmate  of  an  as^ium  who  destroyed  a  keeper  or 
attendant,  who  might  not  be  executed  for  murder.  Such  a  rule  amounts 
to  a  redactio  ab  absardum ;  it  would  abolish  all  distinction  between  the 
sane  and  the  insane,  between  the  responsible  and  the  irresponsible  ;  and 
it  would  consign  to  the  same  punishment  the  confirmed  lunatic  and  the 
sane  criminal.  This  s\>ec\es  of  bodij-uncoiisciousneas  of  action  exists  in 
idiots  as  well  as  in  furious  maniacs,  but  not  in  the  majority  of  lunatics  ; 
and  it  may  be  safely  asserted  that,  if  this  criterion  be  the  true  one, 
acquittals  on  the  ground  of  insanity  have  involved  a  series  of  gross  mis- 
takes for  the  last  sixty  years.  It  may  be  said  that  the  consciousness  of 
the  insane  is  an  insane  consciousness,  while  the  law  implies  the  conscious- 
ness of  a  sound  mind  ;  but  this  involves  a  peizh'o  principii.  There  have 
been  numerous  cases  of  acquittal  in  which,  until  the  act  of  homicide  bad 
been  committed,  there  was  no  imputation  either  against  the  sanity  or  the 
sane  consciousness  of  the  accused.  Having  pointed  out  these  inconsisten- 
cies, we  must  acknowledge  that  in  theory  the  English  law  would  punish 
a  lunatic  just  as  it  would  punish  a  sane  man,  provided  the  lunatic  "  had 
that  degree  of  intellect  which  enabled  him  to  know  and  distinguish  be- 
tween right  and  wrong,  or  between  what  was  lawful  and  unlawful ;  if  he 
knew  what  would  be  the  effect  of  his  crime,  and  consciously  committed  it; 
and  further,  if  with  that  consciousness  he  wilfully  and  intentionally  com- 
mitted it."  In  practice,  however,  it  is  placed  beyond  doubt  that  some 
who  ought  to  be  convicted  under  these  rules  are  acquitted  on  the  legal 
assumption  that  they  were  at  the  time  unconscious  (or  only  insanely  con- 
scious) of  the  wrongfulness  of  their  acts.  Wood  states,  that  of  thirty-three 
men  confined  as  lunatics  in  Bethlehem  who  had  committed  murder,  and 
who  had  been  tried  and  acquitted  on  the  ground  of  insanity,  three  were 
reported  sane ;  and  he  was  quite  satisfied  that  two  of  these  were  not 
insane  at  the  time  they  committed  the  murders.  Of  fifteen  men  who  had 
attempted  to  commit  murder,  five  were  reported  sane,  and  two  of  them,  in 
his  judgment,  ought  not  to  have  been  acquitted  on  the  ground  of  insanity. 
(Plea  of  Insanity,  p.  50.)  According  to  Hood,  in  the  six  years  from 
1852  to  1858,  120  persons  who  were  tried  for  murder,  for  attempts  at 
murder,  or  acts  of  personal  violence,  were  acquitted  on  the  ground  of  in- 
sanity. Of  that  number  79  were  received  into  Bethlehem  Hospital,  and 
in  several  instances  they  exhibited  no  S3aiiptoms  of  insanity  while  they 
were  resident  in  the  asylum.  These  facts  then,  are  sufficient  to  show  that 
the  rule  of  law  generally  adopted  does  not  err  on  the  side  of  severity.  It 
operates,  however,  with  great  uncertainty.  Some  judges  have  admitted 
that  there  might  be  a  consciousness  that  the  act  was  wrong  and  illegal, 
and  yet  the  person  would  be  exempted  from  criminal  responsibility,  pro- 
vided it  was  proved  by  other  circumstances  that  he  labored  at  the  time 
under  a  disease  of  the  mind  sufficient  to  prevent  him  from  exercising  a 
proper  control  over  his  actions. 

When  the  defence  of  insanity  is  set  up  on  a  charge  of  murder — in  order 
to  warrant  the  jury  in  acquitting  a  prisoner,  it  must  be  proved  affirma- 
tively that  he  was  insane  in  a  certain  legal  sense  at  the  time  of  perpe- 
trating the  act;  if  this  be  left  in  doubt,  and  if  the  crime  charged  in  the 
indictment  be  proved,  it  is  their  duty  to  convict  him.  (Reg.  v.  Stokes,  3 
Car.  and  K.,  p.  185.)  It  is  necessary  to  impress  upon  the  mind  of  the 
medical  witness  that  it  is  not  medical  but  legal  insanity  which  is  required  to 
be  proved  on  these  occasions.  As  hardly  two  medical  men  agree  about  what 
is  madness  in  a  medical  sense,  and  as  some  doctors  have  even  held  that 
all  great  criminals  are  necessarily  insane,  it  is  obvious  that  the  power  to 
absolve  from  responsibility  could  not  at  present  be  placed  in  the  hands  of 


720  HOMICIDAL    MANIA    AND    MORAL    INSANITY. 

the  profession  with  a  due  reirard  to  the  protection  of  society  or  a  safe  ad- 
ministration of  the  law.  The  facts  stated  by  Hood  and  Wood,  in  refer- 
ence to  the  admission  of  alleg-ed  criminal  lunatics  into  Bethlehem  show 
that,  either  by  legal  or  medical  ingenuity,  or  both  combined,  sane  criminals 
have  been  incarcerated  as  irresponsible  lunatics. 

Hoyrdcidal  Insanity. — Homicidal  mania  is  commonly  defined  to  be  a 
state  of  partial  insanity,  accompanied  by  an  impulse  to  the  perpetration 
of  murder;  hence  it  is  sometimes  called  impulsive  or  paroxysmal  mania. 
There  may  or  may  not  be  evidence  of  intellectual  aberration,  but  the  main 
feature  of  the  disorder  is  the  existence  of  a  destructive  impulse  which, 
like  an  insane  delusion,  cannot  be  controlled  by  the  patient.  This  impulse, 
thus  dominating  over  all  other  feelings,  leads  a  person  to  destroy  those  to 
whom  he  is  most  fondly  attached,  or  any  one  who  may  be  involved  in 
his  delusion.  Sometimes  the  impulse  is  long  felt,  but  concealed  and  re- 
strained:  there  may  be  merely  signs  of  depression  and  melancholy,  sleep- 
lessness, low  spirits,  and  loss  of  appetite,  as  well  as  eccentric  or  wayward 
and  restless  habits,  but  nothing  to  lead  to  a  suspicion  of  the  fearful 
contention  which  may  be  going  on  within  the  mind.  As  in  suicidal 
mania,  many  of  those  who  are  in  habits  of  daily  intercourse  with  the 
patients  have  been  first  astounded  by  the  act  of  murder,  and  then  only  for 
the  first  time  led  to  conjecture  that  peculiarities  of  language  or  conduct, 
scarcely  noticed  at  the  time,  must  have  been  symptoms  of  insanity.  Oc- 
casionally the  act  of  murder  is  perpetrated  with  great  deliberation  and 
apparently  with  all  the  marks  of  sanity. 

In  Reg.  V.  Vyse  (C.  C.  C,  July,  1862),  the  prisoner,  a  respectable 
woman,  was  charged  with  the  murder  of  her  two  children  by  poisoning 
them  with  strychnine.  The  act  was  done  with  great  deliberation  and 
forethought ;  the  poison  was  purchased  under  false  pretences,  and  there 
was  an  entire  absence  of  motive.  She  was  acquitted  on  the  ground  of 
inisanity.  This  was  considered  to  be  a  ca.se  of  impulsive  mania,  as  there 
was  nothing  to  indicate  intellectual  insanity.  There  was  an  hereditary 
tendency  to  insanity,  coupled  with  the  effects  of  prolonged  nursing  and 
general  constitutional  debility;  but  Hood's  minute  inquiries  brought  out 
facts  which  showed  that  the  prisoner  had  labored  under  disease  which 
might  have  affected  her  mind,  and  have  deprived  her  of  the  proper  con- 
trol of  her  actions.  He  states  that  on  his  first  visit  to  her  in  Newgate,  he 
learned  that  during  the  later  months  of  suckling  she  had  been  mentally 
overworked  and  subjected  to  great  anxiety  and  fatigue.  When  worried 
by  her  business  transactions,  she  suffered  from  a  painful  sensation  seated 
in  the  interior  of  the  cranium  on  the  surface  of  the  brain,  and  which  she 
spoke  of  as  "  perspiring  of  the  brain" — a  symptom  often  complained  of 
by  patients  who  suffer  from  mental  disease,  as  giving  a  creeping,  irri- 
tating feeling,  but  never  more  graphically  described  than  by  Mrs.  Yyse. 
It  is  indicative  of  morbid  action  of  the  brain,  which  is  manifested  by  ex- 
amination after  death.  He  considered  Mrs.  Tyse  to  be  suffering  from 
cerebral  disease,  which  rendered  her  at  the  time  of  the  murders  an  irre- 
sponsible agent. 

The  impulse  to  violence  may  be  dormant  for  weeks  or  months  and  then 
show  itself  by  suicidal  or  ijoniicidal  acts;  but  such  is  the  result,  and  not 
the  proof,  of  mental  disease  The  case  of  Christiana  Edmunds  (Reg.  v. 
Edmunds,  C.  C.  C,  Jan'.  1872)  is  in  this  respect  of  some  interest.  The 
woman,  get.  43.  moving  in  a  respectable  sphere  of  society,  was  charged 
with  the  murder  of  a  boy  at  Brighton,  on  June  12,  1871.  The  deceased 
ate  some  sweets  purchased  in  a  confectioner's  sliop,  died  in  a  short  time 
with  the  symptoms  of  poisoning  with  strychnine  and  strj'chnine  was 


HOMICIDAL    MANIA    AND    MORAL    INSANITY.  72l 

found  in  his  stomach.  The  prisoner  had  procured  sweets  from  this  shop 
by  the  agency  of  little  boys,  had  deliberately  poisoned  the  articles  with 
strychnine  and  returned  them  to  the  shop.  She  had  herself  on  various 
occasions  left  poisoned  sweets  about  in  shops.  How  many  persons  had 
sulfered  from  this  cold-blooded  and  reckless  act  is  not  known  ;  but  she  had 
previously  attempted  to  poison  the  wife  of  a  medical  man,  and  she  imputed 
the  poisoning's  to  the  carelessness  of  the  confectioner.  He  was  able  to 
show  that  his  sweets  as  purchased  were  wholesome,  and,  by  a  chain  of 
circumstances,  the  crime  of  poisoning  them  was  clearly  fixed  upon  the 
prisoner.  She  had  shown  much  cunning  in  her  proceedings.  She  had 
procured  strychnine  on  four  different  occasions  under  false  pretences,  had 
borrowed  the  poison-book  of  the  druggist  and  torn  out  the  leaves  to  con- 
ceal the  fact  that  she  had  purchased  the  poison.  The  defence  was  insanity, 
but  there  was  no  proof  of  intellectual  insanity  about  her.  She  had  shown 
all  the  skill  of  an  accomplished  criminal  in  carrying  out  her  plan  of  general 
poisoning  and  in  using  the  most  artful  means  to  conceal  it  and  to  thrown 
the  imputation  upon  the  confectioner.  Impulse  could  hardly  be  pleaded, 
for  her  criminal  acts  were  extended  over  weeks  and  months.  She  was 
convicted.  She  then,  with  a  view  of  averting  or  delaying  punishment, 
put  in  a  false  plea  of  pregnancy  in  bar  of  execution.  The  capital  sentence 
was  subsequently  remitted  and  the  prisoner  sent  to  Broadmoor  Asylum, 
on  the  statement  that  she  was  of  unsound  mind.  It  appears  that  her 
father  had  died  in  a  lunatic  asylum  when  of  middle  age,  having  suffered 
for  years  before  his  death  from  homicidal  and  suicidal  mania  ;  her  brother 
died  at  Earlswood  Asylum,  an  epileptic  idiot;  her  grandfather  was  a  sub- 
ject of  cerebral  disease  ;  her  sister  suffered  from  hysteria ;  other  relations 
were  afflicted  with  nervous  diseases  of  some  kind  ;  and  she  herself  appears 
to  have  exhibited,  some  eighteen  years  before,  symptoms  of  hysteria  and 
hysterical  paralysis.  (Lancet,  1872,  i.  pp.  89,  107,  734  ;  and  Med.  Times 
and  Gaz.,  1872,  i.  pp.  71,  101,  111.)  This  i)roved  hereditary  tendency  to 
insanity  in  her  family  and  was  the  main  cause  of  the  commutation  of  the 
capital  sentence.  If  we  except  the  nature  of  the  crime,  showing  as  it  did 
an  utter  recklessness  for  human  life,  there  was  nothing  to  indicate  un- 
soundness of  mind,  either  in  a  medical  or  a  legal  sense,  in  this  woman. 
The  only  evidence  of  insanity  would  be  the  atrocity  of  the  act  itself;  but 
on  this  ground  Mary  Ann  Cotton,  executed  at  Durham  for  murder  by 
poison,  might  have  equally  been  pronounced  insane.  There  was  evidence 
that  this  woman  had  destroyed  with  arsenic,  in  the  most  reckless  manner, 
children,  husband,  relatives,  and  friends,  to  the  number  of  twenty  persons. 
She  sent  her  son,  for  whose  murder  she  was  tried,  to  procure  the  poison 
with  which  she  subsequently  killed  him ;  but  this  woman  was  con- 
demned and  executed.  She  could  not  plead  hereditary  taint  or  hysteria 
of  ancient  date. 

These  cases  are  rendered  difficult  by  the  fact  that  there  may  be  no  dis- 
tinct proof  of  the  existence,  past  or  present,  of  any  disorder  of  the  mind, 
so  that  the  chief  evidence  of  mental  disorder  is  the  act  itself;  of  the  exist- 
ence of  insanity,  in  the  common  or  legal  acceptation  of  the  term,  before 
and  after  the  perpetration  of  the  crime,  there  may  be  either  no  evidence 
whatever,  or  it  may  l)e  so  slight  as  not  to  amount  to  legal  proof  Such 
cases  are  regarded  and  descril)ed  by  some  medico-legal  writers  as  instances 
of  insanUi/  of  the  moral  feelings  only,  and  this  condition  has  been,  called 
"  Moral  inxanity,^'  mania  sine  deliino  (p.  (HG,  ante).  Its  existence,  as  a 
state  independent  of  a  simultaneous  disturbance  of  the  reason  or  iatelTect, 
is  denied  by  the  majority  of  lawyers,  as  well  as  by  some  medical  authori- 
ties. Whether  such  a  condition  exists  or  not  is  a  simple  question  of  fact, 
4G 


722  EXAMINATION    OF    MANIACS. 

to  be  established  if  possible  by  clear  and  conclusive  evidence.  Its  exist- 
ence in  the  case  of  a  person  charged  with  murder  appears  to  have  rested 
hitherto  too  much  on  a  mere  medical  dictum.  Intelligent  reasons  have 
rarely  been  assigned  by  those  witnesses  who  have  sought  to  satisfy  a  court 
of  law  that  this  has  as  distinct  an  existence  as  intellectual  insanity  ;  in 
general,  it  is  only  alleged,  and  not  proved  to  exist  in  a  given  case.  If  its 
existence  were  satisfactorily  established,  it  would,  as  Stephen,  J.,  observes, 
do  away  with  one  of  the  essential  ingredients  of  crime — malice,  and  thus 
justify  a  jury  in  acquitting  a  person  charged  with  murder.  The  accused 
on  these  occasions  is  assumed  to  have  been  an  involuntary  agent.  It 
might  be  a  good  defence  to  admit  that  a  man  loaded  a  pistol  and  pointed 
it  at  tbe  head  of  another,  but  that  it  was  fired  by  a  sudden  involuntary 
action  of  the  necessary  muscles  and  not  by  the  prisoner's  will.  The  only 
difficulty  is  to  get  a  jury  to  believe  it.  The  evidence  given  in  support  of 
the  assertion  that  a  man  is  morally,  insane,  generally  speaking,  is  at  least 
as  consistent  with  the  theory  that  he  is  a  great  fool  and  a  great  rogue,  as 
Avith  the  theory  that  he  is  the  subject  of  a  special  disease  the  existence 
of  which  is  doubtful.  (Crini.  Law,  p.  95.)  There  is  no  doubt  that  the 
unrestricted  admission  of  such  a  theor}^  would  go  far  to  do  away  with  all 
punishment  for  crime,  for  it  would  render  it  utterly  impossible  to  draw  a 
line  between  (moral)  insanity  and  moral  depravity.  What  is  crime  but 
the  perversion  of  moral  feelings  ?  Moral  insanity  in  a  person  of  sound 
mind  is  a  contradiction  in  terms. 

In  dealing  with  this  sulyect,  Orange,  late  superintendent  of  Broadmoor 
Criminal  Lunatic  Asylum,  thus  expresses  himself:  "Moral  depravity,  it 
has  been  said,  cares  not  for  law  ;  moral  insanity  cares,  but  cannot  obey  ; 
but  even  if  this  were  admitted  as  a  direct  distinction,  it  would  still  be 
necessar}^  to  prove  that  such  inability  to  obey  arises  from  defect  of  judg- 
ment or  of  will  or  of  self-control,  as  a  result  of  mental  disease."  (Relation 
of  Insanity  to  the  Criminal  Law  of  England,  1877,  p.  10.) 

Examination  of  .Maniacs. — Homicidal  mania  may  coexist  with  a  quiet 
exterior,  disarming  all  suspicion  Medical  men  when  required  to  examine 
patients  cannot  be  too  distrustful  in  dealing  with  them.  With  astounding 
cunning  they  will  prepare  and  conceal  Aveapons  of  destruction,  which  may 
be  used  jn  an  instant  and  without  warning.  The  case  of  Reg.  v.  McKane 
(Salisbur}'  Sum.  Ass.,  1873)  furnishes  a  proof  of  the  difficulty  of  guarding 
against  sudden  acts  of  violence.  The  prisoner  was  charged  with  the 
murder  of  Mr.  Lutwidge,  a  Commissioner  in  Lunacy.  The  prisoner  had 
been  confined  in  an  asylum  for  many  years.  He  was  anxious  to  be  re- 
moved .from  the  Fisherton  Asylum,  where  he  then  was,  and  go  to  Broad- 
moor. He  had  threatened  to  do  something  which  would  send  him  to 
some  other  place,  but  he  had  not  been  treated  as  a  dangerous  lunatic.  As 
the  Commissioner  was  going  round  the  asylum  with  others  for  the 
purpose  of  inspection,  the  prisoner  suddenly  made  a  rush  at  him,  and 
struck  him  violently  on  the  temple  with  a  large  nail  wrapped  in  a  cloth. 
It  penetrated  to  the  brain  of  deceased,  and  he  died  in  a  week  afterwards. 
Medical  evidence  was  given  to  show  that  the  prisoner  Avas  suffering  from 
chronic  mania  ;  that  he  was  subject  to  delusions,  and  that  he  was  not  re- 
sponsible for  his  actions  on  this  occasion.  The  border-line  between  sanity 
and  insanity  is  so  thin,  that  even  experienced  persons  who  have  been  all 
their  lives  associated  with  the  insane  may  be  deceived,  when  in  reality 
the  mind  is  unsound  and  the  patient  unsafe.  A  commissioner  in  lunacy 
deeply  impressed  with  the  conviction  that  a  patient  in  the  asylum  which 
he  was  visiting  was  perfectly  sane  and  fit  to  be  discharged,  in  defiance  of 
the  ph3'sician's  warning,  trusted  himself  alone  in  the  lunatic's  company, 


VARIOUS    FORMS    OF    HOMICIDAL    MANIA.  723 

for  the  purpose,  as  he  said,  of  a  private  conversation.  In  less  than  five 
minutes  afier  they  were  alone,  and,  as  the  lunatic  believed,  nnobserved, 
the  Commissioner  was  throttled  by  his  companion,  and,  but  for  the  timely 
intervention  of  the  physician,  who  had  been  a  secret  spectator  of  the  scene, 
he  would  have  been  strangled.  Some  years  since,  Vance,  an  eminent 
surgeon,  called  to  see  a  lunatic  patient.  When  he  had  reached  the  top  of 
the  stairs  the  patient  suddenly  rushed  at  him  and  threw  him  down  the 
flight,  killing  him  on  the  spot. 

Tardieu  lays  down  the  following  formula  for  the  examination  of  luna- 
tics:  1.  Mental  date :  Three  orders  of  facts  should  be  investigated.  (1) 
The  intellectual  troubles.  (2)  The  perversion  of  the  affective  faculties  and 
the  instincts.  (3)  Alteration  of  the  sensorial  functions.  2.  Somatic  state  : 
The  position,  attitude,  walk,  gestures,  dress,  malformation  of  the  head, 
physiognomy,  expression. 

Homicidal  mania,  in  its  more  common  form,  may  make  its  appearance 
at  all  ages,  even,  it  is  said,  in  children  :  it  is  occasionally  periodical,  and 
the  paroxysm  of  insanity  is  preceded  by  symptoms  of  general  excitement. 
The  patient  experiences  colicky  pains  and  a  sense  of  heat  in  the  abdomen 
or  chest ;  headache,  restlessness,  loss  of  appetite,  and  lowness  of  spirits ; 
the  face  is  flushed  or  pale,  the  pulse  hard  and  full,  and  the  whole  body  is 
in  a  state  of  convulsive  trembling.  An  act  of  violence  is  committed  with- 
out warning,  and  the  patient  appears  as  if  relieved  from  some  oppressive 
feeling.  He  may  be  calm,  and  express  neither  regret,  remorse,  nor  fear; 
he  may  coolly  contemplate  his  victim,  confess  the  deed,  and  at  once  sur- 
render himself  to  justice.  In  some  rare  instances,  he  may  conceal  himself, 
hide  the  weapon,  and,  like  a  sane  criminal,  endeavor  to  obliterate  all 
traces  of  the  crime — thus  showing  a  perfect  consciousness  of  the  illegality 
or  wrongfulness  of  the  act,  and  a  desire  to  evade  discovery.  These  are, 
however,  the  main  features  of  crime,  and  unless  there  is  independent  evi- 
dence of  mental  disorder,  or  of  some  bodily  disease  affecting  the  brain  and 
destroying  the  power  of  self-control,  the  conclusion  must  be  that  the  person 
is  sane  and  responsible.  The  great  problem  to  be  solved  on  these  occa- 
sions is:  What  are  the  plain  practical  distinctions  between  defective 
reasoning  power  arising  from  disease  and  perverted  moral  sense?  The 
latter  condition  alone  should  not  exculpate  a  person  or  absolve  him  from 
punishment,  or  persons  undeniably  sane  who  have  committed  crimes  should 
be  equally  exculpated  and  absolved  from  punishment. 

The  symptoms  above  described  have  been  observed  to  be  more  aggra- 
vated in  proportion  as  the  homicidal  impulse  was  strong.  The  propensity 
to  kill  is  sometimes  a  fixed  idea,  and  the  patient  can  no  more  banish  it 
from  his  thoughts  than  a  person  afflicted  with  insanity  can  divest  himself 
of  the  delusive  ideas  which  occupy  his  mind.  (Esquirol,  t.  2,  p.  105.)  It 
has  been  supposed  that  Esquirol  here  implies  a  state  in  which  there  is  no 
perversion  of  intellect.  The  facts  which  he  mentions,  however,  clearly 
prove  the  contrary ;  for  if  a  patient  has  not  the  power  to  banish  from  his 
thoughts  this  propensity  to  kill,  he  has  passed  beyond  the  bounds  of 
reason,  and  is  really  insane.  The  admission  of  this  fact  proves  that  his 
mind  must  be  unsound.  Esquirol  says,  before  the  perpetration  of  the  act 
there  may  be  no  sign  of  irrational  conversation  or  conduct;  but  he  asks 
the  question — Because  there  is  no  proof  of  irrationality,  are  we  to  assume 
that  these  persons  possess  reason  ?  Is  it  possible  to  reconcile  the  exist- 
ence of  a  rational  state  of  mind  with  the  murder  of  those  who  are  most 
dear  to  them  ?  (Op.  cit.,  vol.  2,  p.  102.)  In  Esquirol's  view,  therefore, 
it  may  be  taken  that  mere  perversion   of  feelings,  irrespective  of  some 


72J-  nOMIGIDAL    MANIA ITS    VARIOUS    FORMS. 

latent  aberration  of  intellect,  does  not  exist,  and  moral  insanity  is  a  con- 
ventional term  for  a  state  in  which  the  proofs  of  mental  disturbance  are 
not  so  clear  as  in  the  geLerality  of  cases. 

An  erroneous  notion  prevails  in  the  public  mind  that  a  homicidal  lunatic 
is  easily  to  be  distinguished  from  a  sane  criminal  by  some  certain  and  in- 
variable symptoms  or  character,  which  it  is  the  duty  of  a  medical  witness 
to  display  in  evidence  and  of  a  medico-legal  writer  to  describe.  But  a  per- 
usal of  the  evidence  given  at  a  few  trials  will  surely  satisfy  those  who 
hold  this  opinion,  that  each  case  must  stand  by  itself.  It  is  easy  to  classif}' 
homicidal  lunatics,  and  say  that  in  one  instance  the  murderous  act  was 
committed  from  a  motive — i.e.  revenge  or  jealousy  ;  in  a  second  from  no 
motive,  but  from  irresistible  impulse ;  in  a  third  from  insane  delusion  ;  in 
a  fourth  from  perverted  moral  feeling,  without  any  sign  of  intellectual 
aVjerration.  This  classification  may  comprise  all  the  varieties  of  homicidal 
insanity,  but  it  does  not  help  us  to  ascertain  in  a  doubtful  case  whether 
an  act  was  or  was  not  committed  under  any  of  these  psychological  condi- 
tions. It  enables  us  to  classify  those  who  are  acquitted  on  the  ground  of 
insanity,  but  it  entirely  fails  in  giving  us  the  power  to  distinguish  a  sane 
from  an  insane  criminal,  or  a  responsible  from  an  irresponsible  agent. 
According  to  Esquirol,  whose  views,  more  or  less  modified,  are  adopted 
by  most  writers  on  the  medical  jurisprudence  of  insanity,  the  facts  hitherto 
observed  indicate  three  degrees  of  homicidal  mania: — 

1.  In  the_^r.s-^  degree  the  propensity  to  kill  is  connected  with  absurd  or 
irrational  motives  or  with  actual  delusion.  The  person  would  be  at  once 
]>ronounced  insane.  Cases  of  this  description  are  not  uncommon,  and 
they  rarely  create  any  difficulty. 

2.  In  the  second  degree  the  desire  to  kill  is  connected  with  no  known 
motive.  It  is  difficult  to  imagine  a  rational  motive  for  the  deed;  the 
person  appears  to  have  been  led  on  by  some  impulse.  There  may  have 
been  delusion  at  the  time,  but  there  is  no  evidence  of  the  pre-existence  of 
this.  With  respect  to  this  class  of  cases  Stephen,  J.,  observes:  "  There 
are  motives  for  all  acts  even  the  maddest,  but  it  is  frequently  impossible 
to  assign  them  specifically.  It  is,  however,  generally  possible  to  form  an 
opinion  whether  a  given  act  was  done  from  some  unknown  mad  motive  or 
for  some  unknown  sane  motive." 

3.  In  the  third  degree  the  impulse  to  kill  is  sudden,  instantaneous,  unre- 
flecting, and  unccnfrollable.  The  act  of  homicide  is  perpetrated  without 
interest,  without  motive,  and  often  on  persons  who  are  most  fondly  loved 
by  the  perpetrator.  It  is  in  this  form,  which  has  been  called  "impulsive 
insanity,"  which  has  given  rise  to  so  much  contention  on  trials  for  murder 
in  which  insanit}^  is  set  up  as  a  defence,  and  therefore  it  will  be  well  to 
consider  this  subject  in  a  legal  aspect.  Stephen,  J.,  thus  comments  upon 
it:  "  It  is  said  that  on  particular  oocasions  men  are  seized  with  irrational 
or  irresistible  impulses  to  kill,  to  steal,  or  to  burn,  and  under  the  influences 
of  such  impulses  they  sometimes  commit  acts  which  would  otherwise  be 
most  atrocious  crimes.  It  would  Ije  absurd  to  deny  the  possibility  that 
such  impulses  may  occur  or  the  fact  that  they  have  occurred  and  have 
been  acted  on.  Instances  are  given  in  which  the  impulse  was  felt  and 
resisted.  The  only  question  which  the  existence  of  such  impulses  can 
raise  in  the  administration  of  criminal  justice  is  whether  the  particular 
impulse  was  irresistible  as  well  as  unresisted.  If  it  was  irresistible  the 
person  accused  is  entitled  to  be  acquitted,  because  the  act  would  not  then 
bo  voluntary  and  not  properly  bis  act.  If  the  impulse  was  resistible,  the 
fact  that  it  proceeded  from  disease  would  be  no  excuse  at  all.     If  a  man's 


HOMICIDAL    MANIA ITS    SPECIAL    CHARACTERS.  725 

nerves  were  so  irritated  by  a  baby's  crying-  that  he  instantly  killed  it,  his 
act  would  be  murder;  it  would  not  be  less  murder  if  the  same  irritation 
and  corresponding  desire  were  produced  by  some  internal  disease.  The 
great  object  of  the  criminal  law  is  to  induce  people  to  control  their  im- 
pulses;  and  there  is  no  reason  why,  if  they  can,  they  should  not  control 
insane  as  well  as  sane  impulses.  The  proof  that  an  impulse  was  irresist- 
ible depends  on  the  circumstances  of  the  particular  case.  The  com- 
monest and  strongest  cases  are  those  of  women  who  without  motive  or 
concealment  kill  their  children  after  recovery  from  childbed." 

In  a  case  tried  at  the  Stafford  Assizes  (Reg.  v.  Humphreys,  Nov.  1878), 
in  which  a  man  was  charged  with  the  murder  of  his  wife,  the  medical  evi- 
dence was  to  the  effect  that  the  prisoner  was  suffering  from  epileptic  mania, 
of  which  an  irresistible  homicidal  impulse  was  one  of  the  features.  Bram- 
well,  J.,  in  summing  up,  said  everybody  was  presumed  to  be  sane  until 
proved  to  be  the  contrary.  Nor  was  it  enough  that  a  man  was  mad  to 
entitle  him  to  an  acquittal.  If  an  insane  man  knew  he  was  committing 
murder,  that  man  was  responsible.  It  was  not  enough  to  have  a  homi- 
cidal mania.  The  object  of  the  law  was  to  guard  against  mischievous 
propensities  and  homicidal  impulses.  A  man  might  be  suffering  under  a 
just  sense  of  some  grievous  wrong  or  outrage  which  would  impel  him  to 
violence,  but  that  strong  impulse,  sane  or  insane,  would  not  entitle  him 
to  an  acquittal.  He  said  this  to  the  jurj^  in  order  to  disabuse  their  minds 
of  a  mischievous  impression  which  existed,  and  which  he  believed  had 
reached  mad  people  themselves.  He  did  not  believe  in  uncontrollable 
impulses  at  all,  and  had  never  heard  of  such  an  impulse  leading  to  action 
where  the  means  of  prevention  were  present.  The  jury  acquitted  the 
accused  on  the  ground  of  insanit}^  and  the  judge  expressed  his  full  con- 
currence in  the  verdict.  There  was  no  direct  proof  of  mental  disease, 
but  there  was  want  of  motive  and  an  absence  of  any  indication  of  ill 
will  against  the  wife. 

The  three  forms  in  w^hich  a  homicidal  propensity  may  thus  present  itself 
in  cases  of  insanity  differ  from  each  other  only  in  degree — the  first  two 
being  strongly  analogous  to,  but  lighter  modifications  of,  the  third.  All 
the  cases  which  came  before  Esquirol  had  these  features  in  common — an 
irritable  constitution,  great  excitability,  singularity  or  eccentricity  of 
character ;  and  previously  to  the  manifestation  of  the  homicidal  feeling 
there  was  a  gentle,  kind,  and  affectionate  disposition.  As  in  other  forms 
of  insanity,  there  was  some  well-marked  change  of  character  in  the  mode 
of  life;  and  this  may  be  taken  as  a  proof  that  there  must  have  been  some 
degree  of  intellectual  disturbance.  The  period  at  which  the  disorder  com- 
menced and  terminated  could  be  easily  defined,  and  the  attack  could  be 
almost  always  referred  to  some  moral  or  physical  cause.  Attempts  at 
suicide  preceded  or  followed  the  attacks;  all  wished  to  die,  and  some  de- 
sired to  be  put  to  death  like  criminals.  In  none  of  the  cases  was  there 
any  discoverable  motive  for  the  act  of  homicide. 

Esquirol  believed  that  there  are  well-marked  distinctions  between  this 
state  and  that  of  the  sane  criminal.  Among  these  he  enumerates:  1.  The 
want  of  accomplices  in  homicidal  mania.  2.  The  sane  criminal  has  alway)^ 
a  motive — the  act  of  murder  is  only  a  means  for  gratifying  some  other 
more  or  less  criminal  passion,  and  is  almost  always  accompanied  by  some 
other  wrongful  act:  the  contrary  exists  in  homicidal  mania.  3.  The  vic- 
tims of  the  criminal  are  those  who  oppose  his  desires  or  his  wishes ;  the 
victims  of  the  maniac  are  among  those  who  are  either  indifferent  to  or 
who  are  the  most  dear  to  him.  4.  The  sane  criminal  endeavors  to  conceal, 
and,  if  taken,  denies  the  crime;  if  he  confesses  it,  it  is  only  with  some 


726  LEGAL    TESTS. 

reservation,  and  when  circumstances  are  too  strong  against  him  ;  but  he 
conimonlv  denies  it  to  the  last  moment :  it  is  the  reverse  with  the  maniac. 
The  exceJDtions  to  which  these  characters  are  open  will  be  considered  here- 
after. They  have,  undoubtedly,  greater  value  in  their  combined  than  in 
their  individual  application,  and  when  in  any  case  they  coexist  there  is 
strong  reason  to  believe  that  the  person  accused  of  murder  is  laboring 
under  homicidal  mania.  The  great  difficulty  in  these  cases,  however,  is 
to  distinguish  moral  depravity  from  insanity.  AVe  agree  with  a  medico- 
legal writer  on  this  subject,  that  "  no  hideousness  of  depravity  can 
amount  to  proof  of  insanity,  unsupported  by  some  evidence  of  a  judgment 
incapacitated,  or  of  a  will  fettered  by  disease.  In  those  cases  in  which 
the  emotions  are  perverted,  and  where  there  is  no  clear  proof  of  deranged 
intellect — cases  which  do  from  time  to  time  occur — the  presumption  of 
insanity  in  regard  to  a  criminal  action  has  to  be  upheld  by  evidence  of  a 
suspension  of  the  will  from  mental  disease.  If  it  can  be  proved  that  the 
act  was  not  voluntary,  this  does  away  with  its  criminal  nature."  But 
in  many  cases  it  is  impossible  to  produce  satisfactory  evidence  of  the  sus- 
pension of  the  will  as  a  result  of  disordered  mind  :  this  suspension  can 
in  general  be  assumed  only  from  the  act  itself — a  dangerous  assumption, 
and  one  that  might  lead  t"o  the  confusion  of  crime  with  insanity  and  to 
the  exculpation  of  all  criminals. 

Legal  Tests. — Admitting  the  existence  of  homicidal  mania,  as  thus  de- 
fined, it  may  become  a  question  how,  when  pleaded  in  defence  for  one 
charged  with  murder,  it  is  to  be  practically  distinguished  from  a  case  in 
which  the  crime  has  been  perpetrated  by  a  really  sane  person.  Tests, 
both  medical  and  legal,  have  been  proposed;  but,  singularly  enough,  in 
no  single  instance  has  the  Court  for  Crown  Cases  Reserved,  or  any  other 
court  silting  in  banco,  delivered  a  considered  written  judgment  on  the 
relation  of  insanity  to  -criminal  responsibility,  though  there  are  several 
such  decisions  as  to  the  effects  of  insanity  on  the  validity  of  contracts  and 
wills.  (Stephen.)  Moreover,  every  judgment  delivered  during  the  last 
forty-eight  years  has  been  founded  upon  an  authority  in  many  ways 
doubtful,  namely,  the  answers  given  by  the  judges  to  questions  put  to 
them  by  the  House  of  Lords,  in  conseciuence  of  the  acquittal  of 
M'Naghten  on  the  ground  of  insanity,  in  1843.  Stephens,  J.,  is  of 
opinion  that  the  authority  of  the  answers  is  questionable,  and  that  they 
leave  untouched  the  most  difficult  questions  connected  with  the  subject. 
(Hist,  of  Crim.  Law  of  Eng  ,vo].  iii.p.  154.)  The  questions  and  answers  are 
as  follows.    Fourteen  of  the  fifteen  judges  consulted  joined  in  the  answers. 

Question  I. — "  What  is  the  law  respecting  alleged  crimes  committed  by 
persons  afflicted  with  insane  delusions  in  respect  of  one  or  more  particular 
subjects  or  persons,  as,  for  instance,  where,  at  the  time  of  the  commission 
of  the  alleged  crime,  the  accused  knew  he  was  acting  contrary  to  law,  but 
did  the  act  complained  of  with  a  view,  under  the  influence  of  insane  delu- 
sion, of  redressing  or  revenging  some  supposed  grievance  or  injury,  or  of 
producing  some  supposed  public  benefit?" 

Ansiuer  I. — "Assuming  that  your  Lordships'  inquiries  are  confined  to 
those  persons  who  labor  under  such  partial  delusions  only,  and  are  not  in 
other  i-espects  insane,  we  are  of  opinion  that,  notwithstanding  the  accused 
did  the  act  complained  of  with  a  view,  under  the  influence  of  insane  delu- 
sion, of  redressing  or  revenging  some  supposed  grievance  or  injury,  or  of 
])roducing  some  pulilic  benefit,  he  is  nevertheless  punishable,  according  to 
the  nature  of  the  crime  committed,  if  he  knew  at  the  time  of  committing 
such  crime  that  he  was  acting  contrary  to  law,  by  which  expression  we 
understand  your  Lordships  to  mean  the  law  of  the  land." 


LEGAL    TESTS.  727 

Question  II. — "  What  are  the  proper  questions  to  be  submitted  to  the 
jury  vvheu  a  person,  afflicted  with  insane  delusions  respecting  one  or  more 
particular  subjects  or  parsons,  is  charged  with  the  commission  of  a  crime 
(murder,  for  instance),  and  insanity  is  set  up  as  a  defence?"  • 

Question  III. — "  In  what  terms  ought  the  question  to  be  left  to  the 
jury  as  to  the  prisoner's  state  of  mind  at  the  time  when  the  act  was  com- 
mitted ?" 

Answers  II  and  III. — "  As  these  two  questions  appear  to  us  to  be 
more  conveniently  answered  together,  we  submit  our  opinion  that  the  jury 
ought  to  be  told  in  all  cases  that  every  man  is  presumed  to  be  sane  and 
to  possess  a  sufficient  degree  of  reason  to  be  responsible  for  his  crimes, 
uutil  the  coutrary  be  proved  to  their  satisfaction.  That  to  establish  a  de- 
fence on  the  ground  of  insanity  it  must  be  clearly  proved  that,  at  the  time 
of  committing  the  act,  the  accused  Avas  laboring  under  such  a  defect  of 
reason  from  disease  of  the  mind,  as  not  to  know  the  nature  and  quality  of 
the  act  he  was  doing,  or,  if  he  did  knew  it,  that  he  did  not  know  that  he 
was  doing  what  was  wrong.  The  mode  of  putting  the  latter  part  of  the 
question  to  the  jury  on  these  occasions  has  generally  been,  whether  the 
accused,  at  the  time  of  doing  the  act,  knew  the  difference  between  right 
and  wrong;  which  mode,  though  rarely,  if  ever,  leading  to  any  mistake 
with  the  jury,  is  not,  we  conceive,  so  accurate  when  put  generally  and  in 
the  abstract,  as  when  put  with  reference  to  the  party's  knowledge  of  right 
and  wrong  in  respect  to  the  very  act  with  which  he  is  charged.  If  the 
question  were  to  be  put  as  to  the  knowledge  of  the  accused,  solely  and 
exclusively,  with  reference  to  the  law"  of  the  land,  it  might  tend  to  con- 
found the  jury  by  inducing  theni  to  believe  that  an  actual  knowledge  of 
the  law  of  the  land  was  essential  in  order  to  lead  to  a  conviction  ;  whereas 
the  law  is  administered  on  the  principle  that  every  one  must  be  taken 
conclusively  to  know  it  without  proof  that  he  does  know  it.  If  the  ac- 
cused were  conscious  that  the  act  was  one  which  he  ought  not  to  do,  and 
if  that  act  was  at  the  same  time  contrary  to  the  law  of  the  land,  he  is 
punishable,  and  the  usual  course,  therefore,  has  been  to  leave  the  question 
to  the  jury  whether  the  accused  had  a  sufficient  degree  of  reason  to  know" 
he  was  doing  an  act  that  was  wrong  ;  and  this  course,  we  think,  is  correct, 
accompanied  with  such  observations  and  corrections  as  the  circumstances 
of  each  particular  case  may  require." 

Question  IV. — "If  a  person  under  an  insane  delusion  as  to  existing 
facts  commits  an  offence  in  consequence  thereof,  is  he  thereby  excused?  " 

Answer  IV. — "The  answer  must,  of  course,  depend  upon  the  nature  of 
the  delusion,  but  making  the  same  assumption  as  we  did  before,  namely, 
that  he  labors  under  such  partial  delusion  only,  and  is  not  in  other  respects 
insane,  we  think  he  must  be  considered  in  the  same  situation  as  to  respon- 
sibility as  if  the  facts,  with  respect  to  which  the  delusions  exist,  M^ere  real. 
For  example,  if  under  the  influence  of  his  delusion  he  supposes  another 
man  to  be  in  the  act  of  attempting  to  take  his  life,  and  he  kills  that  man 
as  he  supposes  in  self-defence,  he  would  be  exempt  from  punishment.  If 
his  delusion  was  that  the  deceased  had  inflicted  a  serious  injury  to  his 
character  and  fortune,  and  he  killed  him  in  revenge  for  such  supposed  in- 
jury, he  would  be  liable  to  punishment." 

It  w"0uld  thus  appear  that  the  law,  in  order  to  render  a  man  responsible 
for  a  crime  looks  for  a  consciousness  of  right  and  wrong  and  n,  knowledge 
of  the  consequences  of  the  act;  while  the  administration  of  justice  rests 
on  the  principle  that  every  one  knows  the  law  and  fears  its  punishment. 
Thus  the  complete  possession  of  reason  is  not  essential  to  constitute  the 
legal  responsibility  of  an  offender ;  and  it  is  also  to  be  inferred,  from  the 


728      CRIMINAL    RESPONSIBILITY    OF    THE    INSANE    HOMICIDE. 

* 

results  of  several  cases,  that  a  man  may  be  civilly  incompetent,  but  suffi- 
ciently sane  to  be  made  criminally  responsible.  The  proofs  required  in 
the  two  cases  are  essentially  distinct. 

It  has  been  objected  to  this  legal  teat  that  it  is  insufficient  for  the  pur- 
pose intended  ;  it  cannot,  in  a  large  majority  of  cases,  enable  us  to  dis- 
tinguish the  insane  homicide  from  the  sane  criminal.  Many  insane  persons 
have  committed  acts  which  they  knew  to  be  wrong,  and  of  the  criminality 
of  which  they  were  at  the  time  perfectly  conscious.  They  have  been 
known  to  murder  others  in  order  to  receive  the  punishment  of  death  at 
the  hands  of  the  law  ;  and  therefore  they  must  have  been  conscious  of  the 
wrongfulness,  or  rather  of  the  illegality,  of  the  act  which  they  were  perpe- 
trating, and  have  known  that  they  were  committing  an  offence  punishable 
by  the  law  of  man.  In  short,  the  criminal  nature  of  the  act  has  often  been 
the  sole  motive  for  its  perpetration.  (Ann.  d'Hyg.,  1852,  t.  1,  p.  3C3.) 
It  has  been  suggested,  with  some  truth,  that  it  is  rather  the  imperfect  or 
defective  appreciation  of  the  motives  to  right  or  against  wrong  action 
which  leads  to  crime  among  the  insane,  and  not  the  mere  ignorance  of 
right  and  wrong.  Most  lunatics  have  an  abstract  knowledge  that  right 
is  right  and  wrong  wrong;  but  in  insanity  the  voluntary  power  to  con- 
trol thought  and  actions  and  to  regulate  conduct  by  this  standard  is  im- 
paired, limited,  or  overruled  by  insane  motives.  A  lunatic  may  have  the 
power  of  distinguishing  right  from  wrong,  but  he  has  not  the  power  of 
choosing  right  from  wrong.  A  criminal  is  punishable,  not  merely  because 
he  has  the  power  of  distinguishing  right  from  wrong,  but  because  he  vol- 
untarily does  the  wrong,  having  the  power  to  choose  the  right.  (On  the 
Kelation  of  Insanity  to  the  Crim.  Law,  by  Orange,  1877.) 

[Criminal  Responsibility  of  the  Insane  Homicide. — A  wide  divergence 
of  opinion  exists  in  the  American  States  as  to  the  legal  effect  of  the 
answers  of  the  English  judges  to  the  questions  propounded  by  the  House 
of  Lords  in  the  excitement  growing  out  of  the  M'Naghten  Case  in  1843. 

1.  It  must  be  conceded  that  these  judicial  responses  wen;  the  mere 
expressions  of  the  individual  opinions  of  the  judges,  and  not  decisions  by 
a  court  of  competent  jurisdiction  pronounced  in  a  case  before  them  ;  in 
other  words,  that  they  are  mere  obiter  dicta,  and  of  no  binding  effect 
upon  any  court  in  England  or  elsewhere.  Sir  James  Fitz  James  Stephen 
has  welf  said  concerning  them  :  "  That  they  were  mere  answers  to  ques- 
tions which  the  judges  were  probably  under  no  obligation  to  answer,  and 
to  which  the  House  "of  Lords  had  probably  no  right  to  require  an  answer, 
as  thev  did  not  arise  out  of  any  matter  judicially  belore  the  house  :" 
Stephen's  Hist.  Crim.  Law  of  England,  vol.  2,  p.  154. 

2.  While  these  answers  have  been  by  common  usage  usually  followed 
by  the  English  trial  judges,  it  is  a  significant  fact  that  they  have  not  re- 
ceived the  approval  of  the  High  Court  for  Crown  Cases  Reserved. 

3.  The  conviction  of  insane  homicides  in  such  cases  as  those  of  Gold- 
stone  and  Cole  in  England,  and  of  similar  cases  in  some  of  the  American 
States,  where  judges  have  followed  the  dicta  of  the  judges,  upon  what 
has  been  commonly  known  as  the  Right  and  Wrong  Test,  has  led  to  a 
strong  revulsion  of  feeling  against  that  doctrine  both  in  England  and  in 
the  A'nierican  States.  The  medical  profession  of  England  instantly  pro- 
tested against  the  answers  of  the  English  judges,  by  the  resolutions 
adopted  July  11,  1844,  at  the  session  of  the  British  Association  of  Medical 
Superintendents,  which  was  the  year  after  the  answers  of  the  English 
judges  were  made.  In  some  of  the  American  States  the  dicta  of  the 
English  judges  was  followed,  notably  New  York,  Pennsylvania,  Massa- 
ehu^setts,  Michigan,  Alabama,  Ohio,  and  other  States.  Writers  and  jurists 


CRIMINAL    RESPONSIBILITY    OF    THE    INSANE    UOMICIDE.       729 

denounced  the  "  Rig-ht  and  Wrong  Test"  on  both  sides  the  Atlantic  : 
Bi'owu's  Med.  Juris.,  §§  18  et  aeq.  ;  Wharton  &  Stille,  §  59  ;  Bishop 
Crini.  Law,  Tth  ed.,  §§  386  et  seq.;  Wharton's  Crini.  Law,  §§  33  et 
aeq.;  Ordronaux  on  Insanity,  419;  Ray  Med.  Juris.,  1(5-19;  Buclcnill  & 
Tuke,  p.  2(i9;  Bell,  Med.  Leg-.  Jour.,  vol.  2,  p.  339  ;  the  same,  Med.  Leg-. 
Jour.,  vol.  7,  p.  88. 

4.  la  August,  1833,  an  Act  of  Parliament  was  passed  in  England  de- 
claring that  if  the  homicide  was  insane  at  the  time  he  committed  the  act 
a  special  .verdict  should  l)e  found  by  the  jury. 

5.  Li  the  American  courts  the  soundness  of  the  doctrine  of  the  dicta 
of  the  English  judges  has  been  severely  criticised  and  overruled,  if  an 
obiter  dicta  of  a  court  can  ever  properly  be  regarded  as  overruled.  The 
most  notable  case  was  that  of  State  v.  Pilvc,  in  which  Chief  Justice  Doe, 
of  the  Supreme  Court  of  New  Hampshire,  wrote  the  masterly  opinion  of 
the  whole  bench,  repudiating  the  doctrine  contained  in  the  answers  of  the 
English  judges  :  49  X.  Hamp.  p.  399;  50  N.  H.  p.  369.  Similar  decisions 
followed  in  the  Supreme  Courts  of  Kentucky  (Kried  v.  Com.,  5  Bush 
(Ky.),  362;  Smith  v.  Com.,  1  Duv.  (Ky.)  224) ;  in  Virginia  (Dejarnette  v. 
Com.,  75  Va.  576);  in  Mis.sissippi  (Cunningham  v.  State,  56  Miss.  269); 
in  Connecticut  (State  v.  Johnson,  40  Conn.  136  ;  Anderson  v.  State,  43 
Conn.  514);  in  Iowa  (State  v.  McWhorter,  46  Iowa,  88;  Stater.  Fettes, 
35  Iowa,  68);  in  Illinois  (Hopp  v.  People,  31  HI.  385);  in  Indiana 
(Bradly  v.  State,  31  Ind.  492) ;  in  Texas  (Harris  v.  State,  18  Texas  Ct.  of 
App.  87);  in  Pennsylvania  (Coyle  v.  Com.,  100  Pa.  573)  ;  in  Georgia 
(Roberts  v.  State,  3  Gra.  310);  in  Massachusetts  (Com.  v.  Rogers,  7 
Mete.  500);  in  the  District  of  Columbia  (People  v.  Daly,  reported  in 
Med.  Leg.  Journal,  vol.  7,  Sept.  No.),  and  more  recently  in  the  notable 
case  of  Parsons  v.  State,  where  Somerville,  Justice,  wrote  the  opinion  of 
the  bench  of  the  Supreme  Court  of  Alabama,  a  masterly  and  exhaustive 
treatise  upon  the  whole  subject,  distinctly  overruling  the  doctrine  answered 
bv  the  English  judges  (which  is,  as  was  Chief  Justice  Doe  in  the  New 
Hampshire  cases,  a  leading  case,  and  is  reported  in  full  in  the  September 
No.  of  vol.  7  of  Medico- Legal  Journal).  Mr.  Justice  Stone  wrote  a  dis- 
senting opinion  as  to  certain  propositions,  but  not  upon  the  main  question, 
and  upon  the  "  right  and  wrong"  theory  he  did  not  dissent. 

6.  The  acquittal  of  Hadfield  in  England,  defended  by  Erskine,  was 
within  the  doctrine  as  stated  in  State  v.  Pike,  in  New  Hampshire,  and 
Parsons  v.  State,  in  Alabama.  Lord  Kenyon,  one  of  the  ablest  of  the 
English  judges,  acted  and  decided  correctly,  under  the  law  of  England, 
when  he  stopped  the  case  before  the  witnesses  for  the  defence  were  all 
sworn,  and  directed  the  acquittal,  as  matter  of  law,  on  the  substantial 
doctrine  of  the  decision  as  laid  down  in  the  Alabama  case.  In  the  case  of 
M'Naghten,  the  eminent  judge  who  tried  that  case  correctly  applied  the 
law  of  England  as  it  then  existed  and  had  been  previously  administered, 
in  directing  an  acquittal,  on  the  assent  of  M'Naghten,  did  not  even  know 
Sir  Robert  Peel,  nor  Mr.  Drummond,  and  he  was,  beyond  all  question, 
laboring  under  an  insane  delusion  which  dominated  his  action.  His 
acquittal  was  correct  under  the  law  of  Entiland,  but  he  would  have  been 
convicted  under  the  recent  dicta  of  the  English  judges.  It  is  doubtless 
true  that  the  excitement  of  that  era,  which  led  to  the  extraordinary  in- 
quiry, may  have  largely  influenced  the  English  judges  in  framinir  their 
answers.  One  of  the  ablest  law  officers  of  the  crown,  Sir  William  Follett, 
admitted  upon  the  appeal  of  Judge  Tyndale  that  he  must  submit  to  a 
verdict  of  acquittal  on  the  ground  of  the  defendant's  insanity  :  Serjeant 


730  MEDICAL    TESTS. 

Ballantyne,  vol.  1,  p.  246.  M'Xaghten  was  defended  by  Mr.  Cockburn, 
afterward  the  Lord  Chief  Justice. 

7.  It  may  be  claimed  that  the  answers  of  the  English  judges  did  not  cor- 
rectly state  the  lavr  of  England,  as  it  had  before  that  time  been  adminis- 
tered in  this  respect,  and  notably  in  the  case  of  Hadtield  v.  M'Naghten, 
and  that  the  answers  set  up  a  new  legal  test  or  criterion,  which  upon  trial 
has  been  found  to  be  against  the  teachings  of  science  and  repugnant  to 
and  in  conflict  with  the  civilization  of  our  age. 

8.  The  action  of  the  English  Home  Secretary  and  the  law  officers  of 
the  Crown  in  recent  cases  indicates  a  great  chanjie  in  English  judicial 
views,  and  the  course  now  taken  of  having  a  full  and  impartial  inquisition 
in  every  case  of  suspected  insanity,  with  competent  experts,  conducted 
by  the  government  officials  before  the  main  trial,  makes  it  extremely  im- 
probable that  any  insane  homicide  will  be  likely  to  be  either  convicted  or 
executed  in  Great  Britain  in  the  near  future.] 

Medical  Tests. — The  tests  which  have  been  proposed  by  medical  jurists 
for  detecting  cases  of  homicidal  mania  are  as  follows: — 

1.  The  acts  of  homicide  have  generally  been  preceded  by  other  striking 
peculiarities  of  conduct  in  the  personj  often  by  a  total  change  of  character. 

2.  Those  persons  who  are  aflected  with  it  have  in  many  instances  pre- 
viously or  subsequently  attempted  suicide — they  have  expressed  a  wish  to 
die  or  to  be  executed  as  criminals.  These  supposed  criteria,  when  tendered 
as  medical  proofs  of  insanity  in  courts  of  law,  have  been  repeatedly  and 
verv  properly  rejected.  They  are  of  too  vague  a  nature  for  practical  use, 
and  apply  as  much  to  cases  of  moral  depravity  as  of  actual  insanity  ;  in 
short,  if  "these  were  admitted  as  pj^oofs,  they  would  serve  as  a  convenient 
shelter  from  punishment  for  many  sane  criminals. 

3.  Motive  for  Crime. — The  acts  are  without  motive;  they  are  in  oppo- 
sition to  all  human  motives.  A  man  known  to  have  been  tenderly  at- 
tached to  his  wife  and  children  murders  them  ;  a  fond  mother  destroys  her 
infant.  It  is  hereby  assumed  or  implied  that  persons  who  are  sane  never 
commit  a  crime  without  an  apparent  motive,  and  that  in  the  perpetration 
of  a  criminal  act  an  insane  person  either  never  has  a  motive,  or  has  one  of 
a  delusive  nature  only.  If  these  propositions  were  true,  it  would  be  easy 
to  distinguish  a  sane  from  an  insane  criminal ;  but  the  rule  wholly  fails  in 
pi-actice.  In  the  first  place,  the  non-discovery  is  here  taken  as  a  proof  of 
the  non-existence  of  a  motive  ;  while  it  is  undoubted  that  motives  may 
exist  for  many  atrocious  criminal  acts  without  our  being  able  to  discover 
them — a  fact  proved  by  the  numerous  recorded  confessions  of  criminals 
before  execution,  in  cases  in  which,  until  these  confessions  were  made,-  no 
motive  for  the  perpetration  of  the  crime  had  appeared  to  the  acutest  minds. 

4.  Confession The  subsequent  conduct  of  the  person  ;  he   seeks  no 

e.scape,  delivers  himself  up  to  justice,  and  acknowledges  the  crime  laid  to 
his  charge.  This  is  commonly  characteristic  of  homicidal  mania;  for  by 
the  sane  criminal  every  attempt  is  generally  made  to  conceal  all  traces  of 
the  crime,  and  he  denies  it  to  the  last,  or  until  he  .sees  that  denial  can  be 
no  longer  serviceable  to  him. 

5.  Accomplices. — The  sane  murderer  has  generally  accomplices  in  vice 
or  crime;  the  homicidal  maniac  has  not.  Upon  this  it  may  be  observed 
that  some  of  the  most  atrocious  murders  committed  in  modern  times  have 
been  proved  to  be  the  acts  of  persons  who  had  neither  accomplices  nor  any 
assignable  inducements  leading  to  the  commission  of  the  crimes.  It  is, 
however,  a  fact  so  far  in  favor  of  the  existence  of  homicidal  insanity,  that 
the  ivsane  never  have  accomplices  in  the  acts  which  they  perpetrate. 
The.se  criteria  can  hardly  be  described  as  medical ;  they  are  circumstances 


MEDICAL    TESTS.  731 

upon  which  a  non-professional  man  may  form  just  as  safe  a  judgment  as 
one  who  has  made  insanity  a  special  study. 

6.  Delusion  in  the  Act. — The  presence  of  delusion  has  been  said  to  char- 
acterize an  act  of  homicidal  mania,  while  premeditation,  precaution,  and 
concealment  have  been  considered  to  be  the  essential  features  of  the  act  of 
a  sane  criminal.  Some  medical  men  think,  if  they  discover  anything-  re- 
sembling a  delusion  in  the  mind  of  an  accused  person,  that  he  is  necessarily 
irresponsible  for  the  act,  but  the  doubtful  theory  of  the  law,  as  supposed 
to  be  laid  down  by  the  judges  in  M'Naghten's  case  (see  p.  726,  ante),  is 
that,  notwithstanding  a  person  labors  under  a  delusion,  if  he  commits  an 
act  which  he  knows  to  be  contrary  to  law,  he  is  liable  to  punishment ;  if 
the  delusion  be  partial,  the  party  accused  is  still  responsible;  and  if  the 
crime  were  committed  for  an  imaginary  injury,  he  would  be  held  equally  " 
responsible.  Much  stress  was  formerly  laid  upon  the  delusion  being  con- 
nected with  the  act  in  ca.ses  of  alleged  insanity  ;  but  it  must  be  remembered 
that,  except  by  the  confessions  of  insane  persons  during  convalescence,  it 
is  not  easy  for  a  sane  mind  to  connect  the  most  simple  acts  of  a  lunatic 
Avith  the  delusion  under  which  he  is  laboring.  Every  act  of  homicide  per- 
petrated by  an  insane  person  is  perhaps  connected  with  some  dekision 
■"./ith  which  he  is  affected  ;  but  it  is  not  to  be  supposed  that  one  who  is 
sane  can  always  discover  this  connection. 

It  may  be  further  observed  that  premeditation,  precaution,  concealment, 
and  flight  are  met  with  in  crimes  committed  by  both  sane  and  insane 
criminals,  although  these  acts  are  certainly  strong  characteristics  of  sanity. 
It  should  be  a  question  for  a  jury  whether,  when  they  are  proved  to  have 
existed  in  any  criminal  act,  there  might  not  have  been  such  a  power  of  self- 
control  in  the  person,  although  in  some  degree  insane,  as  to  justify  a 
conviction.  It  is  not  the  presence  of  a  slight  degree  of  mental  aberration 
which  necessarily  indicates  a  loss  of  power  of  controlling  actions. 

7.  A  Number  of  Murders  perpetrated  at  once. — In  the  acts  of  sane 
criminals  one  person,  or  at  the  most  two,  may  be  destroyed  ;  but,  in  cases 
of  homicidal  mania,  it  is  not  unusual  to  find  a  wife  and  several  children 
killed  by  the  husband,  or  four  or  five  children  at  once  destroyed  by  the 
wife.  In  these  cases  no  motive  but  that  which  is  based  on  some  insane 
delusion,  can  be  suggested  for  such  a  series  of  murders.  Thus  four  infants 
may  be  found  murdered  by  a  mother,  who  admits  the  act,  but  endeavors 
to  account  for  it  by  asserting  that  she  wished  to  convert  them  into  angels, 
or  to  save  them  from  destitution  and  exposure  to  worldly  temptations. 

It  would  be  wrong,  however,  to  infer  from  this  statement  that,  because 
a  man  has  heaped  crime  upon  crime,  he  is  therefore  insane.  This  would 
be  equal  to  making  the  atrocity  of  the  crime  or  crimes  a  test  of  insanity. 
In  the  case  of  Southey  (Reg.  v.  Southey,  Maidstone  Wint  Ass.,  18fi5),  it 
was  proved  that  the  prisoner,  a  man  of  depraved  habits,  had  destroyed 
three  of  his  children  in  London,  and  bad  then  proceeded  to  Ramsgate,  and 
there  deliberately  destroyed  his  wife  and  another  child.  He  pretended  to 
justify  these  five  murders,  and  wished  to  make  it  appear  that  he  Avas  in- 
sane. In  regard  to  this  man's  conduct  through  life,  nothing  but  moral 
depravity  was  proved.  Still,  he  found  medical  defenders,  who  brought 
forward  as  proofs  of  "  delirium,"  statements  which  clearly  showed  that 
they  did  not  understand  the  meaning  of  the  term.  It  was  admitted  that 
if  the  man  had  committed  one  of  the  murders,  he  might  have  been  sane, 
but  having  committed  five  in  succession,  he  was  insane  and  incompetent 
to  judge  of  the  nature  of  his  acts.  The  fallacy  of  such  an  argument  needs 
no  exposure.  There  could  be  no  doubt  of  the  sanity  of  Rush,  who  was 
tried  and  convicted  of  the  simultaneous  murder  of  three  persons.  (Xorwich 


732  HOMICIDAL    MANIA SUMMARY. 

Lent  Ass.,  1849.)  Tbiuking  that  he  had  a  legal  claim  to  an  estate  held 
by  a  Mr.  Jermy,  the  prisoner  went  to  the  house,  concealing  his  features 
with  a  mask,  and  there  shot,  one  after  the  other,  Mr.  Jerniy,  his  son,  his 
son's  wife,  and  a  maidservant,  killing  three  of  them.  The  defence  of  in- 
sanity was  not  set  up.     He  was  convicted  and  executed. 

Summary. — The  foregoing  considerations  lead  to  the  inference  that 
there  are  yto  certain  legal  or  medical  tests  or  characters  whereby  homi- 
cidal mania  can  be  demonstrated  to  exist.  Each  case  must  be  determined 
by  the  circumstances  attending  it ;  but  the  true  criterion  of  irresponsibility 
appears  to  be  whether  the  person,  at  the  time  of  the  commission  of  the 
crime,  had  or  had  not  a  sufficient  power  of  self-control  to  govern  his 
actions;  or,  in  other  words,  whether  he  knew  the  act  was  wrong,  and 
could  avoid  the  perpetration  of  it.  Stephen,  J.,  expresses  a  similar  opinion 
in  stating  that  there  should  be  proof  of  au  absence  of  the  poxcer  of  self- 
control,  caused  by  disease  affecting  the  mind.  This  involves  the  con- 
sideration, not  only  whether  insanity  existed  in  the  accused,  but  whether 
it  had  reached  such  a  degree  as  to  destroy,  not  merely  a  consciousness  of 
the  nature  of  the  act,  but  volition — the  will  to  do  or  not  to  do  it.  If  from 
circumstances  it  can  be  inferred  that  an  accused  person  had  this  power, 
whether  his  case  falls  within  the  above  rules  or  not,  he  should  be  made 
responsible  and  liable  to  punishment.  If,  however,  he  was  led  to  the  per- 
petration of  the  act  by  an  insane  impulse,  or,  in  other  words,  by  an 
impulse  which  his  mental  condition  did  not  allow  him  to  control,  he  is 
entitled  to  an  acquittal  as  an  irresponsible  agent.  The  power  of  con- 
trolling an  act  appears  to  imply  the  existence  of  such  a  state  of  sanity  as 
to  render  the  party  responsible  ;  and  when  there  is  this  want  of  control, 
it  may  be  fairly  concluded  that  there  is  no  sane  intention,  and  that  the 
person  is  irresponsible.  A  test  somewhat  similar  to  this  is  constantly 
applied  by  juries,  under  the  direction  of  our  judges,  to  distinguish  murder 
from  manslaughter  ;  and  it  is  quite  certain  that  sanity  and  homicidal  mania 
are  not  more"  nicely  blended  than  those  shades  of  guilt  whereby  man- 
slaughter passes  into  murder.  The  manner  and  circumstances  under 
which  a  crime  is  committed  will  often  allow  a  fair  inference  to  be  drawn 
as  to  how  far  a  power  of  self  control  existed  or  was  exercised.  A  man  in 
a  violent  fit  of  mania  or  delirium  rushes  with  a  drawn  sword  into  an  open 
street,  and  stabs  the  first  person  whom  he  meets ;  another,  worn  out  by 
poverty  and  destitution,  murders  his  wife  and  children  to  prevent  them 
from  starving,  and  then  probably  attempts  to  destroy  himself;  these  are 
cases  in  which  there  is  a  fair  ground  to  entertain  a  plea  of  irresponsibility. 
But  when  we  find  a  man,  not  showing  any  previous  intellectual  dis- 
turbance, lurking  for  days  together  in  a  particular  locality,  having  about 
him  a  loaded  weapon",  watching  a  particular  person  who  frequents  that 
locality,  not  facing  the  individual  and  shooting  him,  but  coolly  waiting 
until  he  has  an  opportunity  of  discharging  the  weapon  unobserved  by  his 
victim  or  other.- — the  circumstances  appear  to  show  such  a  perfect  adapta- 
tion of  means  to  ends,  and  such  a  power  of  controlling  actions,  that  it  is 
difficult  to  understand  on  what  principle  an  acquittal  on  the  ground  of  in- 
sanity could  have  been  allowed.  We  refer  here  to  the  case  of  M'Naghten, 
tried'for  tlie  murder  of  Mr.  Druramond,  Jan.  1843.  The  acquittal  in  this 
case  was  the  more  remarkable  because  there  was  no  proof  of  general  in-' 
sanity,  and  the  crime  was  committed  for  a  supposed  injury.  According 
to  the  rules  laid  down  l)y  the  fifteen  judges,  from  questions  submitted  to 
them  in  connection  with"  this  case,  this  man  should  have  been  convicted 
{ante,  p.  T2G). 

In  cases  of  alleged  homicidal  mania,  very  vague  meanings  have  been 


ALLEGED    EXISTENCE    OF    DELUSION.  733 

sometimes  assigned  to  the  term  "delusion."  In  Reg.  v.  Burton  (Maid- 
stone Lent.  Ass.,  1863),  the  prisoner,  a  youth  of  18,  was  indicted  for  the 
murder  of  a  boy  at  Chatham.  There  was  no  motive,  but  it  was  argued 
by  the  counsel  that  he  labored  at  the  time  under  a  delusion — the  delusion 
being  a  desire  to  be  hanged.  Tiie  surgeon  of  the  prison  stated  that  he 
had  had  frequent  opportunities  of  examining  the  prisoner  while  in  gaol, 
and  in  his  opinion  he  was  perfectly  sane  ;  so  far  as  the  witness  could  judge, 
he  was  under  no  delusion.  The  jury  returned  a  verdict  of  "guiltv."  If 
the  youth  had  believed  that  he  had  been  already  hanged  for  murder,  this 
might  have  been  considered  a  delusion  ;  but  a  desire  to  be  hanged,  or  to 
die  from  any  violent  cause,  cannot  be  so  regarded.  The  remarks  of  Wight- 
man,  J.,  upon  this  kind  of  defence  contain  all  that  is  necessary  to  show 
its  fallacy.  In  passing  sentence  upon  the  prisoner,  he  said,  "  It  is  stated 
that  you  labored  under  a  morbid  desire  to  die  by  the  hands  of  justice,  and 
for  this  purpose  you  committed  the  murder.  This  morbid  desire  to  part 
with  your  own  life  can  hardly  be  called  a  delusion;  and,  indeed,  the  con- 
sciousness on  your  part  that  you  could  effect  your  purpose  by  designedly 
depriving  another  of  life,  for  which  you  knew  you  would  have  to  suflfer 
the  punishment  due  to  the  greatest  of  crimes,  shows  that  you  were  per- 
fectly able  to  understand  the  nature  and  consequences  of  the  act  which 
you  were  committing,  and  that  you  knew  it  was  a  crime  for  which  by 
law  the  penalty  was  capital.  This  was,  in  truth,  a  further,  and  I  may 
say  a  deeper  aggravation  of  the  crime :  for  you  designedly  intended  to 
compass  your  own  death  by  the  murder  of  another." 

In  forming  a  judgment  of  the  mental  condition  of  an  accused  person,  it 
is  no  part  of  the  province  of  a  witness  to  modify  his  opinion  according  to 
the  punishment  which  may  follow  if  the  plea  be  rejected ;  he  should  sim- 
ply base  it  on  the  medical  facts  of  the  case.  The  legislature  only  is  re- 
sponsible for  the  punishment  adjudged  to  crimes.  Mayo  justly  observed 
that  a  medical  witness  is  summoned  to  a  court  of  justice  in  order  to  enable 
the  judge  and  jury  to  arrive  at  certain  practical  conclusions.  The  ques- 
tion proposed  to  him  involves  a  simple  fact,  and  not  its  consequences; 
and  if  the  latter  consideration  be  entertained  by  him,  it  will  be  liable  to 
bias  his  evidence  on  the  fact,  which  is  his  legitimate  topic.  The  definition 
of  insanity  becomes  very  expansive  when  its  expansion  may  become  pro- 
tective to  a  criminal  with  whom  we  may  ha[)pen  to  sympathize  The 
question  whether  the  accused  is  a  responsible  agent  is  of  a  judicial  nature  : 
our  evidence  should  be  confined  to  the  question  whether  the  accused  is 
insane  in  a  certain  sense  or  meaning  in  which  it  is  understood  and  defined 
1)V  law.  A  medical  witness  in  these  cases  often  moulds  his  evidence  to  a 
foregone  conclusion  on  the  criminal  responsibility  of  the  accused,  and  thus 
lays  himself  open  to  a  remark  from  the  judge  that  he  must  not  encroach 
on  the  functions  of  the  jury.  It  is  certainly  a  great  evil  that,  under  the 
present  mode  of  laying  this  question  before  a  jury,  the  law  operates  un- 
equally. One  case  becomes  a  subject  of  prominent  public  interest,  and 
every  exertion  is  made  to  construe  the  most  trivial  eccentricities  of  char- 
acter into  proofs  of  insanity,  and  to  magnify  the  effects  of  an  hereditary 
tendency  by  proving  that  a  distant  relative  had  been  a  lunatic  :  an  acquit- 
tal follows.  Another  case  may  excite  no  interest:  the  accused  is  con- 
victed, and  either  executed  or  otherwise  punished,  although  the  evidence 
of  insanity,  had  it  been  as  carefully  sought  for  and  brought  out,  would 
have  been  perhaps  stronger  in  this  than  in  the  former  instance. 

The  doctrine  of  "irresistible  impulse"  and  the  theory  of  impulsive  in- 
sanity have  been  strained  in  recent  times  to  such  a  degree  as  to  create  in 
the  public  mind  a  distrust  of  medical  evidence  on  these  occasions.     It  is 


734  MEDICAL    THEORIES. 

obviously  easy  to  convert  this  into  a  plea  for  the  extenuation  of  all  kinds 
of  crimes  for  which  motives  are  not  at  once  apparent,  and  thus  medical 
witnesses  often  expose  themselves  to  severe  rebuke.  They  are  certainly 
not  justified  in  setting  up  such  a  defence,  unless  they  are  prepared  to  draw 
a  clear  distinction  between  impulses  which  are  "  unresisted  "  and  those 
Avhich  are  irresistible.  As  a  judge  once  remarked  in  his  address  to  a  jury, 
"What  is  the  meaning  of  not  being  able  to  resist  an  impulse?  Every 
crime  is  committed  under  an  impulse,  and  the  object  of  the  law  is  to  com- 
pel persons  to  control  or  resist  these  impulses.  If  it  is  made  an  excuse 
for  a  person  who  has  committed  a  crime,  that  he  was  goaded  to  it  by  some 
impulse  which  medical  men  might  choose  to  say  he  could  vot  control,  such 
a  doctrine  would  be  fraught  with  very  great  danger  to  society." 

While  the,  truth  of  these  remarks  is  obvious,  it  must  be  admitted  that 
the  legal  test  for  responsibility  is  not  satisfactory.  In  addressing  the  jury 
in  Reg.  v.  Cockroft,  in  a  trial  for  murder  (Leeds  Aut.  Ass.,  1865),  Mellor, 
J.,  made  the  following  observations  on  the  defence  of  insanity  which  had 
been  set  up:  "It  would  be  dangerous  if  the  idea  went  abroad  that  per- 
sons committing  crime  under  sudden  impulse  were  therefore  to  be  excused. 
At  the  same  time,  he  thought  that  the  definition  of  insanity  which  would 
excuse  from  criminal  responsibility,  as  given  in  M'Naghten's  case,  hardly 
went  far  enough.  He  was  of  opinion  that  a  man  might  know  that  he 
was  doing  an  act  which  was  wrong,  and  still  he  might  be  laboring  under 
such  disease  of  the  mind  as  not  to  be  able  to  restrain  his  impulse  to  do 
that  act,  and  he  should  therefore  not  be  amenable  to  the  criminal  law. 
The  mere  fact,  however,  of  the  prisoner  being  ignorant  and  of  a  low  type 
of  mind  would  be  no  excuse.  If  the  jury  thought  that  the  prisoner  knew 
at  the  time  when  he  committed  the  act  that  he  was  doing  wrong,  and  was 
not  laboring  under  such  a  disease  of  the  mind  as  incapacitated  him  from 
controlling  his  impulses,  he  was  not  entitled  to  acquittal  on  the  ground  of 
insanity.  The  doctrine  of  uncontrollable  impulse,  as  laid  down  by  some 
writers,  was  a  very  dangerous  one,  and  required  to  be  watched  with  the 
utmost  care.  Passion  arising  from  provocation,  however  trivial,  offered 
to  a  mind  however  ill-regulated,  did  not  relieve  the  person  from  criminal 
responsibility."  Hence  it  follows  that  a  man  might  know  that  he  was 
doing  wrong  and  committing  an  act  against  the  laws  of  God  and  man, 
yet  if  with  this  consciousness  of  the  illegality  of  the  act  there  was  a  dis- 
eased condition  of  mind  which  prevented  him  from  controlling  his 
actions,  he  will  be  entitled  to  an  acquittal  on  the  ground  of  insanity. 
With  this  admission,  it  is  unnecessary  to  occupy  space  with  metaphysical 
discussions  regarding  criminal  responsibility ;  for  however  objectionable 
the  theory — if  the  practice  of  the  law  be  in  any  one  case  in  conformity 
with  that'which  has  been  advised  by  writers  on  the  Medical  Jurisprudence 
of  Insanity,  although  it  may  be  even  adverse  to  the  theory  on  which  it  is 
professedly  based,  this  is  all  with  which  we  have  to  concern  ourselves — 
the  principle  is  admitted.  The  great  defect  in  the  English  criminal  law 
is,  not  that  it  will  not  go  even  to  the  full  extent  of  exculpating  a  person 
Avho  has  committed  a  crime  with  a  knowledge  of  its  illegality,  and  under 
what  is  called  an  "uncontrollable  impulse,"  or  an  impulse  which,  owing 
to  mental  disease,  his  reason  was  not  sufficient  to  control,  but  the  micer- 
ta.iniy  of  its  application.  There  are  many  cases  reported  which  show 
that  an  acquittal  on  the  ground  of  insanity,  in  a  trial  for  murder,  is  fre- 
quently a  mere  matter  of  accident. 

Numerous  trials  for  murder  have  within  the  last  few  years  taken  place 
in  which  there  have  been  acquittals  on  the  ground  of  insanity,  and  the 
accused  confined  during  her  Majesty's  pleasure.     In  some  of  these  epilepsy 


PUERPERAL    MANIA.  735 

has  been  associated  with  insanity  The  details  of  these  eases  present  no 
strilviiig-  diti'erence  from  those  recorded  in  the  text,  Avith  the  exception  of 
one,  in  which  a  man  who  had  been  a  lunatic  and  had  recovered  was  tried 
on  a  charge  of  murder  and  acquitted  on  the  ground  of  insanity.  (Reg.  v. 
Blampied,  Maidstone  Sum.  Ass.,  1875.)  The  prisoner  was  charged  with 
the  wilful  murder  of  a  fellow-laborer  named  Catt.  Blampied  became 
insane  in  Dec.  1868,  was  confined  in  an  asylum,  from  which  he  was  dis- 
charged as  cured  in  Dec.  1872,  and  had  ever  since  worked  at  his  trade  in  a 
proper  manner.  The  deceased  man  was  often  associated  with  him,  and 
some  months  previously  a  quarrel  had  taken  place  between  them,  but  it 
was  not  serious,  and  they  were  apparently  on  friendly  terms.  In  April, 
1875,  they  were  working  within. six  feet  of  each  other,  when  the  prisoner, 
without  any  known  provocation,  struck  the  deceased  violently  with  an  adze 
on.  the  back  of  the  head,  fracturing  his  skull  and  causing  his  death.  The 
man  pleaded  not  guilty,  with  every  appearance  of  sanity.  In  the  defence 
it  was  urged  that  he  was  not  responsible  for  the  act  on  the  ground  of  in- 
sanity. Brett,  J.,  told  the  jury  that  the  law  took  no  heed  of  sanity  or 
insanity  abstractedly  considered,  or  of  the  presence  or  absence  of  delusions. 
To  exempt  from  responsibility,  a  man  must  be  so  mad  as  not  to  know  the 
nature  of  the  act  he  committed.  If  he  knew  what  he  was  doing,  and  if  he 
knew  that  it  was  wrong,  then,  however  mad  he  might  be,  he  was  still 
responsible.  He  also  remarked  that  for  three  years  previously  the  prisoner 
had  been  sane  and  had  been  treated  as  sane  by  his  associates.-  These  re- 
marks pointed  clearly  to  a  conviction,  but  the  jury  after  consulting  for  a 
short  time,  found  a  verdict  of  guilty,  but  that  the  prisoner  was  not  ac- 
countable for  his  acts;  in  other  words,  they  acquitted  him  on  the  ground 
of  insanity.  This  shows  that  on  these  occasions  a  jury  may  decline  to 
accept  the  legal  rule  of  responsibility  as  here  laid  down  and  act  upon  their 
own  judgment. 

From  the  number  of  acquittals  which  annually  take  place  on  the  ground 
of  insanity,  it  will  be  understood  that  Broadmoor  and  other  county 
asylums  have  a  large  population  of  criminal  lunatics.  In  1883,  there 
were  535  in  Broadmoor.  In  1881,  five  murderers  were  discharged  from 
Broadmoor,  and  six  died.  It  thus  appears  that  nearly  half  our  lunatic 
murderers  are  eventually  set  at  liberty. 


CHAPTER    LXyil. 

PUERPERAL      MANIA. PYROMANIA. KLEPTOMANIA. —  DIPSOMANIA. RESPONSIBILITV      OP 

DRUNKARDS. DELIRIUM  TREMENS. SOMNAMBULISM. THE  DEAF  AND  DUMB. 

Puerperal  Insanity. — Mania  may  present  itself  in  other  forms  than 
those  hitherto  considered.  Women  who  have  been  recently  delivered  are 
liable  to  sudden  attacks,  in  which  a  disposition  to  murder  their  offspring  is 
the  most  marked  symptom.  This  has  been  long  known  and  recognized  by 
physicians  as  "  puerpei-al  mania."  The  disorder  seldom  attacks  a  woman 
l)efore  the  third  day,  often  not  for  a  fortnight,  and  in  some  instances  not 
until  several  weeks  after  delive^3^  Out  of  ninety-two  cases,  Simpson 
oliserved  that  the  attack  occurred  in  twenty-one  between  the  fifth  and 
the  fifteenth  day.     (Med.  Times  and  Gaz.,  1860,  ii.  p.  201.)     The  most  fre- 


736  PUERPERAL    MANIA. 

quent  period  is  at  or  about  the  commencement  of  lactation,  and  between 
that  and  the  cessation  of  the  uterine  discharges.  According-  to  Esquirol, 
it  is  generally  preceded  or  attended  by  a  suppression  of  the  lochia  and 
milk.  Ashwell  remarked  that  undue  lactation  might  give  rise  to  an  attack 
of  mania,  under  which  the  murder  of  the  offspring  might  be  perpetrated. 
(Dis  of  Women,  p.  732.  See  the  case  of  Reg.  v.  Lacey,  Nottingham  Sum. 
Ass.,  1858.)     It  may  also  come  on  after  forced  or  voluntary  weaning. 

The  symptoms  do  not  differ  from  those  of  mania  generally,  but  it  may 
assume  any  of  the  other  forms  of  insanity  ;  and,  in  one-half  of  the  cafes, 
it  may  be  traced  to  hereditary  tendency.  There  is  a  childish  disposition 
for  harmless  mischief.  The  woman  is  gay  and  joyous,  laughing,  singing, 
loquacious,  inclined  to  talk  obscenely,  and  careless  of  everything  around. 
She  imagines  that  her  food  is  poisoned  ;  she  may  conceal  the  suspicion, 
and  merely  avoid  taking  what  is  offered  to  her.  She  can  recognize  per- 
sons and  things ;  and  can — though  perhaps  she  will  not — answer  direct 
questions.  Occasionally  there  is  great  depression  of  spirits  with  melan- 
cholia. These  facts  are  of  some  importance  in  reference  to  cases  of  alleged 
child-murder.  This  state  may  last  a  few  hours,  or  for  some  days  or  weeks. 
The  murder  of  the  child  is  generally  either  the  result  of  a  sudden  fit  of 
delirium  or  a  sudden  impulse,  with  the  full  knowledge  of  the  wickedness 
and  illegality  of  the  act;  so  that  the  legal  test  of  responsibility,  i.  e.  a 
knowledge  of  right  and  wrong,  cannot  be  strictly  applied  to  such  cases  as 
these,  except  on  the  assumption  that  insanity  already  exists  and  affects 
the  consciousness  of  the  individual.  A  woman  has  been  known  to  request 
her  attendants  to  remove  the  child,  but  she  has  afterwards  taken  an 
opportunity  to  destroy  it.  In  such  cases  of  deliberate  child-murder  there 
is  no  motive,  no  attempt  at  concealment,  nor  any  denial  of  the  crime  on  de- 
tection. There  is  in  general  a  full  consciousness  of  the  illegality  of  the  act, 
but  apparently  an  entire  want  of  power  to  control  the  murderous  feeling. 

Women  in  the  pregnant  state  have  been  known  to  perpetrate  murder, 
apparently  from  some  sudden  perversion  of  their  moral  feelings ;  there  has 
])cen  probably  latent  intellectual  disturbance,  but  not  sufficient  to  attract 
the  notice  of  friends.  There  is  such  a  sympathy  between  the  uterine 
organs  and  the  brain  as  may  account  for  the  occurrence  of  such  cases ;  but 
we  are  not  aware  that  irresponsibility  on  the  ground  of  insanity,  unless 
-there  were  independent  proofs  of  this  condition,  has  been  admitted  in  this 
country.  It  would  be  unsafe  to  act  on  such  a  principle.  On  the  occur- 
rence of  pregnancy,  mania,  melancholia,  and  other  disordered  and  capricious 
states  of  mind,  mav  show  themselves  in  women  predisposed  to  attacks  of 
this  kind ;  but  it  cannot  be  admitted  that  the  pregnant  state  ]iroduces  per 
se  a  disposition  to  rob,  steal,  or  murder.  An  intelligent  woman,  ret.  29, 
who  was  advanced  in  pregnancy,  felt  a  strong  desire  to  murder  her  three 
children,  to  whom  she  was  fondly  attached.  She  informed  her  husband 
and  her  medical  attendant  of  this  feeling,  which  haunted  her  in  spite  of 
every  effort  to  shake  it  off.  She  was  sent  away  from  the  children.  Such 
feelings,  when  they  cannot  be  controlled,  and  the  current  of  thought 
changed,  indicate  the  existence  of  incipient  mania.  There  can  be  no  doubt 
that,  as  a  rule,  a  pregnant  ^^'oman  possesses  a  free  will  just  as  in  the  or- 
dinary condition,  and  that  she  is  as  fully  conscious  of  her  actions.  Stulz 
affirms  that  since  this  doctrine  of  responsibility  in  reference  to  pregnant 
women  has  been  made  known  by  medical  men,  there  has  been  a  cessation 
of  criminal  acts  on  the  part  of  these  women.  (Ann.  d'llj^g.,  1873,  t.  2, 
p.  149.) 

Pyromania. — This  is  described  as  a  form  of  insanity  in  which  there  is  a 
morbid  disposition  of  mind  leading  to  impulsive  acts  of  incendiarism  with- 


KLEPTOMANIA.  737 

out  any  motive.     It  is  a  condition  not  specially  recognized  by  English 
jurists  nor  in  English  courts  of  justice. 

Kleptomania.  Propensity  to  Thieve. — This  term  has  been  applied  by 
Marc  to  that  form  of  insanity  which  is  said  to  manifest  itself  by  a  pro- 
pensity to  acts  of  theft.  It  is  alleged  by  him  and  others  that  this 
propensity  has  often  shown  itself  in  women  laboring  under  disordered 
menstruation,  or  among  those  who  were  far  advanced  in  pregnancy — the 
motive  being  the  mere  wish  of  possession.  It  is  not,  however,  confined 
to  the  female  sex.  Pregnancy,  according  to  him,  should  be  a  good  excul- 
patory plea  when  a  well-educated  woman,  of  strictly  moral  conduct,  steals 
some  unimportant  article  of  no  value  to  herself,  compared  with  her  worldly 
means  and  position  in  society.  There  arc  several  instances  on  record  show- 
ing that  well-educated  persons  moving  in  a  respectable  sphere  of  society 
have  been  guilty  of  petty  acts  of  theft.  The  articles  taken  have  been 
valueless  compared  with  their  means.  Instances  of  this  kind  have  been 
brought  before  our  police-courts,  and  this  motiveless  impulse  to  theft  has 
been  occasionally  pleaded  ;  but  in  most  of  them  the  following  facts  have 
been  established  by  evidence:  1.  A  perfect  consciousness  of  the  act  and 
of  its  illegality.  2.  The  article,  though  of  trifling  value,  has  still  been  of 
some  use  to  the  person  ;  thus  women  have  stolen  articles  either  adapted  to 
female  use  or  on  which  money  could  be  raised.  3.  There  have  been  art 
and  precaution  in  endeavoring  to  conceal  the  theft.  4.  Either  a  denial  of 
the  act  when  detected,  or  some  evasive  excuse.  When  circumstances  of 
this  kind  are  proved,  either  the  persons  charged  with  stealing  should  be 
made  responsible,  or  theft  should  be  openly  tolerated.  The  evidence  of  a 
disordered  state  of  mind  should  not  be  allowed  to  depend  on  the  nature  of 
the  act,  or  every  morally  depraved  person  might  bring  forward  a  plea  of 
insanity  for  any  crime  or  offence.  In  a  trial  which  took  place  at  the  Middle- 
sex Sessions,  in  Aug.  1878,  a  man  was  charged  with  stealing  a  portmanteau 
from  a  railway  station.  In  his  defence,  the  prisoner  said  that  he  was  a 
kleptomaniac ;  but  the  plea  did  not  avail  him.  This  case  shows  that 
Marc's  suggestion  has  reached  the  class  of  common  thieves.  When  the 
facts  proved  really  justify  a  plea  of  insanity  in  a  case  of  stealing,  the  rule 
appears  to  be  (Tindal,  C.  J.)  that  there  should  be  proof  that  the  prisoner 
was  incompetent  to  know  that  the  particular  act  in  question  was  a  wrong 
one.  (Reg.  v.  Yaughan,  Monmouth  Sum.  Ass.,  1844.)  When  there  is 
satisfactory  evidence  on  this  point,  the  person  will  be  acquitted  on  the 
ground  of  insanity.  This  is  shown  by  the  following  case,  which  was 
tried  at  the  Middlesex  Sessions,  Feb.  1875.  A  clergyman  named  Hall, 
well  educated,  was  charged  with  stealing  two  pairs  of  ladies'  gloves.  The 
prisoner  entered  a  glove-shop  in  the  evening,  and  asked  to  look  at  some 
dress  gloves.  He  was  show^n  a  box,  but  expressed  a  wish  for  a  darker 
color.  While  the  shopwoman  turned  for  the  purpose  of  getting  them,  he 
took  two  pairs  from  the  drawer,  and  concealed  them  in  his  pocket.  He  at 
first  denied  that  he  had  them  ;  offered  to  pay  for  them,  and  tried  to  leave  ; 
but  was  detained.  When  before  the  magistrate,  he  said  he  was  liable  to 
attacks  on  the  brain,  at  which  times  he  did  not  know  what  he  was  doing. 
Tiike  deposed  that  some  years  before  he  had  on  two  occasions  attended 
the  prisoner  for  disease  of  the  brain.  He  was  a  man  of  high  attainments. 
He  had  recently  seen  him,  and  found  him  suffering  from  brain-disease,  so 
that  at  times  he  was  quite  mad.  He  believed  that  the  prisoner  did  not 
know  the  nature  or  quality  of  the  act  he  committed  at  the  time  of  its  com- 
mission, and  that  his  opinion  of  the  mental  state  of  the  prisoner  was  not 
affected  by  hearing  the  evidence  for  the  prosecution.  The  jury  found  a 
verdict  of  not  guilty,  on  the  ground  of  insanity ;  and  he  was  ordered  to  be 
47 


738  CRIMINAL    RESPONSIBILITY  "OF    DRUNKARDS. 

detained  during  her  Majesty's  pleasure.  Although  the  prisoner  had  shown 
in  the  act  the  usual  cunning  of  thieves  in  stealing  behind  the  back  of  the 
vendor,  in  trying  to  conceal  the  theft,  denying  it,  and  trying  to  escape, 
the  evidence  was  very  conclusive  in  showing  that  he  labored  under  mania. 
The  articles  stolen  were  not  such  as  he  could  use  or  wear,  and  of  only 
paltry  value. 

Dipsomania.     Drunkenness.      Civil  Responsibility  of  Drunkards 

This  state,  which  is  called  in  law  frenzy,  is  regarded  as  a  temporary  form 
of  insanity.  Jurists  and  legislators  have  differed  widely  respecting  the 
degree  in  which  drunkards  should  be  made  responsible  for  their  acts. 
When  the  mind  of  a  man  is  completely  weakened  by  habitual  drunkenness, 
the  law  infers  irresponsibility,  unless  it  plainly  appears  that  the  person 
was  at  the  time  of  the  act,  whether  of  a  civil  or  of  a  criminal  nature,  endowed 
with  full  consciousness  and  reason  to  know  its  good  or  evil  tendency.  Any 
deed  or  agreement  made  by  a  person  when  drunk  is  not  invalidated  by 
our  law^,  except  in  a  case  in  which  the  intoxication  has  proceeded  so  far  as 
to  deprive  him  of  all  consciousness  of  what  he  is  doing;  and  a  court  of 
equity  will,  not  interfere  in  any  case,  unless  the  drunkenness  is  proved  to 
have  been  the  result  of  collusion  by  others  for  the  purposes  of  fraud.  When 
the  drunkenness  has  occasioned  a  temporary  loss  of  the  reasoning  powers, 
the  person  is  incapable  of  giving  valid  consent,  and  therefore  cannot  enter 
into  a  contract  or  agreement,  for  this  implies  a  mutual  assent  of  the  par- 
ties. Partial  drunkenness,  therefore,  provided  the  person  knew  what  he 
was  about,  does  not  vitiate  a  contract  or  agreement  into  which  he  may 
have  entered.  Thus  the  law  appears  to  define  two  states  in  drunkenness  : 
one  in  which  it  has  proceeded  to  but  a  slight  extent,  and  it  is  considered 
that  there  is  still  a  power  of  rational  consent;  another,  in  which  it  has 
proceeded  so  far  that  the  person  has  no  consciousness  of  the  transaction, 
and  therefore  can  give  no  rational  consent.  The  proof  of  the  existence  of 
this  last  state  would  render  all  the  civil  acts  of  a  person  void  (see  p.  769, 
ante).  A  confession  made  by  a  man  while  in  a  state  of  drunkenness  is 
legally  admissible  as  evidence  against  him  and  others,  provided  it  be  cor- 
roborated by  circumstances.  In  a  case  tried  a  few  years  since,  the  pris- 
oner confessed,  while  drunk,  that  he  had  committed  a  robbery  and  murder 
which  had  taken  place  some  time  before,  but  of  which  he  had  not  been 
suspected.  He  mentioned  a  spot  where  the  property  of  the  murdered  per- 
son had  been  concealed  by  him,  and  the  whole  of  the  circumstances  of  the 
murder.  The  property  was  found  as  he  had  described  it,  and  the  case  was 
clearly  brought  home  to  him,  chiefly  by  collateral  evidence  from  his  own 
confession.  He  was  convicted.  In  one  case  (C.  C  C,  Oct.  1849),  a  man 
pleaded  his  drunkenness  at  the  time  of  his  first  marriage  as  a  defence  to  a 
charge  of  bigamy.  There  was  evidence  to  show  that  he  was  partly  in- 
toxicated when  the  ceremony  was  performed;  it  was  proved,  however, 
that  he  was  sufficiently  conscious  of  the  whole  of  the  proceedings,  and  ho 
was  convicted.     (Lond.  Med.  Gaz.,  vol.  xliv.  p.  162.) 

By  the  Inebriates  Acts  (42  and  43  Vict.  c.  19,  and  51  and  52  Yict.  c. 
19),  a  person  given  to  drink  may  voluntarily  enter  a  retreat  provided  for 
such  persons  for  a  definite  period,  not  exceeding  twelve  months;  and, 
having  thus  voluntarily  placed  himself  under  restraint,  he  cannot  leave  the 
house  of  retreat  until  the  expiration  of  the  stipulated  time. 

Criminal  Responsibilitij  of  Drunkards. — When  homicide  is  committed 
by  a  man  in  a  state  of  drunkenness,  this  is  held  to  be  no  excuse  for  the 
crime.  If  voluntarily  induced,  whatever  may  be  its  degree,  it  is  not  ad- 
mitted as  a  ground  of  irresponsibility,  even  although  the  person  might  not 
have  contemplated  the  crime  when  sober.     (Reg.i;.  Reeves,  Derby  Wint. 


CRIMINAL    RESPONSIBILITY    OP    DRUNKARDS.  739 

Ass.,  1844.)  Thus  it  appears  that  when  the  state  of  drunkenness  is  such 
that  any  civil  act  would  be  void,  a  person  may  still  be  held  lej^ally  respon- 
sible for  a  crime  like  murder.  Some  judges  have  admitted  a  plea  of  ex- 
culpation when  the  crime  has  been  committed  in  a  state  of  frenzy  arising 
from  habitual  drunkenness;  but  even  this  is  not  general.  The  question 
whether  the  person  was  or  was  not  drunk  at  the  time  of  committing  tlie 
crime  may  be,  however,  occasionally  of  some  importance.  It  was  held  by 
Paterson,  J.,  that,  although  drunkenness  is  no  excuse  for  any  crime  what- 
ever, yet  it  is  of  very  great  importance  in  cases  in  which  there  is  a  ques- 
tion of  intention.  A  person  may  be  so  drunk  as  to  be  utterly  unable  to 
form  any  intention  at  all,  and  yet  he  may  be  guilty  of  very  great  violence. 
(Reg.  V.  Cruse.)  If  the  drunkenness  has  produced  a  diseased  state  of  the 
mind,  then  a  criminal  act  perpetrated  by  the  person  might  admit  of  excul- 
pation, either  on  the  ground  of  insanity  or  of  the  want  of  sane  conscious- 
ness at  the  time  of  the  act ;  but  the  difficulty  is  to  prove  in  such  cases  the 
existence  of  actual  disease  in  a  sufficient  degree  to  render  the  person  irre- 
sponsible in  a  legal  sense.  When  it  is  a  question  whether  the  accused  was 
actuated  by  malice  or  not,  a  jury  may,  under  certain  circumstances,  be  re- 
quired to  take  the  fact  of  drunkenness  into  their  consideration,  and  this 
may  have  some  influence  upon  their  verdict.  While,  then,  drunkenness 
does  not  furnish  any  excuse  for  a  crime,  it  may  become  material  with 
reference  to  the  intent  with  which  a  crime  has  been  perpetrated.  (Law 
Times,  Sept.  27,  1845,  p.  542.)  It  is  obvious  that,  if  drunkenness  were 
to  be  readily  admitted  as  a  defence,  three- fourths  of  the  crimes  committed 
in  this  country  would  go  unpunished. 

[The  law  as  now  settled  in  England  and  the  American  States  may  be 
stated  as  follows  : — 

While  drunkenness  is  not  per  se  a  defence  upon  a  charge  of  crime, 
yet  mental  unsoundness  superinduced  by  excessive  intoxication,  and  con- 
tinuing after  it  has  subsided,  may  excuse ;  or  where  the  mind  is  de- 
stroyed by  a  long-continued  habit  of  drunkenness;  or  where  the  long- 
continued  drunkenness  has  caused  an  habitual  madness,  which  existed 
when  the  offence  was  committed,  the  victim  would  not  be  responsible.  For 
if  the  reason  be  perverted  or  destroyed  by  a  fixed  disease,  although 
brought  on  by  his  own  vices,  the  law  holds  him  not  accountable  :  Rex 
V.  Meakin,  7  Car.  &  P.  297;  Reume's  Case,  1  Lewin,  76;  Reniger  v. 
Fogassa,  Plow.  1;  1  Russ.  on  Crimes  (9th  ed.),  12;  1  Bishop  Cr.  L, 
(6th  ed.)  406;  1  Wharton  Cr.  L.  (8th  ed.),  sec.  48;  McDonald  C.  L.  of 
Scot.  16;  1  Hale,  4;  Black.  Com.  26;  Beaslev  v.  State,  50  Ala.  149; 
Peo.  V.  Odill,  I  Dak.  Ter.  197  ;  Estes  v.  State,  55  Ga.  30  ;  Baily  v.  State, 
26  Ind.  422  ;  Roberts  v.  People,  10  Mich.  401 ;  s.  c.  19  Mete.  402;  State 
V.  Hundley,  46  Mo.  414;  State  v.  Thompson,  12  Nev.  140;  Lanergan  v. 
People,  50  Barb.  (N.  Y.)  266  ;  Maconnehey  d.  State,  5  Ohio,  77  ;  Com.  v. 
Green,  1  Ashm.  (Pa.)  289;  U.  S.  v.  Forbes,  Crabbe  (D.  C),  558;  Stuart 
V.  State,  57  Tenn.  178;  Carter  v.  State,  12  Texas,  500;  Bell's  Med. 
Jurisp.  of  Inebriety,  p.  10,  and  cases  there  cited. 

The  rule  of  law  is  well  settled  that  evidence  of  intoxication  is  always 
admissible  to  explain  the  conduct  and  intent  of  the  accused  in  cases  of 
homicide,  although  the  rule  does  not  apply  in  lesser  crimes,  where  the 
intent  is  not  a  necessary  element  to  constitute  a  degree  or  phase  of  the 
crime:  Bell's  Med.  Jur.  of  Inebriet}'",  p.  10,  and  cases  there  cited. 

In  cases  where  the  law  recognizes  different  degrees  of  a  given  crime, 
and  provides  that  wilful  and  deliberate  intention,  malice,  and  premeditation 
must  be  actually  proved  to  convict  in  the  first  degree,  it  is  a  proper  subject 
of  inquiry  whether  the  accused  was  in  a  condition  of  mind  to  be  capable 


740  CRIMINAL    RESPONSIBILITY    OF    DRUNKARDS. 

of  premeditation  :  Graj,  J.,  in  Hopt  v.  People,  104  U.  S.  631  ;  Buswell  on 
Insanity,  §  450  ;  Peun  v.  McFall,  ,Addison,  255  ;  Keenan  v.  Common- 
wealth, 44  Pa.  St.  55;  Jones  v.  Com.,  75  Pa.  St.  403;  State  v.  Johnson, 
40  Conn.  136;  Pirttle  v.  The  State,  9  Humph.  663;  Haile  v.  State,  11 
Humphrey,  154;  Smith  v.  Duval  (Kv.),  224;  Bosswell  v.  Com.,  20 
Gratt.  860;  Willis  i;.  Com.,  32  Gratt. '929  ;  People  v.  Belencia,  21  Cal. 
544  ;  People  v.  Kin!,^  2"  Cal.  507  ;  People  v.  Lewis,  36  Cal.  531  ;  People 
V.  Williams,  43  Cai.  344 ;  Farrell  v.  State,  43  Texas,  508 ;  Colbath  v. 
State,  2  Tex.  App.  391 ;  State  u.  White,  14  Kan.  538;  Schlacken  v.  State, 
9  Neb.  241;  104  U.  S. 

The  reason  of  this  rule  of  law  rests  upon  the  fact  that  intoxication  is  a 
circumstance  to  be  weighed  in  connection  with  the  other  circumstances 
surrounding  the  commission  of  the  act  in  determining  whether  it  was  in- 
spired by  deliberate  and  malicious  intent,  and  whether  immediately  before 
and  at  tiie  time  of  his  act  the  intoxication  of  the  accused  was  so  great  as 
to  render  him  incapable  of  forming  a  design  or  intent,  which  the  jury 
must  find  from  the  facts  in  the  case,  without  regard  to  opinions  of  others: 
Buswell  on  Insanity,  §  452  ;  Marshall's  Case,  1  Lew.  Cr.  Cas.  76  ;  Thacher, 
J.,  in  Kelly  v.  State,  3  S.  &  M.  518 ;  Armor  v.  State,  63  Ala.  173 ;  People 
V.  Belencia,  21  Cal.  544. 

And  because,  since  he  who  voluntarily  becomes  intoxicated  is  subject 
to  the  same  rules  of  law  as  the  sober  man,  it  follows:  that  where  a 
provocation  has  been  received  which,  if  acted  upon  instantly,  would  miti- 
gate the  offence  if  committed  by  a  sober  man,  the  question  in  the  case  of 
a  drunken  man  sometimes  is,  whether  such  provocation  was  in  fact  acted 
upon,  and  evidence  of  intoxication  may  be  considered  in  deciding  that 
question  :   Buswell  on  Insanity,  §  423  ;  State  xi.  McCants,  1  Speer,  384. 

The  New  York  Penal  Code  defines  precisely  this  question  of  respon- 
sibility in  that  State  in  such  cases  as  follows:  "§  22.  Intoxicated  persons 
— No  act  committed  by  a  person  while  in  a  state  of  intoxication  shall  be 
deemed  less  criminal  by  reason  of  his  having  been  in  such  condition.  But 
whenever  the  actual  existence  of  any  particular  purpose,  motive,  or  intent 
is  a  necessary  element  to  constitute  a  particular  species  or  degree  of  crime, 
the  jury  may  take  into  consideration  the  fact  that  the  accused  was  intoxi- 
cated at  the  time,  in  determining  the  purpose,  motive,  or  intent  with  which 
he  committed  the  act."] 

In  cases  in  which  the  head  has  sustained  any  physical  injury,  as  among 
soldiers  and  sailors,  drunkenness,  even  when  existing  to  a  slight  extent, 
produces  sometimes  a  fit  of  temporary  insauit}^,  leaving  the  mind  clear 
when  the  drunken  fit  is  over.  The  law  makes  no  distinction  between 
this  state  and  ordinary  drunkenness,  although  juries  occasionally  show 
by  their  verdicts  that  some  difference  ought  to  be  made. 

Hallucinations  and  illusions  are  a  common  effect  of  drunkenness,  and 
may  lead  to  the  commission  of  criminal  acts.  Marc  relates  a  case  where, 
two  friends  being  intoxicated  the  one  killed  the  other  under  an  illusion 
that  he. was  an  evil  spirit.  The  drunkenness  of  the  accused  was  held  to 
have  been  voluntary  ;  and  he  was  condemned.  A  case  of  this  description 
CReg.  V.  Patteson)  was  tried  at  the  Norfolk  Lent  Ass.,  1840.  A  man  while 
intoxicated  killed  his  friend,  who  was  also  intoxicated,  under  the  illusion 
thnt  he  was  some  other  person  who  had  come  to  attack  him.  It  is  re- 
ported that  the  guilt  of  the  prisoner  was  made  to  rest  upon  the  fact 
whether,  had  he  been  sober,  he  would  have  perpetrated  the  act  under  a 
similar  illusion.  As  ho  had  voluntarily  brought  himself  into  a  state  of 
intoxication  this  was  no  justification,  and  he  was  found  guilty  of  man- 
slauirhter. 


ACTS    DURING    FITS    OF    DELIRIUM    TREMENS.  741 

The  proof  of  drunkenness  may  fail,  but  still,  if  the  person  charged  with 
the  death  acted  under  an  illusion,  he  will  be  acquitted.  In  Keg.  v.  Price 
(Maidstone  Sum.  Ass.,  184()),  it  was  proved  that  the  prisoner,  who  had 
been  on  friendly  terms  with  the  deceased,  was  going  home  at  night, 
having  previously  been  in  company  with  him  at  a  public-house.  Ac- 
cording to  the  prisoner's  statement,  a  man  sprang  upon  him  from  tljc 
hedge  by  the  roadside,  and  demanded  his  money  and  his  watch,  or  else  he 
said  he  would  have  his  life  ;  the  prisoner  closed  with  him  and  beat  him 
severely,  inflicting  such  injuries  that  he  died  shortly  afterwards.  The 
supposed  robber  turned  out  to  be  his  friend,  and  it  was  believed  that  he 
had  made  an  attempt  to  rob  the  prisoner  jokingly  ;  the  result,  however, 
was  that  the  attempt  had  ended  in  this  fatal  manner.  The  prisoner 
throughout  told  the  same  story,  and  there  did  not  appear  to  be  the 
slightest  ground  for  suggesting  that  it  was  untrue.  Coltman,  J.,  after 
hearing  the  evidence  of  the  witness,  said  it  appeared  to  be  quite  clear  that 
the  prisoner  had  acted  under  an  impression  that  he  was  protecting  his 
own  life  from  the  attack  of  a  robber,  and  under  such  circumstances  he 
could  not  be  held  to  be  criminall}^  responsible.  The  jury  accordingly  re- 
turned a  verdict  of  not  guilty,  and  the  prisoner  was  discharged. 

Delirium  Tremens. — This  is  a  disordered  state  of  mind  proceeding 
from  an  abuse  of  intoxicating  liquors.  Habitual  drunkenness  is  the  pre- 
disposing, while  abstinence  from  drink  may  be  the  immediately  exciting 
cause.  Thus  the  disorder  frequently  does  not  show  itself  until  the  accus- 
tomed stimulus  has  been  withdrawn  for  a  certain  period.  It  commences 
with  tremors  of  the  hands,  by  which  it  is  known  from  ordinary  delirium 
and  restlessness;  and  the  individual  is  subject  to  hallucinations  and  illu- 
sions, sometimes  of  a  horrible  kind,  referring  to  past  occupations  or  events. 

The  patients  are  often  violent,  and  prone  to  commit  suicide  or  murder 

more  commonly  the  former  ;  hence  they  require  close  watching.  Persons 
proved  to  be  laboring  under  this  disorder  are  incompetent  to  the  per- 
formance of  any  civil  act ;  and  they  are  not  responsible  for  criminal  acts 
committed  while  they  are  suffering  from  an  attack.  Acquittals  have  even 
taken  place  on  charges  of  murder,  when  there  was  deliberation  as  well  as 
an  apparent  motive  for  the  act.  Thus,  then,  although  this  disorder  mav 
have  been  voluntarily  brought  on  by  habitual  drunkenness,  the  law  admits 
it  as  a  sufficient  plea  for  irresponsibility,  while  in  a  case  of  confirmed 
drunkenness  it  rejects  the  plea.  In  delirium  there  is  a  formed  disease  of 
the  brain,  while  voluntary  drunkenness  merely  produces  a  temporary  dis- 
turbance of  its  functions.  In  one  trial  the  evidence  showed  that  homicide 
had  been  committed  by  the  accused  while  he  was  laboring  under  an  attack 
of  delirium  tremens.  (Reg.  v.  Simpson,  Appleby  Sum.  Ass.,  1845.)  The 
prisoner's  mind  had  become  unsettled  from  this  disorder,  brought  on  bv 
habitual  drunkenness.  In  another  case  the  plea  was  also  admitted  bv  the 
jury,  although  it  was  scarcely  supported  by  the  medical  evidence.  (Re.ir. 
V.  Watson,  York  Wint.  Ass.,  1845.)  In  one  case,  Reg.  v.  Burns  (Liver- 
pool Sum.  Ass.,  1865),  a  man  laboring  under  delirium  tremens  was 
charged  with  the  murder  of  his  wife.  After  the  act  he  appeared  calm, 
and  said  that  he  knew  perfectly  well  what  he  had  done ;  "  his  wife  was  in 
league  with  men  who  M'ere  hidden  in  the  walls."  Bramwell,  B.,  in 
charging  the  jury,  said,  "there  were  two  kinds  of  insanity  by  reason  of 
which  a  prisoner  was  entitled  to  be  acquitted;  probably  the  jury  would 

not  be  of  opinion  that  the  prisoner  did  not  know  the  quality  of  his  act 

that  it  would  kill,  and  was  wrong;  but  it  was  still  open  to  them  to  acquit 
him  if  they  were  of  opinion  that  he  was  suffering  from  a  delusion  leading 
him  to  suppose  that  which,  if  true,  would  have  justified  him  in  the  act. 


742  ACTS    DURING    FITS    OF    DELIRIUM    TREMENS. 

One  more  remark  he  would  make — viz,  that  drunkenness  was  no  excuse, 
and  that  a  prisoner  cannot  bj  drinking-  qualify  himself  for  the  perpetra- 
tion of  crime  ;  but  if  through  drink  his  mind  had  become  substantially 
impaired,  a  ground  of  acquittal  would  then  fairly  arise."  The  prisoner 
was  acquitted.  In  Reg.  v.  Chaplain  (Warwick  Ass.,  Nov.  1878),  the 
prisoner  was  charged  with  felonious  wounding  by  firing  a  revolver  at  two 
persons.  It  was  proved  that,  at  the  lime  of  the  acts,  the  prisoner  was 
sufleriug  from  an  acute  attack  of  delirium  tremens,  after  sudden  cessation 
from  excessively  hard  drinking.  Medical  evidence  also  proved  that  at  the 
time,  and  for  two  days  after,  he  was  in  such  a  state  that  he  would  not 
know  the  nature  of  his  acts.  He  fired  the  shots  under  the  delusion  that 
some  one  was  breaking  into  the  house.  Upon  this  evidence  the  prisoner 
was  found  not  guilt}^  on  the  ground  of  insanity.  In  another  case  (Reg, 
r.  M'Gowan,  Manchester  Ass.,  Oct.  1878),  it  was  proved  that  the  pris- 
oner, who  was  charged  with  the  murder  of  his  wife,  had  been  drinking 
heavily  for  two  or  three  weeks.  The  medical  evidence  was  to  the  effect 
that  he  was  sufi'ering  from  temporary  disease  of  the  brain  as  a  result  of 
excessive  drinking ;  that  the  man  knew  what  he  had  done,  as  he  had  vol- 
untarily given  himself  up  for  it ;  but  that  he  was  not  accountable  for  his 
actions.  Manisty,  J.,  said  if  a  man's  insanity  was  so  fixed,  habitual,  and 
permanent  that  it  reduced  him  to  a  state  of  being  without  reason  or  mind, 
then  he  was  not  accountable  or  responsible  for  his  actions,  But  if  the 
prisoner's  insanity  was  only  temporary  and  produced  by  his  OAvn  ex- 
cesses the  law  did  not  excuse  him  from  the  results  of  his  acts.  The  man 
was  found  guilty.  In  a  recent  case  (Reg.  v.  Raines,  Leicester  Ass.,  Jan. 
1886),  Day,  J.,  ruled  that  if  a  man  were  in  such  a  state  of  intoxication 
that  he  did  not  know  the  nature  of  his  act,  or  that  his  act  w^as  wrongful, 
his  act  would  be  excusable. 

[The  rule  of  law  is  well  established,  both  in  England  and  in  the  Ameri- 
can States,  that  insanity  produced  by  delirium  tremens  is  a  good  defence 
to  a  criminal  charge.     Even  if  induced  by  intoxication,  the  victim  is  no 
more  punishable  for  his  acts  than  if  the  delii'ium  had  resulted  from  causes 
not  under  his  control :  Regina  v.  Davis,  14  Cox  C.  C.  563 ;  Bell  on  Med. 
Juris,  of  Inebriety,  9,  and  cases  there  cited;  J.  Crisp  Poole,  Med.  Leg. 
Jour.,  vol.  8,  p.  44;  U.  S.  v.  McGlue,  1   Curt.  1 ;  Wharton's  Crim.  Law 
(8th  ed.),   sec.  48;  People  v.  Williams,  43  Cal.  344;  U.  S.  v.  Clarke,  2 
Cr.  C.  C.  158  ;  Lanergan  v.  People,  50  Barb.  (N.  Y.;  266 ;  s.  c.  6  Parker 
Cr.  R.  (N.  Y.)  209;  O'Brien  v.   People,   48  Barb.  274;  State  v.  Dilla- 
hunt,  3  Harr.  (Del.)  551  ;  State  v.  McGonigal,  5  Harr.  (Del.)  510;  Cluck 
V.  State,  40  Ind.  563 ;  Bradley  v.  State,  26  Ind.  423  ;  O'Herrin  v.  State, 
14  Ind.  420;  Dawson  v.  State,  16  Ind.  428;  Fisher  v.  State,  64  Ind.  435 
Smith  V.  Com.,    1  Duv.   (Kv.)  224;  Roberts  v.   People,   10  Mich.  401 
State  V.  Hundlev,  46  Mo.  414;  State  v.  Sewell,  3  Jones  (N.  C.)  L.  245 
Cornwell  v.   State,   Mart.    &  Y.   (Tenn.)   147  ;  Carter  v.  State,  12  Tex 
500 ;  Boswell  v.  Com.,  30  Graft.  (Ya.)  860 ;  U.  S.  v.  Drew,  5  Mason  C 
C.  283.] 

As  in  one  of  the  cases  above  noticed,  an  attack  of  delirium  tremens 
may  be  brought  on  by  the  sudden  withdrawal  of  alcoholic  stimulants 
from  a  person  long  accustomed  to  take  them  in  excess.  The  sudden  ab- 
stinence from  other  narcotics,  such  as  opium  and  hydrate  of  chloral,  may 
induce  a  similar  attack.  A  person  might  thus  be  rendered  temporarily 
unconscious  of  his  actions  and  therefore  legally  irresponsible  for  an  act  of 
violence  committed  while  he  was  in  this  state.  A  case  occurred  in 
Canada,  in  which  this  question  arose  in  reference  to  hydrate  of  chloral. 
There  is  reason  to  believe  that  this  drug  would  operate  on  the  brain  and 


ACTS    IN    A    STATE    OF    SOMNAMBULISM.  743 

nervous  system  in  the  same  manner  as  alcohol,  opium,  and  morphine. 
(Guy's  Hosp.  Gaz.,  Jan.  1879,  p.  9.) 

Somnambulism. — Tliis  term  strictly  applies  to  sleep-walking,  but  the 
medico-legal  facts  are  chiefly  confined  to  acts  of  violence,  perpetrated 
unconsciously,  or  in  a  state  of  "unconscious  cerebration"  during  sleep,  in 
Avhich  it  is  presumed  that  malice  and  intention,  the  chief  ingredients  of 
crime,  are  wanting  It  has  been  a  contested  question  among  medical  jurists, 
how  far  a  person  should  be  held  responsible  for  an  act  perpetrated  in  that 
half-conscious  state  which  exists  when  he  is  suddenly  aroused  from  sleep. 
There  is  no  doubt  that  the  mind  is  at  this  time  subject  to  hallucinations 
and  illusions,  which  may  be  more  active  and  persistent  in  some  persons 
than  in  others;  but  it  is  difficult  to  suppose,  unless  we  imagine  there  is  a 
sudden  access  of  insanity,  that  a  person  should  not  recover  from  the 
delusion  before  he  could  perpetrate  an  act  like  murder.  A  remarkable 
case  of  this  description,  that  of  Bernard  Schedmaizig,  will  be  found 
reported  by  Marc.  This  man  suddenly  awoke  at  midnight,  and  saw,  as 
he  believed,  a  frightful  phantom.  He  twice  called  out,  "  Who  is  that  ?" 
and  receiving  no  answer,  and  imagining  that  the  phantom  was  advancing 
upon  him,  he  seized  a  hatchet  which  was  beside  him,  attacked  the  supposed 
spectre  and  killed  his  wife.  He  was  charged  with  murder,  but  was  pro- 
nounced "  not  guilty,''  on  the  ground  that  he  was  not  at  the  lime  conscious 
of  his  actions.  A  pedlar  in  the  habit  of  walking  about  the  country  armed 
with  a  sword-stick,  while  lying  asleep  on  the  high-road  was  roused  by  a 
man  accidentally  passing,  who  seized  and  shook  him  by  the  shoulders. 
The  pedlar  suddenly  awoke,  drew  his  sword  and  stabbed  the  man,  who 
died.  The  pedlar  was  tried  for  manslaughter.  His  irresponsibility  was 
strongly  urged  by  his  counsel,  on  the  ground  that  he  could  not  have  been 
conscious  of  an  act  thus  perpetrated  while  in  a  half-waking  state  ;  and 
this  defence  was  supported  by  the  opinion  of  a  medical  witness.  The 
prisoner  was  however,  found  guilty.  Under  such  circumstances,  it  was 
not  unlikely  that  an  idea  had  arisen  in  the  prisoner's  mind  that  he  had 
been  attacked  by  robbers  and  therefore  had  stabbed  the  man  in  self- 
defence.  In  1878,  one  Simon  Fraser  was  tried  in  Scotland  for  the  murder 
of  his  child.  It  was  proved  that  he  lifted  the  child  from  its  bed  and  killed 
it  by  dashing  its  head  against  the  wall  of  the  room.  The  defence  was 
that  it  was  done  unconsciously  while  he  was  in  a  state  of  somnambulism. 
He  dreamed  that  he  had  seen  a  wild  beast  jump  into  his  bed  and  he  rose  to 
attack  it.  It  seems  that  from  boyhood  he  had  been  accustomed  to  get  up 
in  his  sleep.  Clerk,  L.  J.,  directed  the  jury  to  find  that  the  prisoner  "  had 
killed  his  child  when  unconscious  of  the  act,  by  reason  of  his  condition  as 
a  somnambulist,  and  that  he  was  not  responsible  for  his  actions."  (Brit. 
Med.  Jour.,  1878,  ii.  p.  108.)  In  Reg.  v.  Byron  (Winchester  Wint.  Ass., 
1863),  it  was  proved  that  a  blow  struck  by  a  drunken  person  during  sleep 
had  caused  death.  The  prisoner  and  the  deceased  were  soldiers  in  the 
same  regiment.  The  prisoner  was  in  the  street  drunk,  and  the  deceased, 
seeing  this,  took  him  in,  to  prevent  his  being  arrested  for  drunkenness, 
and  placed  him  on  his  bed.  In  this  state  he  lay  for  some  time  insensible. 
In  the  course  of  the  afternoon  the  deceased  went  up  stairs  to  see  him  ;  he 
tried  to  awaken  him,  when  the  prisoner  suddenly  kicked  out  and  his  boot 
came  violently  against  the  lower  part  of  the  abdomen  of  the  deceased. 
The  prisoner  did  not  awake,  but  appeared  then  to  be  quite  insensible. 
The  deceased  died,  and  it  was  found  that  the  blow  had  caused  rupture  of 
the  intestines.  As  in  order  to  constitute  the  crime  of  manslaughter  it 
must  be  shown  that  the  person  charged  did  something  knowingly,  and  the 
prisoner  was  not  in  a  state  to  have  known  anything,  it  was  held  that  there 


74-1  THE    DEAF    AND    DUiMB. 

was  no  case  against  him  and  he  was  acquitted.     The  act  was  committed 
during-  sleep,  but  the  sleep  was  the  result  of  voluntary  drunkenness. 

Somnambulism  may  become  a  subject  of  discussion  under  a  contested 
policy  of  life  insurance,  in  which  it  may  be  provided  that  it  shall  be 
vitiated  by  suicide.  If  a  man  falls  from  a  height  and  is  killed  while  in  a 
state  of  somnambulism,  would  this  be  considered  an  act  of  suicide  within 
the  meaning  of  the 'policy  ?  The  proviso  against  suicide  has  been  held  to 
include  only  intentional  killing  (case  of  Borradaile  v.  Hunter,  Lond.  Med. 
Gaz.,  vol.  xxxvi.  p.  826),  and  in  death  under  these  circumstances  the  kill- 
ing cannot  be  said  to  be  intentional:  it  can  be  regarded  only  as  an  acci- 
dent— therefore  it  is  reasonable  to  infer  that  the  policy  would  not  be  void. 
It  is  impossible,  however,  to  lay  down  any  general  rules  relative  to  cases 
of  this  description,  since  the  circumstances  attending  each  case  will  sutfi- 
ciently  explain  how  far  the  act  of  murder  or  suicide  has  been  committed 
during  a  state  of  somnambulism,  or  under  an  illusion  continuing  from  a 
state  of  sleep. 

The  Deaf  and  DuiMB. 

It  was  formerly  laid  down  in  the  law-books,  that  a  person  born  deaf 
and  dumb  was  by  presumption  of  law  an  idiot,  but  in  modern  practice 
want  of  speech  and  hearing  does  not  imply  want  of  capacity  either  in 
the  understanding  or  memory,  but  only  a  difficulty  in  the  means  of  com- 
municating knowledge;  and  when  it  can  be  shown  that  such  a  person  has 
under^itanding,  which  many  in  this  condition  reveal  by  signs,  he  may  be 
tried  and  suffer  judgment  and  execution.  A  deaf-and-dumb  person  is  not 
incompetent  to  give  evidence,  unless  he  is  also  blind ;  he  may  be  examined 
through  the  medium  of  a  sworn  interpreter  who  understands  his  signs. 
This  condition  does  not  justify  restraint  or  interdiction,  unless  there  is 
at  the  same  time  mental  deficiency.  A  deaf-and-dumb  person  who  has 
never  been  instructed  is  altogether  irresponsible  for  any  action  civil  or 
criminal.  Such  a  person  cannot  even  be  called  on  to  plead  to  a  charge, 
when  there  is  reason  to  suppose  that  he  cannot  understand  the  nature  of 
the  proceedings.  A  deaf-and-dumb  woman  was  charged  with  cutting  off 
the  head  of  her  child.  By  signs  she  pleaded  "not  guilty,"  but  she  could 
not  be  made  to  understand  the  nature  of  the  other  proceedings  against 
her.  Upon  this  she  was  discharged  and  subsequently  confined  as  a 
criminal  lunatic.  In  Reg.  v.  Goodman  (Stafford  Sum  Ass.,  1841),  a  deaf- 
and-dumb  man  was  convicted  of  theft  and  sentenced  to  imprisonment. 
He  was  made  to  comprehend  the  proceedings  by  signs  and  talking  with 
the  fingers.  In  Reg.  v.  Brook  (Buckingham  Sum.  Ass.,  1842),  the  pris- 
oner could  read  and  write  well.  He  was  charged  with  feloniously  cutting 
and  stabbing.  The  proceedings  \vere  reported  to  him  in  writing.  He 
was  convicted,  and  the  judge,  having  sentenced  him  to  a  year's  imprison- 
ment, handed  down  his  judgment  in  writing,  which  he  recommended  him 
to  read  and  ponder  over  in  prison.  In  Reg.  v.  Jackson  (Bedford  Sum. 
Ass.,  1844),  Alderson,  B.,  held  that,  before  the  evidence  of  a  dumb  wit- 
ness can  be  received,  the  court  must  be  satisfied  that  he  understands  the 
obligation  of  an  oath. 

It  has  been  decided  in  the  Ecclesiastical  Courts  that  the  consent  of  a 
deaf-and-dumb  person,  given  by  signs,  renders  a  matrimonial  contract 
valid,  provided  the  person  has  a  full  and  proper  understanding  of  their 
meaning.  An  incompetency  to  enter  into  contracts,  or  unsoundness  of 
mind,  must  not  be  inferred  to  exist  merely  in  consequence  of  a  person 
being  deaf  and  dumb.    In  the  case  of  Harrod  v.  Harrod  (Yice-Chanc.  Ct., 


FEIGNED    DEAFNESS    AND    DUMBNESS.  745 

June,  1854),  an  attempt  was  made  to  deprive  the  plaintiff  of  his  ri<^hts  ou 
the  ground  that  he  was  an  illeg-itimate  child.  The  marriage  of  his  parents 
took  place  thirty  years  previously,  but  the  marriage  was  said  to  be  void 
by  reason  of  the  alleged  incapacity  of  his  mother  to  enter  into  the  con- 
tract;  the  mother  was  deaf  and  dumb,  and  of  more  than  ordinary  dull  in- 
tellect. Wood,  V.  C,  said  there  was  an  important  difference  between 
"unsoundness  of  mind"  and  "dulness  of  intellect."  The  presumption 
in  such  cases  was  always  in  favor  of  sanity,  and  the  fact  of  a  person 
being  deaf  and  dumb  did  not  raise  a  presumption  the  other  way.  Ex- 
perience showed  that  the  deaf  and  dumb  were  not  necessarily  of  unsound 
mind.  The  woman  had  assented  to  the  marriage  in  form  and  substance, 
and  with  a  perfect  knowledge  of  what  she  was  doing.  In  the  ceremony 
of  marriage  it  had  never  been  held  that  the  repetition  of  the  words  was 
necessary.  The  woman  conducted  herself  with  great  propriety  before  and 
after  the  marriage,  and  a  child  was  born  in  due  course.  There  was  no 
ground  for  an  issue. 

Feigned  Deafnesi^  and  Dumbness. — From  these  statements  it  will  be 
perceived  that  medical  evidence  is  of  but  little  importance  in  relation  to 
the  deaf  and  dumb.  Indeed,  there  are  only  two  cases  in  which  this  kind 
of  evidence  is  likely  to  be  called  for:  first,  when  there  is  accompanying 
mental  deficiency,  in  which  case  the  general  rules  elsewhere  given  are 
applicable ;  and  second,  when  there  is  a  suspicion  that  the  deafness  and 
dumbness  are  feigned.  There  will  be  no  great  difficulty  in  detecting  an 
imposition  of  this  kind.  It  may  be  found  that  the  alleged  deafness  and 
dumbness  did  not  come  on  until  a  motive  existed,  and  that  there  was  no 
apparent  cause  but  the  very  suspicious  one  of  evading  responsibility  for 
some  offence  committed.  It  requires  great  skill  to  maintain  an  imposture 
of  this  kind.  Such  persons  are  immediately  thrown  off  their  guard  by 
addressing  them  in  a  voice  a  little  above  or  a  little  below  the  common 
conversational  tone;  when  a  change  in  the  eye  or  the  features  will  at  once 
indicate  that  they  hear  and  understand  what  is  said. 

In  Reg.  V.  Yaquierdo  (Herts  Sum.  Ass.,  1854),  the  prisoner,  who  was 
charged  with  murder,  was  found  by  the  jury  to  be  wilfully  mute.  The 
man  refused  to  plead,  althoug'h  it  was  obvious  that  he  was  well  aware  of 
the  nature  of  the  proceedings.  No  counsel  could  be  assigned  to  him,  as 
this  could  not  be  done  without  the  prisoner's  consent.  He  was  convicted. 
Shortly  after  the  trial,  this  man  was  found  to  be  insane,  but  not  mute. 

If  the  impostor  can  write,  he  may  perhaps  be  detected  by  the  ingenious 
plan  adopted  by  the  Abbe  Sicard.  When  the  deaf  and  dumb  are  taught  to 
write,  they  are  taught  by  the  eve.  The  letters  are  only  known  to  them 
by  their  form,  and  their  value  in  any  word  can  be  understood  only  by  their 
exact  relative  position  with  respect  to  each  other.  A  half-educated  im- 
postor will  spell  his  words  or  divide  them  incorrectly;  and  the  errors  in 
spelling  will  always  have  reference  to  sound — thereby  indicating  that  his 
knowledge  has  been  acquired  through  the  ea,r,  and  not  alone  through  the 
eye.  A  man  who  had  defied  all  other  means  of  detection  wrote  down 
several  sentences,  in  which  the  misspelling  was  obviously  due  to  errors 
produced  by  the  sound  of  the  words,  thereby  showing  that  he  must  have 
he'ard  them  pronounced.  The  Abbe  concluded,  without  seeing  him,  that 
the  man  was  an  impostor,  and  he  subsequently  confessed  the  imposition. 


74^6  PRINCIPLES    OF    LIFE    IXSURANCB. 


LIFE  INSURANCE. 


CHAPTER   LXVIII. 

PRINCIPLES    OF    LIFE    INSURANCE. MEDICAL    RESPONSIBILITY. WHAT     DISEASES    HAVE    AND 

WHAT  HAVE  NOT  A  TENDENCY  TO  SHORTEN  LIFE  ? CONCEALMENT  OF  DISEASES. CON- 
CEALMENT OF  HABITS. MATERIAL  CONCEALMENT. WHAT  IS  INTEMPERANCE  ? PROXI- 
MATE    AND      REMOTE      EFFECTS. OPIDM-EATIXG. INVETERATE      SMOKING. INSANITY. 

VOIDANCE    OF    POLICIES    BY    SUICIDE. INSURANCE    MURDERS. 

The  iasurance  of  a  life  is  a  contract  whereby  the  insurer,  in  considera- 
tion of  a  certain  sum  of  money,  called  a  joremium,  either  in  a  gross  sum 
or  in  periodical  payments — proportioned  to  the  age,  sex,  profession,  health, 
and  orher  circumstances  of  the  person  whose  life  is  insured — undertakes  to 
pay  to  the  person  for  whose  benefit  the  insurance  is  made,  a  stipulated 
sum,  or  an  equivalent  annuity,  upon  the  death  of  the  individual  whose 
life  is  insured  (or  on  his  attaining  a  certain  age),  whenever  this  event 
shall  happen,  if  the  insurance  is  for  the  whole  life ;  or,  in  case  this  shall 
happen  within  a  certain  period,  if  the  insurance  is  only  for  a  limited  time. 
The  deed  by  which  this  contract  is  made  is  called  a  policy,  and  it  is  con- 
cerning the  stipulations  of  the  policy,  and  the  meaning  to  be  put  upon 
certain  medical  terms  used  in  it  that  litigation  commonly  arises.  The 
amount  of  premium  payable  will  be  regulated  by  the  mean  expectation  or 
duration  of  life  of  the  individual;  and  this  it  is  well  known  is  not  only 
different  at  different  ages,  but  is  greater  at  certain  periods  of  life  among 
women  than  among  men. 

The  sum  for  which  a  person's  life  has  been  insured  cannot  be  recovered 
until  after  the  death  of  the  person  and  distinct  proof  of  death.  Those  who 
would  benefit  by  the  death  must  prove  the  fact  of  death  when  this  is  open 
to  doubt.  A  man  suddenly  disappeared  while  at  Brighton  within  a  week 
after  an  insurance  had  been  effected  on  his  life.  The  man's  clothes  were 
found  on  the  beach,  and  the  jury  were  asked  to  infer  from  this  fact  that, 
the  man  was  drowned  while  bathing,  and  that  his  body  had  been  carried 
out  to  sea.  No  one  had  seen  him  go  into  the  water.  The  jury  were  dis- 
charged without  a  verdict.  It  was  quite  possible  that  the  clothes  had  been 
designedly  placed  there,  and  that  the  man  had  gone  off  in  another  direc- 
tion, and  was  then  living.  The  editor  met  with  a  remarkable  case.  In 
1878  a  young  merchant  was  staying  at  an  hotel  in  Barmouth.  One  morn- 
ing he  went  to  ])athe  alone  from  the  beach.  His  clothes,  containing  money 
and  his  watch,  were  subsequently  found;  but  the  body  of  the  supposed 
drowned  man  was  not  found.  An  insurance  on  his  life  was  paid.  Six 
months  after,  the  supposed  deceased  was  recognized  and  challenged  in 
South  America  bv  a  friend  ;  and  the  insurance  money  had  to  be  refunded. 
The  missing  man  had  l)een  in  pecuniary  difficnlties.  He  took  with  him  to 
bathe  an  extra  suit  of  clothes,  and  decamped,  leaving  money  in  the  pockets 
of  the  clothes  on  shore  in  order  to  avoid  suspicion. 


LIFE    INSURANCE — MEDICAL    RESPONSIBILITY.  747 

Different  rules  have  been  fj^iven  by  actuaries  for  calculating  the  expecta- 
tion or  duration  of  life  at  different  ages.  One  of  the  most  simple  of  these 
rules  for  calculating-  the  duration  of  life  from  five  to  sixty  years  has  been 
given  by  Willich  :  He  considers  the  probable  duration  to  be  equal  to  two- 
thirds  of  the  difTerence  between  the  age  and  eighty.  Thus  in  a  man  twenty 
years  of  age  the  dilference  is  equal  to  sixty  ;  and  two-thirds  of  this  age,  or 
forty  years,  is  the  probable  duration  of  life  for  a  person  of  average  health 
at  twenty. 

With  respect  to  the  influence  of  profession,  a  higher  premium  is  de- 
manded by  some  offices  for  the  insurance  of  the  lives  of  persons  whose 
occupations  expose  them  to  great  risk — as,  for  instance,  of  persons  actually 
engaged  in  military  or  naval  service. 

Above  all  other  conditions,  the  general  state  of  health  of  the  person  is 
likely  to  have  a  most  important  influence  on  the  mean  duration  of  life; 
and  it  is  here  that  medical  science  lends  its  aid — first,  by  showing  how  far 
a  contract  may  be  safely  entered  into  when  the  person  is  affected  with 
disease  ;  and  second,  by  showing  whether  a  diseased  state  of  the  body 
really  existed  in  the  person  insured,  although  at  the  time  of  insurance  it 
may  have  been  alleged  that  he  was  healthy  and  free  from  disease. 

As  in  the  case  of  all  civil  contracts,  the  law  requires  that  there  should 
be  a  strict  compliance  with  the  conditions  by  each  party,  it  follows  that  if 
any  fraud  has  been  committed  by  the  insured — if  he,  or  those  to  whom  he 
trusted  in  his  dealings  with  the  office,  have  concealed  from  the  insurers  the 
existence  of  any  disease  under  which  he  was  at  the  time  laboring,  or  any 
symptoms  indicative  of  a  probable  attack  of  disease  ;  or  if  he  or  they  have 
knowingly  or  wilfully  misrepresented  his  actual  bodily  condition — then 
the  contract  will  be  void,  and  the  amount  of  the  premiums  forfeited.  This 
forfeiture  is  a  usual  condition  in  the  policy.  Actions  on  policies  of  life  in- 
surance are  not  unfrequent.  In  a  case  of  life  insurance  an  action  is  never 
likely  to  be  brought  for  the  recovery  of  the  amount  of  a  policy,  except 
when  there  is  reason  to  believe  that  a  wilful  fraud  has  existed  in  the  con- 
tract. Juries  always  regard  such  actions  with  disfavor  ;  and,  while  judges 
interpret  the  law  strictly,  the  onus  of  proof  is  entirely  thrown  on  the  offices. 
Hence  the  insured  are  placed  in  a  very  advantageous  position.  These  actions, 
in  nine  cases  out  of  ten,  depend  upon  the  construction  put  on  the  medical 
terms  of  the  contract ;  hence  it  is  our  duty  to  see  how  medical  defects  are 
likely  to  arise  in  reference  to  the  policy. 

The  Relations  of  Medical  3Ien  with  Insurance  Offices.  Medical  Re- 
sponsibility.— The  practice  with  some  offices  of  obtaining  a  certificate 
gratuitously  from  the  medical  attendant  of  the  person  proposing  to  insure 
his  life  is  one  great  source  of  litigation.  The  responsibility  of  causing  the 
life  to  be  accepted  or  rejected  is  thus  thrown  entirely  upon  the  usual 
medical  attendant  of  the  person  ;  for,  as  we  shall  see  hereafter,  an  appli- 
cation for  a  certificate  from  a  medical  practitioner  who  is  a  stranger,  is 
very  likely  to  be  treated  as  a  fraud,  and  may  lead  to  the  disputing  of  the 
policy,  the  medical  attendant  of  the  person,  it  is  true,  is  the  only  indi- 
vidual who  can  properly  certify  to  the  real  state  of  previous  health,  and 
therefore  to  him  an  application  is  generally  made.  He  is  sometimes 
expected  to  furnish  an  important  certificate  of  this  kind  gratuitously  ; 
and  should  it  happen  to  be  unfavorable,  he  is  exposed  to  the  risk  of  losing 
what  may  probably  be  a  lucrative  portion  of  his  practice.  The  question 
is,  whether  an  insurance  office  has  a  right  to  place  a  medical  man  in  such 
a  position  as  this.  In  the  issuing  of  the  policy  the  insurers  and  insured 
are  equally  benefited,  for  the  contract  would  certainly  not  be  made  except 
upon  a  supposition  of  reciprocal  advantage.     The  medical  attendant,  with- 


7-18  [diseases  tending  to  shorten  life. 

out  whose  sanction  the  policy  could  not  in  all  cases  be  properly  effected, 
QOt  only  derives  no  benefit,  but  is  actualist  exposed  to  the  risk  of  loss  for 
performing  in  an  honorable  and  conscientious  manner  an  invidious  duty 
thus  forced  upon  him.  Such  a  state  of  things  ought  not  to  be.  Many 
actions  for  the  recover}^  of  disputed  policies  have  shown  clearly  that  the 
practice  leads  to  great  carelessness  and  indifl'erence  on  the  })art  of  medical 
men  in  drawing  up  these  certificates,  and  this  produces  in  the  end  a  more 
serious  loss  to  the  representatives  of  the  insured  than  if  the  life  had  not 
been  accepted.  It  must  be  remembered  that  it  is  not  the  insurers  who 
suffer  b\'  misconduct  on  the  part  of  a  medical  man  who  signs  such  a  cer- 
tificate, but  the  representatives  of  the  insured.  It  is  always  professed 
that  such  communications  are  confidential;  but  in  more  than  one  instance 
medical  men  have  found  that  the  contents  of  their  certificates  have  become 
known  to  their  patients,  and  have  even  been  publicly  used  as  evidence  in 
courts  of  law. 

In  the  event  of  a  medical  practitioner  being  called  upon  to  sign  a  cer- 
tificate of  this  kind,  the  safer  course  would  be  that  he  should  decline  the 
proposal,  except  upon  a  professional  consultation  with  the  medical  officers 
appointed  by  the  insurers.  If,  however,  from  private  considerations  he  is 
compelled  to  sign  the  certificate,  it  is  his  duty  to  use  the  greatest  caution, 
not  merely  in  returning  answers  to  the  formal  questions  on  the  paper,  but 
in  detailing  all  fiarticvlars  known  to  him  respecting  the  state  of  health  of 
the  person.  In  acting  otherwise,  he  would  be  doing  the  greatest  possible 
injury  to  the  representatives  of  the  insured,  and  probably  damage  his  own 
reputation.  There  is  no  intermediate  course  :  the  duty  must  either  be 
performed  carefully,  conscientiously,  and  honorably,  or  it  must  be  de- 
clined altogether.  It  is  a  fallacy  to  suppose  that  any  equivocation  or 
concealment  in  the  declaration  can  escape  detection;  and  yet,  from  the 
evidence  which  has  been  given  at  some  trials,  it  is  probable  that  such  an 
idea  had  existed  in  the  mind  of  the  medical  attendant  M'ho  attached  his 
name  to  the  certificate. 

Diseases  tending  to  shorten  Life. — Let  us  take  the  case,  however,  that 
this  preliminary  duty  has  been  properl}^  performed  ;  important  medical 
questions  ma}^  arise  respecting  the  alleged  infringement  of  the  conditions 
of  a  policy.  The  list  of  diseases  specified  in  the  inquiries  comprises  a 
great  variety — affections  of  the  head  :  apoplexy,  palsy,  epileptic  or  other 
fits  ;  disease  of  the  brain,  insanity  ;  disease  of  the  lungs,  spitting  of  blood, 
asthma,  inflammation  ;  disease  of  the  heart ;  dropsy  ;  diseases  of  the 
bowels,  liver,  kidneys,  or  urinary  organs;  gout,  rheumatism,  hernia; 
phthisis,  or  any  hereditary  malady. 

In  the  proposals  of  some  offices  the  mysterious  word  "fits"  occupies  a 
very  prominent  position,  but  it  is  difficult  to  say  what  this  word  thus 
isolated  actuall}^  means.  Thus  it  may  comprise  apoplexy,  epilepsy,  par- 
alysis, syncope,  convulsions  from  any  cause,  and  even  asphyxia.  The 
word  is  too  indefinite  for  a  certificate,  and  should  be  expunged.  In  the 
meantime,  a  court  of  law  will  not  allow  insurers  to  benefit  by  the  use  of 
ambiguous  terms  in  the  contract,  and  it  has  therefore  commonly  restricted 
the  meaning  of  the  word  "  fits"  to  attacks  of  epilepsy.  The  main  condi- 
tion, however,  is  involved  in  the  terms — "any  other  disease  or  disorder 
tending  to  shorten  life.''''  Upon  the  meaning  of  these  words  litigation^ 
commonly  turns,  and  the  opinions  of  medical  experts  are  required. 

It  is  impossible  to  lay  down  any  general  rules  for  determining  what 
diseases  have,  and  what  diseases  have  not,  a  tendency  to  shorten  life. 
Any  deviation  from  health  might  be  so  interpreted  ;  but  the  law  puts  a 
proper  limitation  here  upon  the  meaning  of  the  words,  considering  them 


MATERIAL    CONCEALMENT.  749 

to  apply  to  those  diseases  only  which,  in  a  medical  view,  are  regarded  as 
of  a  serious  nature,  and,  as  a  general  rule,  are  likely  either  directly  or 
indirectly  to  affect  the  duration  of  life  of  any  person  laboring  under  them. 
A  disease  tending  to  shorten  life  must  not  be  taken  to  signify  only  one 
of  those  maladies  which  have  commonly  a  rapid  and  fatal  course,  as 
phthisis  and  malignant  disease  ;  it  may  apply  to  dropsy,  gout,  asthma, 
insanity,  and  many  diseases  of  a  chronic  character.  When  the  existence 
of  these  diseases,  or  even  a  well-marked  tendency  to  them,  is  concealed 
from  the  insurers,  or  omitted  to  be  stated  through  mistake — even  without 
fraudulent  intention — the  policy  in  the  event  of  death  becomes  void,  be- 
cause the  risk  incurred  is  really  different  from  the  risk  understood  and 
intended  at  the  time  of  the  agreement.  Such  diseases  are  not  necessarily 
fatal;  but  this  is  not  the  question:  their  tendency  is  to  diminish  the  ex- 
pectation of  life,  and  if  medical  evidence  establish  this  with  regard  to  any 
disorder  intentionally  concealed,  whether  chronic  or  acute,  the  contract  is 
at  an  end. 

Ribits. — A  person  may  be  laboring  under  no  actual  disease  at  the  time 
of  effecting  the  insurance,  but  his  habits  may  be  such  as  to  produce 
general  injury  to  health,  and  to  have  a  tendency  to  shorten  life.  Con- 
cealment of  habits  the  effect  of  which  on  health  must  or  ought  to  be 
known  to  all  medical  men,  may  be  just  as  fatal  to  a  policy  as  the  conceal- 
ment of  a  serious  disease.  Although  they  may  not  always  be  included 
in  the  questions  put  by  the  office,  yet  the  law  will  hold  that  the  insurers 
should  be  made  acquainted  with  all  circumstances  which  might  reason- 
ably affect  the  risk.  Concealed  habits  of  drunkenness  have  thus  given 
rise  to  medical  questions  of  considerable  importance  ;  and  in  one  re- 
markable instance,  which  will  be  mentioned  hereafter,  a  question  arose 
as  to  whether  the  practice  of  opium-eating,  v.'hich  had  been  concealed 
from  the  insurers,  had  or  had  not  a  tendency  to  shorten  life.  Some 
exposures,  partly  of  a  civil  and  partly  of  a  criminal  nature,  have  rendered 
insurance  olfi^^es  much  more  strict  in  their  inquiries.  In  the  rules  already 
quoted,  special  information  is  demanded  upon  the  existence  of  material 
circumstances  touching  health  or  habits  of  life,  and  whether  the  person  is 
01"  is  not  of  temperate  habits.  Any  facts  bearing  upon  these  questions, 
if  known  to  the  medical  attendant,  must  of  course  be  stated.  The  exist- 
ence of  such  habits  must  be  known  to  the  person  himself,  and  the  declara- 
tion which  he  signs  is  so  explicit  that,  if  there  be  intentional  concealment 
by  him,  no  individual  can  reasonably  complain  of  the  violation  of  the 
policy  and  the  forfeiture  of  the  premiums. 

Miterial  Concealment. — Some  medical  practitioners  entertain  the 
opinion  that,  provided  they  can  certify  that  the  person  is  in  good  health 
at  or  about  the  time  of  the  insurance,  this  is  all  that  the  insurers  need 
know.  The  same  opinion  is  commonly  entertained  bv  the  insured,  and 
the  latter,  after  having  been  attended  by  one  medical  'man  for  an  illness, 
will  apply  to  another,  a  comparative  stranger,  to  certify  to  his  condition 
of  health  for  insurance.  We  must  not  lend  ourselves  to  this  svstem, 
which  is  based  sometimes  upon  a  mistake,  at  others  upon  fraud.  lif  med- 
ical men  would  decline  signing  the  papers  under  such  circumstances  they 
would  not  only  save  themselves  from  censure,  but  be  actually  conferring 
a  benefit  upon  the  applicant  by  preventing  him  from  obtaining  a  policy 
upon  terms  which  on  his  death  may  render  it  invalid,  and  entail  a  for- 
feiture of  the  premiums.  From  what  has  already  been  said  it  will  be 
understood  that  the  exact  state  of  health  of  the  person  at  the  time  of  the 
insurance  does  not  represent  the  whole  of  the  risks  incurred  by  the  office. 
The  restoration  to   health,  as  in  a  case  of  diseased  lungs,  may  be  only 


7/)0  MATERIAL    CONCEALMENT. 

temporary ;  it  may  be  speedily  followed  by  phthisis,  and  the  insurers, 
therefore,  ought  to  be  informed  of  the  previous  condition  as  well  as  the 
present  state  of  the  applicant.  The  conditions  in  the  declaration  are  so 
explicit  upon  this  point  as  to  render  it  scarcely  necessary  to  refer  to  the 
propriety  of  making  this  addition  to  the  certificate.  The  disease  under 
which  the  insured  had  labored  may  have  been  of  a  trivial  kind,  and  not 
likely  to  affect  the  risk ;  nevertheless,  the  safer  plan  is  to  state  it.  The 
option  will  then  lie  with  those  who  are  to  incur  the  risk.  When  facts  of 
tlais  kind  are  either  concealed  or  not  plainly  stated,  the  question  of  how 
far  they  were  or  were  not  material  to  be  laid  before  the  insurers  is  always 
left  to  the  jury,  who  are  guided  in  their  verdict  by  their  own  common 
sense  as  well  as  by  medical  opinions. 

Some  medical  men  have  adopted  the  plan  of  signing  certificates,  but 
have  declined  to  make  any  written  reply  to  certain  queries;  as,  for  in- 
stance, the  general  query — "  Can  you  give  any  and  what  information  re- 
specting the  habits  of  the  applicant?"  If  nothing  more  be  known  con- 
cerning these,  it  should  be  so  stated ;  if,  however,  the  existence  of  any 
habits  affecting  health  be  known  to  us,  we  shall  do  an  injury  to  the  appli- 
cant and  ourselves  by  withholding  information  on  the  subject.  It  may 
be  the  means  of  causing  a  heavier  premium  to  be  demanded  for  insurance 
than  if  the  facts  were  known,  and  if  this  should  not  happen  the  omission 
is  very  likely  to  give  rise  to  future  litigation. 

If,  under  any  circumstances,  a  jury  should  find  that  the  concealment  is* 
material,  the  legal  consequence  is  that  the  policy  is  void.  It  is  not  at  all 
necessary  that  the  person  should  die  of  the  disease  concealed.  This  rule 
was  laid  down  by  Lord  Tenterden  in  the  case  of  a  Colonel  Lyon.  The 
colonel  insured  his  life  by  two  policies  in  May  and  June,  1823,  and  died 
of  a  bilious  remittent  fever  in  October  following.  Payment  was  refused, 
on  the  ground  of  misrepresentation  and  concealment.  Colonel  Lyon  re- 
ferred the  office  for  a  certificate  of  his  health  to  a  gentleman  who  had  not 
attended  him  for  three  years  previously.  His  answers  to  the  printed 
questions  were  that  he  had  had  no  other  medical  attendant,  and  that  he 
•had  never  had  a  "  serious  illness."  The  medical  man  to  whom  he  referred 
certified  that  his  life  was  insurable,  and  the  policy  was  issued.  It  ap- 
peared in  evidence,  however,  that  the  deceased  had  been  attended  by  two 
other  medical  men  from  Feb.  to  April,  1823,  for  hepatitis,  fever,  and  a  de- 
termination of  blood  to  the  head.  One  of  these  employed  very  acute 
Treatment;  he  considered  him  to  be  in  a  dangerous  state,  and  would  not 
have  certified  him  to  be  in  health  until  the  end  of  May,  1823.  All  agreed 
that  the  deceased  did  not  die  of  the  disease  for  which  he  had  been  thus 
attended.  Lord  Tenterden  stated  it  to  be  his  opinion  that,  if  a  man 
referred  to  one  practitioner  because  he  could  speak  well  of  his  health,  and 
thought  that  if  he  referred  to  other  medical  men  they  would  not  so  certify, 
although  the  insured  did  not  die  of  the  disease  with  which  he  was  then 
afflicted,  the  policy  would  be  void.  A  verdict  was  accordingly  given  for 
the  defendants. 

The  practice  of  referring  to  medical  men  who  have  been  only  recently 
consulted  is  not  infrequent.  The  opinion  of  the  usual  medical  attendant 
might  be  unfavorable,  or  he  might  report  on  the  existence  of  habits  which 
would  render  the  life  uninsurable,  or  insurable  only  at  a  high  premium. 
This  want  of  fair  dealing,  however,  commonly  defeats  its  object.  There 
is  expensive  litigation,  and  the  policy  is  pronounced  to  be  void. 

Among  the  diseases  upon  the  concealment  of  which  policies  have  been 
most  frequently  disputed   may  be  enumerated   gout,  dropsy,  paralysis, 


WHAT    IS    INTEMPERANCE?  751 

epilepsy,  spitting  of  blood,  incipient  phthisis,  delirium  tremens ;  and  to 
this  list  may  be  added  drunkenness,  intemperance,  and  irregular,  lewd 
habits. 

Intemperate  Habits. — In  a  large  number  of  cases  the  payment  of  policies 
is  resisted  on  the  ground  of  concealed  drunkenness  and  general  habits  of 
intemperance.  There  is  some  difficulty  in  those  cases  because  medical  men 
may  entertain  different  opinions  respecting  the  effects  of  such  habits  upon 
the  general  health,  and  tlie  degree  to  which  they  may  be  safely  carried. 
There  is  one  thing,  however,  certain — whatever  may  be  our  opinion  of 
their  effect  on  health,  we  are  bound  to  state,  if  known  to  us,  that  they 
exist,  and  thus  put  it  out  of  the  power  of  a  company  to  dispute  a  policy 
upon. such  a  ground.  From  the  frequent  concealment  of  habits  of  this 
kind,  most  offices  now  adopt  the  practice  of  making  it  a  special  question, 
to  which  a  plain  negative  or  affirmative  answer  should  always  be  given — 
"  Are  you  now,  and  have  you  always  been,  of  temperate  habits  of  life?  " 

It  is  well  known  that  "  intemperance"  is  a  relative  term  and  may  be 
differently  construed  by  different  medical  witnesses.  The  real  question, 
however," divested  of  its  sophistry,  is  this — Can  any  person  indulge  in  an 
e.Kcessive  use  of  alcoholic  liquids  without  this  practice  sooner  or  later 
leading  to  an  impairment  of  health,  by  producing  disorder  of  the  stomach 
and  liver  and  remotely  affecting  different  organs  ?  The  effects  of  such 
habits  may  not  show  themselves  immediately  :  but  the  office  requires  to 
be  informed  of  their  existence  or  non-existence,  and  not  of  the  period 
when  they  are  likely  to  affect  health  visibly,  or  to  engender  a  fatal  disease. 
To  assert  that  a  man  can  be  addicted  to  excessive  drinking  without  im- 
pairing his  health,  is  contrary  to  experience.  There  is  no  such  compen- 
sation or  balance  of  habits  as  is  supposed  to  exist  in  these  cases.  Habit 
may  accustom  a  man  to  intemperance — it  may  enable  him  to  drink  a  large 
quantity  of  alcoholic  liquid  without  being  apparently  injuriously  influenced 
by  it  at  the  time ;  but  a  deranged  state  of  the  system  will  sooner  or  later 
follow,  and  delirium  tremens  or  dropsy  will  probably  supervene.  A  good 
constitution  may  enable  a  man  to  resist  the  pernicious  effects  for  a  certain 
time ;  but  ultimately  they  will  show  themselves  in  some  form  of  disease 
and  the  result  of  his  intemperance  is  made  apparent  in  his  early  death. 
It  is  unfortunate  that  no  light  is  permitted  to  be  thrown  on  such  cases  by 
pathology.  Post-mortem  examinations  are  not  always  made  in  these  cases ; 
for  the  death  being,  as  it  is  called,  natural  it  is  not  commonly  thought 
necessary  to  inspect  the  body,  although  the  condition  of  the  liver  and 
other  organs  might  at  once  remove  any  difficulty  which  arose  from  the 
conflicting  evidence  on  the  habits  of  the  deceased.  In  all  cases  of  a  con- 
tested policy,  one  important  principle  is  uniformly  acted  upon — those 
who  resist  the  payment  are  bound  to  prove  what  they  allege  by  con- 
clusive and  satisfactory  evidence.  A  court  will  not  receive  probability  or 
conjecture  ;  the  evidence  must  be  certain.  Hence  many  suits  fail  from 
the  medical  evidence  going  no  further  than  to  show  that  a  particular 
disease  or  habit  had  prohably  existed  at  the  time  of  insurance.  If  the 
disease  or  habits  be  shown  to  have  certainly  existed,  the  evidence  may 
still  fail  to  prove  satisfactorily  that  the  concealment  was  either  wilful  or 
material. 

Contested  cases  of  life  insurance  often  show  the  imperfect  manner  in 
which  medical  observations  respecting  health  or  disease  are  made,  and 
that  the  medical  treatment  of  persons  whose  lives  are  insured  may  become 
a  material  question  in  the  event  of  a  policy  being  disputed.  In  the  case 
of  Chattock  v.  Shawe,  in  reference  to  an  insurance  on  the  life  of  Gresw^old, 
a  question  arose,  not   only  concerning  the  concealment  of  intemperate 


752  OPIUM-EATING. 

babits,  but  as  to  the  concealed  existence  of  delirium  tremens — from  the 
examination  of  haudwriting,  as  well  as  from  the  description  given  by 
non-professional  witnesses.  It  was  here  even  doubtful  what  had  caused 
the  death  of  the  deceased.  According  to  one  medical  witness,  it  was  a 
curious  combination  of  Asiatic  cholera,  phrenitis,  and  epilepsy.  It  was 
proved  that,  more  than  three  years  before  the  insurance  was  effected,  this 
man  had  met  with  a  fall  and  he  was  afterwards  seized  with  a  fit,  described 
by  some  witnesses  as  epileptic,  by  others  as  arising  from  concussion  of 
the  brain.  The  existence  of  intemperance  and  epilepsy  prior  to  the 
insurance  was  not  made  out  to  the  satisfaction  of  the  jury,  and  they 
returned  a  verdict  for  the  representatives  of  the  insured. 

Opium-eating. — There  is  another  habit  the  concealment  of  which  gave 
rise  to  an  important  trial — the  practice  of  opium-eating.  The  Earl  of 
Mar  effected  an  insurance  on  his  life,  and  two  years  afterwards,  i.  e.  in 
1828,  he  died  of  jaundice  and  dropsy  at  the  age  of  fifty-seven.  The  in- 
surance company  declined  to  pay  the  amount  of  the  policy,  on  the  ground 
that  the  earl  was,  at  the  time  of  the  insurance,  and  had  been  for  some 
time  previously,  an  opium-eater.  This  practice  was  concealed  from  the 
insurers ;  and  it  was  further  alleged  that  it  had  a  tendency  to  shorten  life. 
It  was  clearly  proved  in  evidence  that  the  earl  had  been  a  confirmed 
opium-eater  up  to  the  time  of  his  death.  According  to  Christison,  the 
deceased  had  taken  laudanum  for  thirty  years,  at  times  to  the  amount  of 
two  or  three  ounces  daily — a  tablespoonful  for  a  dose.  He  was  a  martyr 
to  rheumatism,  and,  besides,  lived  rather  freely.  Man}^  persons  who  were 
constantly  about  him  and  many  intimate  friends,  deposed  that  until  the 
rear  of  the  insurance  he  was  of  a  cheerful  disposition  and  clear  in  his 
intellect.  Some  of  them  admitted  that  they  then  perceived  a  change  in  his 
habits,  which  they  attributed  to  the  adverse  circumstances  in  which  he 
was  compelled  to  live.  In  1825  Abercrombie  found  him  enfeebled  and 
broken  down  in  constitution,  but  without  any  definite  complaint.  The 
main  question  at  the  trial  was  whether  opium-eating  had  a  tendency  to 
.shorten  life — for  on  this  the  issue  turned — whether  concealment  from  or 
the  non-communication  of  this  practice  to  the  office  was  or  was  not  mate- 
rial. Christison,  Alison,  Abercrombie,  and  Duncan  were  examined  on 
the  part  of  the  insurers;  and  although  they  entertained  the  opinion  that 
the  habit  had  a  tendency  to  shorten  life,  they  were  unable  to  adduce  any 
facts  or  cases  in  support  of  it.  Their  opinion  was  based,  not  on  personal 
experience,  but  on  the  general  effects  of  opium  as  manifested  by  its  action 
on  the  brain,  by  its  produring  disorder  of  the  digestive  organs  and  giving 
to  the  person  a  worn  and  emaciated  appearance  In  most  of  the  instances 
collected  there  was  no  evidence  that  life  had  been  shortened  by  the  prac- 
tice. On  the  contrary,  some  of  the  persons  had  carried  it  on  for  years, 
and  had  attained  a  good  old  age.  The  jury  returned  a  verdict  for  the 
plaintiffs,  not  on  the  ground  that  the  practice  was  innocuous  and  its  con- 
cealment immaterial,  so  much  as  on  the  technical  point  that  the  insurers 
had  not  made  the  usual  and  careful  inquiries  into  the  habits  of  the  deceased ; 
and  they  were  therefore  considered  as  having  taken  upon  themselves  the 
risk  from  their  own  lachen.  It  appears  that  the  general  question  with 
respect  to  haluts  was  not  answered  by  the  medical  referee,  and  it  was 
therefore  considered  that  the  office  had  waived  the  knowledge  of  them. 
A  new  trial  was  granted  on  the  ground  of  misdirection,  but  the  suit  was 
compromised. 

Hence  no  decision  was  come  to  in  this  case  on  an  important  question, 
which  is  very  likely  to  arise  again.     It  will  be  desirable,  therefore,  to  ex- 


TOBACCO-SMOKING.  753 

amine  some  of  the  facts  connected  with  opium-eating,  in  order,  if  possible, 
so  see  how  far  it  really  tends  to  shorten  life.  In  the  case  of  the  Earl  of 
Mar,  it  appeared  to  be  a  fair  inference  that  the  habit  did  not  shorten  his 
life,  for  he  is  represented  to  have  indulged  in  it  for  thirty  years;  and  for 
twenty-eight  years,  according  to  the  statements  of  his  friends,  no  inju- 
rious effects  had  followed.  Christison  subsequently  collected  from  nu- 
merous sources  no  fewer  than  twenty-five  cases,  from  which  we  learn  that 
opium  has  been  taken  in  large  quantities  for  forty  years  together  without 
producing  any  marked  injury  to  health. 

On  the  whole,  however,  we  are  bound  to  conclude  that  the  habit  of 
opium-eating  is,  as  a  rule,  injurious  to  health,  and  is  therefore  calculated 
to  shorten  life.  In  any  proposal  for  life  insurance,  the  insurers  should  be 
informed  of  this  habit  when  it  exists,  and  no  medical  man  should  sanction 
its  concealment  merely  because  many  persons  addicted  to  it  have  lived  for 
years  in  apparently  tolerable  health.  One  of  the  questions  put  to  a  medical 
man  is,  Avhether  he  knows  any  material  circumstances  touching  the  health 
or  habits  of  the  person,  to  which  the  other  inquiries  in  the  certificate  do 
not  extend,  and,  if  so,  he  is  required  to  state  them.  Now,  without  going 
the  length  of  saying  that  the  life  of  an  opium-eater  is  uninsurable  upon  a 
common  risk,  the  habit  is  itself  sufficiently  material  to  require  that  it 
should  be  declared  in  reply  to  such  a  question  as  this.  The  practice  may 
be,  and  often  is,  concealed  from  a  medical  attendant ;  then  the  insured,  if 
not  candid  in  avowing  its  existence,  must  expose  his  representatives  to 
the  risk  of  losing  all  benefit  under  a  policy.  Independently  of  medical 
facts,  which  appear  to  favor  both  sides  of  the  question,  a  jury  would  prob- 
ably be  guided  to  a  verdict  by  the  effect  actually  produced  on  the  constitu- 
tion of  a  person  who  has  been  addicted  to  the  practice.  If  it  has  continued 
many  years,  and  there  is  no  proof  of  his  health  having  in  consequence 
undergone  any  remarkable  change,  this  might  be  regarded  by  the  jury  as 
the  best  possible  evidence  in  favor  of  the  concealment  not  being  in  such  a 
case  material.  The  insurers  could  not  equitably  complain  of  the  verdict 
in  the  Earl  of  Mar's  case,  for  as  he  began  opium-eating  at  twenty-seven, 
and  died  at  fifty-seven,  without  any  obviously  injurious  effects  being  pro- 
duced by  the  use  of  the  drug,  it  could  not  be  said  that  in  his  case  at  least 
the  practice  had  shortened  life.  It  is  rarely  in  our  power  to  apply  any 
better  or  more  practical  test  than  this,  under  circumstances  in  which  medi- 
cal facts  appear  to  bear  both  ways.  The  case  is  very  different  from  intem- 
perance in  the  use  of  alcoholic  liquids ;  and  no  one  can  doubt  that  in  this 
form  the  results  must  be  inevitably  to  impair  health  and  shorten  life.  The 
facts  here  bear  one  way,  and  if  instances  of  longevity  can  be  adduced 
among  spirit-drinkers,  they  are  well  known  and  generally  admitted  to  be 
exceptions  to  the  rule.  The  queries  put  by  insurance  offices  are  now  so 
explicit  that  they  must  be  considered  as  including  the  habit  of  opium- 
eating;  and  there  does  not  appear  to  be  any  just  pretence  for  evading  the 
admission  of  the  practice,  either  on  the  part  of  the  insured  or  (if  known 
to  him)  of  his  medical  attendant. 

Tobacco-smoking. — The  prevalent  habit  of  smoking  tobacco  has  never 
been  adequately  regarded  in  relation  to  life  insurance.  Although  excessive 
smokers  are  liable  to  attacks  of  dyspepsia,  loss  of  muscular  and  nervous 
power,  weakness,  amaurosis,  and  other  derangements  of  the  system,  there 
is  no  evidence  to  show  that  the  practice  has  a  tendency  to  shorten  life. 
The  habit  should  be  stated  in  the  certificate,  if  known  to  the  medical 
referee  and  to  be  of  an  inveterate  kind.  (See  Ann.  d'Hyg.,  1866,  t.  2, 
p.  152.)  This  would  at  least  prevent  objections  on  the  part  of  a  captious 
48 


75i  VOIDANCE    OF    POLICIES    BY    SUICIDE. 

company.  There  is  no  rule  of  law  on  this  point,  if  we  except  a  dictum 
of  Lord  Mansfield:  "The  insured  need  not  mention  what  the  insurer 
ought  to  know,  what  he  takes  upon  himself  the  knowledge  of,  what  he 
waives  being  informed  of;  the  insurer  need  not  be  told  general  topics  of 
speculation." 

Insanity. — When  we  are  called  upon  to  say  what  diseases  have  a  ten- 
dency to  shorten  life,  there  is  commonly  no  difficulty  in  giving  a  reply, 
since  the  name  of  the  disease,  its  known  effects  upon  the  body,  the  degree 
of  the  mortality  produced  by  it,  and  its  intractableness  are  data  upon 
which  a  medical  opinion  may  be  easily  expressed.  There  are  some  dis- 
eases, however,  respecting  which  it  is  not  so  easy  to  return  an  answer ; 
and  among  these  may  be  mentioned  insanity,  which  has  already  given 
rise  to  discussion  in  a  court  of  law.  The  treatment  of  this  malady  falls 
out  of  the  usual  line  of  practice;  and  there  are  comparatively  few  in  the 
profession  who  have  made  themselves  acquainted  with  statistical  details 
respecting  it. 

There  was  formerly  a  notion  that  insanity  had  a  tendency  to  prolong 
life;  but  statistics  have  shown  that  the  insane  are  more  liable  than  the 
sane  to  various  diseases,  and  that  when  attacked  they  sink  more  easily 
under  them  ;  hence  the  mortality  of  the  insane,  cseteris  j^aribus,  is  much 
above  the  average  of  that  of  the  sane  population.  Among  other  fatal 
diseases,  the  insane  are  specially  liable  to  attacks  of  paralj'sis  and  epilepsy  ; 
and  paralysis,  however  slight,  is  commonly  the  forerunner  of  death  in 
these  cases.  In  private  asylums,  the  mortality  is  always  less  than  in 
public  hospitals ;  but  researches  have  proved  that  the  mortality  of  the 
insane  has  been  much  reduced  by  the  introduction  of  an  improved  system 
of  management  and  treatment. 

Observations  have  shown  that  the  mortality  among  male  is  greater  than 
among  female  lunatics,  and  the  more  advanced  the  age  the  greater  the 
proportionate  rate  of  mortality.  The  concealment  of  insanity  in  any  of 
its  forms,  or  even  the  concealment  of  a  known  hereditary  tendency  to  this 
malady,  would  be  considered  material,  insomuch  as  either  condition  forms 
a  special  question  to  which  a  direct  answer  should  be  returned. 

Suicide. — Among  the  conditions  in  policies  of  insurance,  there  is  gener- 
ally a  stipulation  in  the  contract  that  the  policy  shall  be  void  if  the  per- 
son who  insures  his  life  commits  suicide.  Thus  a  medical  question  may 
arise  as  to  whether  suicide  was  or  was  not  committed  in  a  particular  case. 
A  person  may  die  from  poison,  wounds,  drowning,  or  other  forms  of 
asphyxia ;  and  it  may  be  difficult  to  say  whether,  in  certain  cases,  the 
death  arose  from  accident,  suicide,  or  from  violence  inflicted  by  another. 
Such  cases  are  often  left  in  great  uncertainty  at  coroner's  inquests — the 
evidence  received  being  imperfect  or  insufficient;  because  in  cases  of 
sudden  death,  provided  there  be  no  suspicion  of  murder,  it  is  considered  of 
little  moment  to  make  a  strict  inquiry.  If  the  life  of  the  deceased  should 
happen  to  be  insured  under  a  policy  containing  this  condition  respecting 
suicide,  the  question  may  become  of  great  importance  to  the  interest  of  the 
insurers,  and  they  will  require  clear  evidence  that  the  death  was  natural 
or  accidental,  and  not  suicidal,  before  paying  the  amount  of  the  policy. 
The  cause  of  death  should  in  all  cases  of  violence  be  determined  by  a  medi- 
<-al  man  ;  this  will  put  an  end  to  any  dispute  concerning  the  payment  of 
the  policy,  and  relieve  the  representatives  from  the  trouble  and  expense  of 
litigation.  If  the  death  be  sudden,  and  any  suspicious  circumstances  are 
left  unexplained,  a  civil  action  may  follow.  We  are  not,  therefore,  safe  if 
at  a  coroner's  inquest  we  suppose  that  we  have  only  to  satisfy  a  jury  by  a 


INSURANCE    MURDERS.  755 

hasty  opinion  expressed  from  an  external  view  of  the  body,  or  an  ill-con- 
ducted inspection,  merely  because  it  may  appear  to  us  quite  certain  that 
the  deceased  could  not  have  been  murdered.  Should  the  deceased  be  one 
of  that  class  of  persons  on  whose  lives  insurances  are  commonly  effected, 
the  whole  of  the  circumstances  connected  with  the  examination  of  the  body, 
and  the  medical  opinion  of  the  cause  of  death,  must  come  to  light,  and,  if 
the  examination  was  carelessly  performed,  will  probably  be  made  the  sub- 
ject of  a  severe  cross-examination.  There  have  been  several  painful 
exposures  of  this  kind,  because  the  medical  witness  thoug-ht  any  kind  of 
evidence  would  serve  the  pur))ose  of  a  coroner's  jury.  The  verdict  of  a 
jury  at  an  inquest  is  not  binding-  on  a  company;  they  have  not  only  a 
right,  but  often  good  reason  to  dispute  it,  and  they  frequently  exercise 
this  privileg-e.  The  insurance  companies  are  exposed  to  all  kinds  of  frauds, 
actually  leading,  as  in  the  case  of  burial  clubs  (a  kind  of  life  insurance), 
to  the  perpetration  of  murder  for  the  sake  of  the  small  amount  insured. 

Among  the  medico-legal  questions  connected  with  this  subject  is  the 
following  :  Does  the  proviso  in  the  policy  respecting  suicide  include  all 
acts  of  self-destruction  ;  or  is  it  restricted  only  to  those  cases  in  which  a 
sane  or  a  partially  insane  person  consciously  destroys  himself?  This 
question  has  been  elsewhere  fully  considered.  Tlie  act  of  suicide  does  not 
necessarily  indicate  insanity  ;  but  even  if  it  did,  the  rule  of  law,  as  settled 
by  a  majority  of  the  judges  in  reference  to  this  proviso  in  cases  of  life  in- 
surance, is  that,  whenever  an  insured  person  destroys  himself  intentionally, 
whatever  may  be  the  state  of  his  mind,  the  policy  is  void.  If  a  person, 
whether  sane  or  insane,  kills  himself  unintentionally,  then  the  insurers  are 
liable  ;  but  the  onus  of  proof  in  this  case  lies  upon  the  plaintiffs,  i.  e.  those 
who  would  benefit  by  the  policy.  A  question  here  arises — Can  an  insane 
person  be  said  to  have  the  same  "  intention"  to  destroy  himself  that  could 
be  ascribed  to  one  who  was  sane  ?  Is  not  the  intention  affected  by  the 
state  of  insanity.  This  may  iu  some  measure  depend  on  the  degree  which 
the  mental  disorder  has  reached.  According  to  Tardieu,  the  decision  of  a 
French  tribunal  on  this  subject,  Aug.  8,  1854,  was  to  the  following  effect  : 
"  Whosoever  has  caused  his  own  death  under  an  attack  of  insanity  cannot 
be  considered  to  have  fallen  a  victim  to  '  suicide'  in  the  sense  in  which  this 
term  is  used  in  policies  of  insurance."  (Ann.  d'Hyg.,  1864,  t.  2,  p.  394.) 
According  to  the  practice  of  some  British  offices,  the  act  of  suicide  does  not 
render  a  policy  void  ;  but  in  the  Government  life  insurances  there  is  a 
provision  to  the  effect  that  they  will  be  void  in  case  of  death  by  the  hands 
of  justice  or  by  suicide. 

Insurance  3Iurders. — The  insurance  of  the  lives  of  others  has  been 
considered  to  be  objectionable,  on  the  ground  that  it  tends  to  create  an  in- 
terest in  the  death  of  a  person,  and  thus  to  lead  to  secret  acts  of  murder. 
The  14  George  III.,  c.  48,  expressly  enacts  that  no  insurance  on  a  life 
shall  be  valid,  unless  the  person  insuring  has  a  direct  legitimate  interest  in 
the  person  whose  life  is  insured.  This  statute  was  enacted  for  the  purpose 
of  preventing  gambling  in  policies,  and  to  guard  society  against  the  risk 
of  persons  insuring,  and  then  contriving  the  death  of  the  insured,  for  the 
sake  of  the  payments  to  be  made  under  the  policy.  Its  effect  is  simply 
to  render  the  policy  void ;  it  does  not  require  that  the  premiums  shall  be 
refunded,  nor  does  it  award  any  penalty  to  the  offenders.  As  policies  of 
life  insurance  may  be  bought  and  sold  like  other  property,  they  may  fall 
into  the  hands  of  persons  who  have  no  other  interest  in  them  than  the  de- 
sire that  such  policies  should  speedily  become  claims  by  the  death  of  the 
insured.  The  interest  of  such  holders,  it  has  been  justly  observed,  lies 
in  the  death,  and  not  in  the  life,  of  the  insured. 


756  INSURANCE    MURDERS. 

The  revelations  at  Liverpool  (Reg.  v.  Flannagan  and  Higgins,  Liver- 
pool Feb.  Ass.,  1884),  and  the  case  of  Reg.  v.  Powell,  (Worcester  Spring 
Ass.,  1888),  and  the  Deptford  murder  cases  in  1889,  show  what  terrible 
prevalence  there  is  of  murder  for  the  purpose  of  procuring  insurance 
moneys ;  and  point  to  the  extreme  necessity  that  exists,  in  consequence  of 
the  lax  way  in  which  small  policies  are  effected,  of  medical  men  being 
careful  as  to  the  giving  of  death  certificates. 


LIST  OF  CASES  CITED. 


ABDUL  AZIZ,  case  of,  257 
Absolom  V.  Statham,  306 
Agnew  V.  Jobson,  510 
Aldridge,  Stothard  v.,  620 
Alexander,  Dr.,  case  of,  125 
Allen  V.  Chester  Ry.Comp.,  329 
Anderson,  case  of,  579 
Anderton  v.  Gibbs,  618 
Ankers,  Reg.  v.,  248 
Armand,  M.,  case  of,  255,  423,  424 
Armstrong,  case  of,  460 
Atkinson,  Mrs.,  case  of,  166 
Aubert,  case  of,  323 
Austen,  Smith  u.,  716 


BABBAGE  V.  Babbage,  42 
Baddeley,  De,  and  wife,  Reg.  v., 
Bagley,  Frazier  v.,  621,  659 
Bagster,  Miss,  case  of,  704 
Bainbrigge  v.  Bainbrigge,  716 
Baines,  Reg.  v.,  742 
Baker,  Harwood  v.,  712 
Baker,  Reg.  v.,  73,  150 
Banbury  Peerage  case,  632 
Banks,  Isabella,  case  of,  88 
Barber,  Howes  v.,  660 
Barlow,  Reg.  v.,  218 
Barnett  v.  Roberts,  312 
Bartlett,  Reg.  v.,  198 
Barton  and  Bennett,  Lamb  v.,  307 
Barton,  case  of,  713 
Bernays,  case  of,  362 
Berri,  Due  de,  case  of,  340 
Betts  V.  Clifford,  35 
Binns,  Nichols  and  Freeman  v.,  712 
Bishop  and  Williams,  Rex  v.,  436 
Blagg,  Reg.  v.,  365 
Blampied,  Reg.  v.,  735 
Blewett,  case  of,  712 
Bocarme,  Count,  case  of,  203 
Borradaile  v.  Hunter,  744 
Bough  ton.  Sir  T.,  case  of,  82 
Bousted,  Price  v.,  643 
Bowes,  Reg.  y.,  216 
Bowyer,  Reg.  v.,  223 
Boyden,  Reg.  v.,  227 
Boyle  and  wife,  case  of,  671 
Boys,  Morgan  v.,  714 
Brain,  Rex  v.,  536  , 

Bravo,  Mr.,  case  of,  153 
Brinckley,  Reg.  v.,  673 


521 


Brixey,  case  of,  639 

Brock  V.  Kelly,  592 

Bromwich  v.  Waters,  604,  608,  667 

Brook,  Reg.  v.,  744 

Brown,  Reg.  v.,  526 

Budd,  Reg.  v.,  24Si 

Burdett  v.  Thompson,  714 

Burke,  case  of,  432,  436,  437 

Burns,  Reg.  v.,  741 

Burton,  Reg.  v.,  717,  733 

Byron,  Reg.  v.,  743 


pALDER,  Reg.  v.,  522 

\J     Cameron,  Ann,  case  of,  451 

Campbell,  case  of,  432,  436 

Cannon  v.  Cannon,  694,  704 

Carlo  Ferrari,  case  of,  436 

Cartledge,  Reg.  v.,  516 

Cartwright,  case  of,  712 

Cass,  Reg.  v.,  269 

Castro  or  Orton,  Reg.  v.,  317,  319,  326, 

327,  589,  620 
Cayley  and  Phillips,  Reg.  v.,  519,  520 
Chaplin,  Reg.  v.,  742 
Chapman,  Reg.  v.,  347 
Chantrelle,  Reg.  v.,  88,  185,  221,  455 
Chatfield,  Reg.  v.,  347 
Chattock  V.  Shawe,  751 
Chester  Ry.  Compy.,  Allen  v.,  329 
Clarke,  Reg.  v.-,  510 
Cleator  Moor  case,  460 
Clifford,  Betts  v.,  35 
Coble,  Mrs.,  case  of,  288 
Cockroft,  Reg.  v.,  734 
Coghlan,  case  of,  712 
Collier  and  .Jones,  Reg.  v.,  663 
Colvin,  Lord  v.,  642 
Commonwealth  ?;.  Porter,  618 
Conde,  Prince  de,  case  of,  407 
Cook,  case  of.  217 
Coombs  family,  case  of,  134 
Corfield,  Durnell  r.,  715 
Cotterall  v.  Cotterall,  617 
Cotton,  Reg.  v.,  721 

Count  Bocarme,  case  of,  203  , 

Countess  Goerlitz,  case  of,  371,  420 
Courvoisier,  case  of,  269 
Cowley,  Reg.  v.,  508 
Cox,  Reg.  v.,  435 
Cresswell,  Reg.  v.,  585 
Creuse,  Reg.  v.,  297 


(757) 


^58 


LIST    OF    CASES    CITED. 


Croft,  Mudway  v.,  715 
Crook,  Reg.  v.,  139 
Cruse,  Reg.  v.,  739 


D ALMAS,  Reg.  v.,  260,  268 
Darley  and  Moon,  Reg,  v.,  517 
Davies,  case  of,  791 
Day,  case  of,  712 
Day,  Reg.  v.,  216 
Day  V.  Day,  625 
Dean,  Reg.  v.,  640 
De  Baddeley  and  wife,  Reg.  v.,  521 
Delafosse  v.  Fortescne,  660 
De  la  Pomraerais,  case  of,  229 
De  Tourville,  case  of,  251 
Devonald  v.  Hope,  494 
Dixblanc,  Reg.  v.,  415 
Dodd,  Reg.  v.,  249 
Dodwell,  Reg.  v.,  703,  718 
Donelan  and  Reed,  Reg.  v.,  312 
Donnelly,  case  of,  482 
Dos  Santos,  case  of,  635 
Douglas  Peerage  case,  619 
Drake,  Riley,  case  of,  227 
Drummond,  Mr.,  case  of,  732 
Duo  de  Berri,  case  of,  351 
Duchess  of  Kingston,  case  of,  39 
Duchess  of  Manchester,  case  of,  715,  716 
Duchesse  de  Praslin,  case  of,  243 
Duke  of  Orleans,  case  of,  329 
Durham    v.   Durham,   otherwise    Milner, 

646,  694,  704 
Durnell  v.  Corfield,  715 
Dyson,  case  of,  618 

EAGER  V.  Grimwood,  608 
Earl  of  Essex,  case  of,  260 
Earl  of  Mar,  case  of,  752 
Ebermann,  case  of,  324 
Eden,  Renouf  y.,  616 
Edmonds,  Reg.  v.,  268 
Edmunds,  Christina,  Reg.  v.,  720 
Edney  or   Hunter,   Hunter  v.,   643,  697, 

704 
Edwards  v.  Edwards,  713 
Eley,  Reg.  v.,  570 
Elphlck,  case  of,  242 
Essex,  Earl  of,  case  of,  260 


I7ABRICIUS,  Dr.,  case  of,  301 
.      Fenwick  and  French,  case  of,  456 
Ferrari,  Carlo,  case  of,  436 
Fisher,  Reg.  v.,  114 
Flack,  case  of,  268 

Flannagan  and  Higgins,  Reg.  v.,  135,  756 
Foreman,  Reg.  v.,  294 
FortescuH,  Delafosse  v.,  660 
Franck,  Dr.,  case  of,  423 
Franklin  and  Randall,  Reg.  v.,  135 
Eraser,  Simon,  case  of,  743 
Frazer  v.  Bagley,  621,  659 
Freeman  and  Nichols  v.  Binns,  712 
French  and  Fenwick,  case  of,  456 


GAITSKELL,  case  of,  372 
Garden,  case  of,  712 
Gardner,  case  of,  268 
Gardner  Peerage  case,  614,  618 
Gardner  v.  Llewellyn,  594 
Garry,  Reg.  v.,  267,  268 
Gavan,  Reg.  v.,  Ill 
Gedney  v.  Smith,  625 
Gibbons,  Reg.  v.,  261,  361 
Gibbs,  Anderton  v.,  618 
Goerlitz,  Countess  of,  case  of,  371,  420 
Golding  and  Neal,  Reg.  v.,  666 
Gooch,  Lady,  case  of,  625 
Gooch,  Reg.  v.,  342 
Good,  case  of,  398 
Goodale,  Reg.  v.,  247,  268,  269 
Goodfellow,  Reg.  v.,  370 
Goodman,  Reg.  v.,  744 
Green,  Reg.  ?;.,  351 
Griffin  and  Venn,  case  of,  515 
Grimwood,  Eager  v.,  6U8 


HALFORD,  White  v.,  713 
Hall,  Reg.  v.,  737 

Hall  V.  Semple,  702 

Halls,  case  of,  461 

Hardie,  Reg.  v.,  518 

Hargreaves,  Reg.  v.,  144 

Harmer,  Reg.  v.,  660 

Harrington,  Reg.  v.,  268 

Harris,  Reg.  v.,  649 

Harrod  v.  Harrod,  744 

Harwood  v.  Baker,  712 

Haynes,  Reg.  v.,  112 

Haynes  v.  Haynes,  643 

Haywood,  Mr.,  case  of,  98 

Heany,  Reg.  i'.,  294 

Heap,  Reg.  v.,  516 

Heath,  Reg.  v.,  269 

Hemming,  Nunn  v.,  705 

Hennah,  Reg.  v.,  74,  172,  528 

Hewitt  V.  Perry,  590,  644 

Higgins    and    Flannagan,    Reg.    v.,    135, 
756 

Hill,  Reg.  v.,  705 

Hill  V.  Philp,  696 

Hodgson,  Reg.  v.,  293 

Hodgson,  Weir  and  wife  v.,  589 

Hodgson,  Whitbv  v.,  599 

Hollis,  Reg.  v.,  599 

Hope,  Devonald  v.,  494 

Hopley,  Reg.  v.,  296 

Hornshaw,  case  of,  396 

Hotham,  Wood  v.,  637 

Howes  V.  Barber,  660 

Huelin,  Mr.,  case  of,  412 

Humphreys,  Reg.  v.,  725 

Hunt,  case  of,  231 

Hunt  V.  Hunt,  660 

Hunter,  Borradaile  v.,  744 

Hunter  v.  Hunter,  otherwise  Edney,  646, 
694,  704 

Hutchins  ?;.  Hutchins,  625 

Hyderabad,  Second,  Chloroform  Commis- 
sion, 199 


LIST    OF    CASES    CITED. 


759 


TRVIN,  ANN,  case  of,  577 
J.     Isaacs,  Reg.  i\,  528 
Isgate,  Reg.  v.,  364 


JACKSON,  MRS.,  case  of,  166 
Jacksou,  Reg.  v.,  227,  744 
Jacobs,  Sarah,  case  of,  4S7 
Jacobs  and  wife,  Reg.  v.,  487 
James,  Mrs.,  case  of,  88 
Jaiioo,  Mussamat,  case  of,  625 
Jerniy,  Mr.,  case  of,  3t)6,  732 
Jobson  and  others,  Aguew  i'.,  510 
John,  Percy  Malcolm,  case  of,  235 
Jones  and  Collier,  Reg.  v.,  663 
Jones,  Reg.  v.,  303 


KELLY,  Brock  v.,  592 
Kelly,  Reg.  r.,  48,  305 
Kemmler,  case  of,  470 
Kennedy  v.  Brown,  38 
Kent,  Constance,  Reg.  v.,  639 
Kerr,  Reg.  v.,  427 
Kerslake,  Roberts  v.,  692,  713 
King,  Reg.  v.,  125 
Kingston,  Duchess  of,  case  of,  39 
Kuiofht,  Reg.  v.,  511 


LABRIE,  case  of,  316 
Lacey,  Reg.  v.,  736 
LaflFarge,  Madame,  case  of,  134 
Lamb  v.  Barton  and  Bennett,  307 
Lamson,  Reg.  v.,  46,  235 
Lane,  Harriet,  case  of,  319,  506 
Lavton,  Treherne  ?■.,  596 
Lee,  Reg.  v.,  242,  246,  371,  372 
Lesiirgues,  case  of,  318 
Levy,  case  of,  665 
Lewis,  Reg.  v.,  351 
L'Hotellier,  case  of,  597 
Libbey,  Reg.  v.,  276,  279,  569 
Lipski,  Reg.  v.,  102,  373 
Llewellyn,  Gardner  v.,  594 
Lord  V.  Colvin,  642 
Lord,  Parker  ;;.,  712 
Lunnum,  Reg.  v.,  420 
Luscombe  v.  Prettyjolin,  604,  618 
Lutwidge,  Mr.,  case  of,  722 
Lyddon,  Reg.  v.,  181 
Lyon,  Colonel,  case  of,  750 


MACAULEY,  Sharpe  v.,  713 
Macrae,  case  of,  649 
Mackenzie,  Colonel,  case  of,  378 
McEwan,  Reg.  v.,  664 
McGowan,  Reg.  v.,  290,  742 
McKane,  Reg.  v.,  722 
McKonkey,  Reg.  v.,  231 
McMuUen,  case  of.  73 
McNasliten,  case  of,  726,  731,  732,  734 
Maddock,  Reg.  v.,  696 

Manchester,   Duchess  of,  case  of,  715,  716 
Mar,  Earl  of,  case  of,  752 


Martin,  Reg.  v.,  582 

Maskerry  v.  O'Connor,  19 

Mawer,  Peter,  case  of,  166 

Maxted  v.  Morris,  36 

May,  Reg.  v.,  580 

May  brick,  Reg.  v.,  76,  123 

Mayer,  case  of,  171 

Mayer,  Dr.,  case  of,  234 

Maynard,  Reg.  v.,  569 

Millar,  Reg.  v.  412 

Milner  or  Durham  v.  Durham,  646,  694, 

704 
Montgomery,  case  of,  248,  269 
Moon  and  Darley,  Reg.  v.,  517 
Moore,  Reg.  v.,  268,  520 
Mordaunt  v.  Mordaunt,  692 
Moreland,  Reg.  v.,  304 
Morgan  v.  Boys,  714 
Morris,  Reg.  v.,  107 
Mudway  v.  Croft,  715 
Miiller,  Salome,  case  of,  318 
Murray,  case  of,  718 


NEAL  AND  GOLDING,  Reg.  v.,  666 
Newton,  Reg.  v.,  528 
Newton  v.  Bagster,  704 
Nichols  and  Freeman  v.  Biuns,  712 
Norman,  Reg.  v.,  437,  639 
Nunu  V.  Hemming,  705 


O'BRIEN,  Reg.  v.,  414 
Ogilvy,  Reg.  v.,  700 
Orleans,  Due  d',  case  of,  329 
Orton  or  Castro,  Reg.  v.,  317,   319,   326, 

327,  589,  620 
Owen  and  othei'S,  Reg.  v.,  602 
Oxford,  Reg.  v.,  690 


PALMER,  Reg.  v.,  88 
Pardon,  Reg.  v.,  202 
Parker  v.  Lord,  712 
Pascoe,  Reg.  v.,  519 
Patteson,  Reg.  v.,  740 
Pauw,  case  of,  229 
Pearson,  Reg.  v.,  221 
Pel,  case  of,  371 
Peltzer,  case  of,  362 
Perry,  Hewitt  v.,  690,  644 
Peters,  Mrs.,  case  of,  88 
Phillips  and  Cayley,  Reg.  v.,  519,  520 
Phillips,  Reg.  v.,  165 
Philp,  Hill  v.,  696 
Pinckard,  case  of,  414 
Pink,  case  of,  346 
Pitt,  Reg.  v.,  551 
Poramerais,  De  la,  case  of,  229 
Porter,  Commonwealth  v.,  618 
Powell,  Reg.  v.,  756 
Praslin,  Duchesse  de,  case  of,  243 
Prettyjolm,  Luscombe  v.,  605,  618 
Price,  Reg.  v.,  741 
Price  V.  Bousted,  643 
Prince  de  Conde,  case  of,  407 


760 


LIST    OF    CASES    CITED. 


Pritchard,  Reg.  v.,  44 
Pym,  Reg.  v.,  308 
Pyue,  Reg.  v.,  582 


Q 


UAIN,  Reg.  v.,  308 


EANDALL  AND  FRANKLIN,  Reg.  v.,  135 
Raynon,  Reg.  v.,  310 
Redstone,  Reg.  v.,  376 
Reed  and  Douelan,  Reg.  v.,  312 
Reeves,  Reg.  v.,  738 
Reid,  case  of,  514 
Reid,  Rex  v.,  337 
Renaud,  case  of,  247 
Renouf  ?;.  Eden,  616 
Reppingull  v.  Reppingull,  658 
Reynolds,  Reg.  .i;.,  150,  717 
Rich  V.  Pierpoiut,  35 
Richardson,  Reg.  v.,  365 
Riel,  Madame,  case  of,  415 
Riley,  Reg.  v.,  160 
Roberts  v.  Barnett,  312 
Roberts  v.  Kerslake,  692,  713 
Robinson,  Reg.  v.,  584 
Rollings,  case  of,  295 
Ross,  Elizabeth,  Rex  v.,  437 
Ross  Touchet,  Reg.  v.,  690 
Roux,  Maurice,  case  of,  255,  423,  424 
Rowlands,  Reg.  v.,  268 
Rumble,  Reg.  v.,  169,  517 
Rush,  Reg.  v.,  366,  731 
Russell,  Lord  W.,  case  of,  269 
Russell,  Reg.  v.,  87 


OAINSBURY,  case  of,  228 

0     Sands,  case  of,  389 

Saxon,  Reg.  v.,  293,  299,  331,  332,  335 

Schall,  case  of,  324 

Schedmaizig,  Bernard,  case  of,  743 

Scott,  case  of,  306 

Scott  V.  Wakem,  696 

Seahara,  Reg.  v.,  144 

Sell,  Reg.  v.,  569 

Sellis,  case  of,  255,  259 

Sellis,  Rex  v.,  261 

Semple  and  Wiuslow,  Weldon  r.,  696,  702 

Semple,  Hall  v.,  702 

Senior,  case  of,  569 

Serjeant,  Warne  v.,  689 

Sewell  V.  Wells,  713 

Sharpe,  Reg.  v.,  515 

Sharpe  v.  Macauley,  713 

Shawe,  Chattock  v.,  751 

Shaw,  Reg.  v.,  411,  413 

Shrimpton,  Reg.  v.,  268 

Shuttleworth,  case  of,  700 

Simpson,  Reg.  v.,  741 

Slane,  Reg.  v.,  290 

Smethurst,  Reg.  v.,  88 

Smith,  case  of,  579,  705 

Smith,  Gedneyu.,  625 

Smith  V.  Austen,  716 


Smyth  V.  Smyth,  315 

Snarey,  Reg.  v.,  663 

Soames,  Mrs.,  case  of,  166 

Solignon,  case  of,  322 

South,  Rex  v.,  587 

Southey,  Reg.  v.,  731 

Sprague,  Reg.  v.,  214 

Sprowle,  Reg.  v.,  516 

Stagg,  Mr.,  case  of,  393 

Stauff,  case  of,  372 

Staunton  and  others,  Reg.  v.,  481,  484 

Steele,  Reg.  v.,  214 

Stewart,  Mr.,  case  of,  99,  619 

Stipler,  case  of,  311 

Stokes,  Reg.  v.,  719 

Stone,  Reg.  v.,  346 

Stothard  v.  Aldridge,  620 

Stowler,  Reg.  v.,  580 

Stroud,  Reg.  v.,  527 

Stulz,  case  of,  692 

Stuart,  case  of,  311 

Succi,  case  of,  481 

Suydam,  Levy,  case  of,  628 

Sweenie,  case  of,  664 

Sylvester,  West  v.,  715 


TALBOT,  case  of,  305 
Tanner,  Dr.,  case  of,  487 
Taylor,  Louisa  J.,  Reg.  v.,  145 
Taylor,  Reg.  v.,  528 
Thiebault,  Paul,  case  of,  470 
Thomas,  Reg.  v.,  291,  300 
Thompson,  Burdett  v.,  714 
Thompson,  Reg.  v.,  269,  293 
Thornhill,  Reg.  v.,  599 
Tichborne  case,  the,  317,  319,  326,  327, 

589,  620 
Timms,  Reg.  v.,  292 
Tourville,  De,  case  of,  251 
Touchet,  Ross,  Reg.  v.,  690 
Town  sh  end  Peerage,  619 
Treherne  v.  Layton,  595 
Troughear,  Selina,  case  of,  427 


VAMPLEW,  Reg."  v.,  599,  683 
T       Vaughan,  Reg.  v.,  792 
Venn  and  Griffin,  Reg.  v.,  516 
Vyse,  Reg.  v.,  720 


WAINWRIGHT,  Reg.  v.,  319,  506 
Wakem,  Scott  v.,  606 
Wallis  and  Wallis,  Reg.  ?;.,  158,  587 
Wallis,  Reg.  v.,  228,  518,  519 
Walworth  murder,  the,  295,  347 
Warburton,  Reg.  v.,  349 
Ward,  Reg.  v.,  279 
Warne  v.  Serjeant,  589 
Warner,  Dr.,  case  of,  217 
Waters,  Bromwich  v.,  604,  608,  667 
Watson,  Reg.  v.,  796 
Webb  V.  Page,  35 
Webster,  Reg.  v.,  124 
Weir  and  wife  v.  Hodgson,  589 


LIST    OF    CASES    CITED. 


761 


Weldon,  Mrs,,  case  of,  696,  702 

Weldon  v.  Semple  and  Winslow,  696,  702 

Wells,  Sewell  v.,  713 

Welsh  Fasting  Girl,  case  of,  457 

West,  Reg.  v.,  575,  611 

West  V.  Sylvester,  715 

Whisker,  Reg.  v.,  527 

Whitby  ?;.  Hodgson.  599 

White,  Reg.  v.,  163'  663 

White  V.  Halford,  713 

Wilson,  Catherine,  Rex  v.,  166 

Williams  and  Bishop,  Reg.  v.,  436 

Windham,  Mr.,  case  of,  759,  763 


Winslow  and  Semple,  Weldon  v.,  696,  702 

Winslow,  Reg.  v.,  88 

Wiseman,  Rex  ?;.,  672 

Wood  V.  Hotham,  637 

Woodford,  Reg.  v.,  419 

Woodman,  Reg.  v.,  511 

Wooler,  Reg.  v.,  43 

Wright  V.  Wilkin,  41 


yAQUIERDO,  Reg.  v.,  745 
1      Yaxley,  Reg.  v.,  393 
Yoolow,  David,  case  of,  707 


CITATIONS  IN  AMERICAN  EDITION. 


ABBOTT,  Baxter  v.,  58 
Abbott  V.  People,  53 
Abrams  v.  Foshee,  52(3 
Abrams  v.  State,  526 
Adams,  Rawlins  v.,  595 
Adams,  Robinson  v.,  57 
iEtna  Life  Ins.  Co.,  Edington  v.,  54 
All  Lee,  State  v.,  32 
Al.  Mut.  Ins.  Co.,  Leitch  v.,  60 
Alexander  v.  Jonquill  &  Sterling,  53 
Allen  V.  Stout,  53 
Allen  V.  Stunter,  56 
Allerton,  R.  v.,  603 
Almond  v.  Nugent,  357 
Am.  Seamen's  Fund  Soc.  v.  Hopper,  679 
Anderson  v.  The  State,  677.  729 
Anderson,  Upchurch  v.,  595 
Anderson,  Wheeler  v.,  679 
Anderson,  Watson  v.,  59        ' 
Ann  V.  State,  526 
Anthony  v.  Smith,  55 
Appeal,  Dunham's,  57 
Appeal,  Passmore's,  61 
Armill,  McGregor  ??.,  62 
Armor  v.  State,  740 
Armstrong  v.  Town  of  Ackley,  54 
Arnold's  Will,  58,  59 
Atchison,  etc.,  v.  Thul,  62 
Atlas  Ins.  Co.,  Lapham  ?-.,  60 
Augsburgh,  People  v.,  61 
Augusta  Ins.  Co.,  Perkins  v.,  60 
Augustine,  Shed  v.,  61 
Aulago  Co.  V.  Davis,  53 


BABB,  State  v.,  53 
Baber,  State  v.,  56 
Bailey,  State  v.,  62 
Baily  v.  State,  739 
Baird  v.  Daily,  60 
Baird  v.  Morford,  356 
Baker,  Slaler  v.,  357,  358 
Baldwin  v.  State,  57 
Ball,  Mannin  v.,  678 
Bangs,  Com.  v.,  526 
Barber,  Dickinson  v.,  58 
Barker  v.  Coleman,  54 
Barley,  Dewitt  v.,  57 
Barnes  v.  Ingals,  60 
Barney,  Schneider  i'.,  61 
Barrett,  Chandler  v.,  62 
Barrows  w.  Downs,  61 


Bascomb,  Fairchild  v.,  56,  59 

Bass  Furnace  Co.  v.  Glasscock,  52 

Bates,  Eckles  v.,  54 

Batten  v.  State,  54 

Baum,  Haynes  v.,  595 

Baxter  v.  Abbott,  58 

Beasley  v.  State,  739 

Beaubien  v.  Cicatte,  57 

Bederly,  Durrell  v.,  61 

Belencia,  People  v.,  740 

Bell,  Fenwick  v.,  60 

Bemis  v.  Centr.  Vt.  R.  Co.,  61 

Bennett  v.  Mehan,  53 

Benny  v.  Philpot,  603 

BerghofF,  Vanhoover  v.,  356,  357 

Bernadotti,  R.  u.,  31 

Bernal,  People  v.,  598 

Bessorne,  Cunee  v.,  62 

Bierce  v.  Stocking,  56 

Bigelow,  M'Ewen  v.,  61 

Binns,  Nichols  v.,  679 

Bird  V.  State,  52 

Bishop  ;;.  Spining,  61 

Bishop,  Stowe  v.,  61 

Blackburn,  State  v.,  31 

Blackwell  v.  State,  598 

Blake,  Carpenter  v.,  357 

Blake  v.  People,  53 

Blanchard  v.  Nestle,  678 

Blanton,  Garrison  v.,  57 

Bloomington  v.  Sclirock,  46 

Boardman  ?\  Woodman,  57,  61 

Bodenhamer,  Flynt  v.,  54,  61 

Boehm,  Carter  v.,  61 

Boener,  Gramm  v.,  357 

Bogle  V.  Winslow,  357 

Bolin  V.  State,  32 

Booth  V.  Cleveland  Rolling  Mill  Co.,  53 

Booth,  Sheldon  v.,  60 

Boswell  V.  Com.,  740,  742 

Boswell  V.  The  State  of  Alabama,  677 

Bowman,  Plunkett  v.,  61 

Bowman,  State  v.,  55 

Bowman  v.  Woods,  46 

Boyd  V.  State,  54 

Boydston  v.  Gittner,  54 

Boyle  V.  State,  54 

Bradley,  May  v.,  58 

Bradley  v.  Salmon  Falls  Mfg.  Co.,  53 

Bradly  v.  State,  729 

Bragg,  Ellingwood  v.,  56 

Braiily  v.  State,  680 

(763) 


764 


CITATIONS    IN    AMERICAN    EDITION, 


Brantley  v.  Swift,  61 
Brayman,  Cominonwealtli  v.,  58 
Briggs  I'.  Titus,  595 
Brouson,  Stickney  v.,  27 
Brooke  v.  Townshend,  57 
Brooke,  Welch  r.,  55 
Brotherton,  People  v.,  56 
Brovrn,  Travis  v.,  52 
Browne,  Com.  v.,  54,  526 
Browning  v.  Reane,  678 
Bruce,  Clarke  v.,  56,  58 
Buchanan  v.  State,  62 
Buckley  v.  Rice,  53 
Buffum  V.  Harris,  52 
Burns,  Ultey  v.,  357 
Burns  ;.•.  Welch,  60 
Burton  v.  Driggs,  53 
Burton,  Reg.  v.,  680 
Butler  V.  Ins.  Co.,  57 


CAHILL,  Pinney  v.,  56 
Calder,  Wenger  v.,  357 
Campbell's  Case,  603 
Campbell  v.  Richards,  61 
Campbell  v.  Russell,  60 
Campbell  r.  State,  32,  53 
Carew  v.  Johnston,  678 
Carmichael  in  re,  678 
Carpenter  v.  Blake,  357 
Carpenter  f.  Eastern  Trans.  Co.,  60 
Carpenter  v.  Garrett,  595 
Carriugton  v.  Richardson,  595 
Carter  c.  Brehm,  61 
Carter  v.  State,  46,  739,  742 
Caryle,  Ocean  Nat.  Bk.  v.,  27 
Casey,  Com.  v.,  31 
Castner  v.  Sliker,  61 
Cattell,  Mullin  v.,  679 
Ceru  V.  Doiidioan,  53 
Cent.  Vt.  R.  Co.,  Bemis  v.,  61 
Chadd,  Folkes  v.,  60 
Chambers,  Craig  v.,  356 
Chamberlain,  Comer  v.,  595 
Chamberlain  v.  Porter,  357,  358 
Chandler  v.  Barrett,  62 
Charter  Oak  Life  Ins.  Co.  v.  Rodel,  57 
Chase,  Hovey  v.,  678 
Chase  r.  State,  57 
Chic.  R.  R.  Co.,  Curtis  v.,  53 
Chic,  etc.,  R.  Co.  v.  George,  53 
Chic,  etc.,  R.  Co.,  Quaife  v.,  56 
Chicago,  etc.,  Neilson  v.,  52,  61 
Chicago,  etc.,  R.  Co.,  Stone  v,,  62 
Church  V.  Hubbard,  61 
Cicatte,  Beaubien  v.,  57 
Citizens'  Gas  Light  Co.  v.  O'Brien,  54 
City  of  Appleton,  Smalley  v.,  54 
City  of  Aurora  v.  Hillman,  60 
Clapp  V.  Fullerton,  57,  58 
Clark  1-.  Bruce,  56,  58 
Clark,  Dew  v.,  678,  679 
Clark  V.  Fisher,  52,  61 
Clark,  Knox  v.,  61 
Clark,  State  v.,  54 
Clark  V.  The  State,  57 


Clarke,  Wicks  r.,  595 

Clary  v.  Clary,  57 

Cleveland  Rolling  Mill  Co.,  Booth  v.,  53      . 

Clopper,  Union  Pacific  R.  Co.,  60 

Cluck  V.  State,  742 

Cock  V.  Potter,  54 

Col  bath  V.  State,  740 

Cole  V.  State,  53,  57 

Cole,  Washington  v.,  55 

Coleman,  Barker  v.,  54 

Com.  r.  Bangs,  526 

Com.,  Boswell  i-.,  740,  742 

Com.  V.  Browne,  54,  526 

Com.  V.  Casey,  31 

Com.,  Coyle  v.,  729 

Com.  V.  Demain,  526 

Com.,  Douglass  v.,  510 

Com.  V.  Frith,  680 

Com.  V.  Green,  739 

Com.,  .Jones  v.,  740 

Com.,  Kilpatrick  r.,  31 

Com.,  Kried  v.,  729 

Com.  V.  Le  Blanc,  598 

Com.,  M'Lain  v.,  55 

Com.,  Mills  r.,  526 

Com.,  Mitchell  v.,  526 

Com.,  Mockabee  v.,  31 

Com.  V.  Moster,  677,  680 

Com.  r.  Mnllins,  598 

Com.  V.  Murray,  31 

Com.  Mut.  Life  Ins.  Co.,  Hagadorn  v.,  59 

Com.  V.  Parker,  526 

Com.,  SmitU  v.,  729,  742 

Com.  V.  Strieker,  603 

Com.  V.  Sturtevant,  55 

Com.  V.  Synes,  54 

Com.  V.  Williams,  31 

Com.,  Willis  v.,  740 

Com.,  Young  v.,  31 

Comer  v.  Chamberlain,  595 

Comin  v.  Piper,  54 

Commonwealth  v.  Braymom,  58,  57 

Commonwealth,  Dejaruette  r.,  56,  57,  729 

Commonwealth  v.  Fairbanks,  58 

Commonwealth  v.  Haskell,  678,  680 

Commonwealth,  Keenan  v.,  740 

Commonwealth,  Parnell?-.,  59 

Commonwealth  v.  Rich,  58 

Commonwealth  v.  Rogers,  57,  58,  61,  680, 

729 
Commonwealth  v.  Schneider,  678 
Commonwealth,  Scott  r.,  680 
Commonwealth  v.  Wilson,  58 
Con.  Ins.  Co.,  Paddock  v.,  60 
Conger,  Sisson  v.,  58 
Congress,  etc,  Co.  v.  Edgar,  62 
Conlan,  Penn  Co.  v.,  61 
Conn.  Mutual  Life  Ins.  Co.  v.  Lathrop,  56, 

57 
Cook  V.  State,  54 
Coombes,  Ft.  Wayne  v.,  61 
Cooper  V.  State,  5"4,  55,  526 
Cope  V.  Cope,  603 
Cornwell  v.  State,  742 
Cotton  V.  Cotton,  526 
Coryell  v.  Stone,  56 


CITATIONS    IN    AMERICAN    EDITION. 


765 


Coyle  V.  Com,,  729 
Cowen,  Sullivan  v.,  54 
Cowles  V.  Merchants,  58 
Cowley  V.  People,  61,  62 
Cousin  V.  Sturtevaut,  54 
Craig  V.  Chambers,  356 
Cram  v.  Cram,  57 
Cratchley,  Rex  v.,  592 
Crawford,  Morse  v.,  57 
Crenshaw,  State  v.,  54 
Crittenden  v.  Rogers,  27 
Crittenden,  Russell  «.,  61 
Cross  V.  Cross,  603 
Cross,  State  v.,  54 
Cross,  Kilgrove  v.,  57 
Cross,  State  v.,  61 
Cuddhy,  Washburn  v.,  46 
Culver  V,  Dwight,  53 
Cunee  v.  Bessorne,  62 
Cunningham  v.  State,  729 
Curtis  V.  Chic.  R.  R.  Co.,  53 
Cuthbertson,  Yardley  v.,  61 
Cutler,  Eidt  v.,  54 


DAILY,  Baird  v.,  60 
Daly,  People  i>.,  729 
Darrand,  State  v.,  31 
Darrell  v.  Bederly,  61 
Davidson,  McNiel  v.,  52 
Davis,  Aulago  Co.  v.,  53 
Davis  V.  Mason,  61 
Davis,  Regina  v.,  742 
Davis  V.  State,  54,  56,  62 
Dawson  v.  State,  742 

Dejarnette  I'.  Commonwealth,  56,  57,  729 
Delaware  &  Co.  v.  Starrs,  60 
Demain,  Com.  v.,  526 
Dement,  ex  parte,  62 
Den  V.  Van  Cleve,  598 
Dennett  v.  Dennett,  678 
Deshon  v.  Merchants'  Bank,  58 
Detwiler,  Mertz  v.,  54 
Dew  V.  Clark,  678,  679 
Dewey,  Higgins  v.,  61 
Dewitt  V.  Barley,  57,  58 
Dewitt,  Wale  v.,  46 
Dexter  v.  Hall,  56,  61 
Dick,  Reed  v.,  60 
Dickinson  v.  Barber,  58 
Dickinson  v.  Fitchburgh,  52 
Dickinson,  State  v.,  526 
Dillahuut,  State  w.,  742 
Dillard  r.  State,  55 
Dillis  V.  State,  62 
Doe  V.  Reagan,  53,  57 
Dole  V.  Johnson,  52,  61 
Dolz  V.  Morris,  60 
Donelly  v.  State,  32 
Doolittle,  Forsyth  v.,  61 
Doolittle  V.  State,  54 
Doudican,  Ceru  v.,  53 
Dougherty  v.  Snyder,  61 
Doughty  V.  Doughty,  59 
Douglass  V.  Com.,  510 
Downs,  Barrows  v.,  61 


Dove  V.  State,  67 
Drake  v.  Glover,  61 
Draper,  State  v.,  31 
Drew,  U.  S.  v.,  742 
Driggs,  Burton  v.,  53 
Drinkald,  .Jameson  r.,  60 
Duffield  V.  Morris,  57,  677 
Dunham's  Appeal,  57 
Dunn  V.  State,  31 
Duval,  Smith  v.,  740 
Dwight,  Culver  v.,  53 
Dyce  Sombre,  Princep  v.,  59 


IMSTERN  Trans.  Co.,  Carpenter  v.,  60 
J     Eastern  Trans,  v.  Hope,  60 
Eckles  V.  Bates,  54 
Edgar,  Congress,  etc.,  Co.  v.,  62 
Edwards,  State  v.,  598 
Eggers  V.  Eggers,  57,  62 
Eggles  V.  People,  54 
Eidt  V.  Cutler,  57 

Ellington  i;.  iEtna  Life  Ins.  Co.,  ^4 
Ellingwood  v.  Bragg,  56 
Elliott  V.  Van  Buren,  53,  54 
Enoch,  Rex  v.,  592 
Epp  V.  State,  46,  62 
Erb,  State  v.,  57 
Estate  of  Toomes,  53,  58 
Estes  V.  State,  739 
Evans  v.  People,  54,  526 
Evans,  Stone  v.,  358 
Ex  parte  Dement,  62 

FAIRBANKS,  Commonwealth  v.,  58 
Fairchild  v.  Bascomb,  56,  59 
Falery,  Louisville,  etc.,  R.  Co.  v.,  54 
Farrell  v.  State,  740 
Feltes,  State  v.,  56,  680 
Fenwick  v.  Bell,  60 
Ferguson,  Napier  v.,  54,  55 
Ferguson  ?;.  Tweedy,  595 
Fettes,  State  v,,  729 
Filer  v.  N.  Y.  Central  R.  Co.,  54 
Finley,  People  v.,  59 
Fisher,  Clark  v.,  52,  61 
Fisher  v.  Nichols,  357 
Fisher  v.  State,  742 
Fitchburg,  Dickenson  v.,  52 
Fitzgerald,  State  v.,  526 
Flanagan  v.  State,  598 
Fleischer,  Gates  v.,  357 
Flynt  I'.  Bodenheimer,  54,  55,  61 
Fogassa,  Reniger  v.,  739 
Folkes  V.  Chadd,  60 
Folwell,  State  v.,  53 
Forbes,  Walker  v.,  61 
Forbes,  U.  S.  v.,  739 
Forman's  Will,  677,  679 
Forsythe  v.  Doolittle,  61 
Foshee,  Abrams  v.,  526 
Foster  v.  Marshall,  595 
Francke  v.  His  Wife,  59 
Franks,  Sower  v.,  357 
Frere  v.  Peacock,  679 


766 


CITATIONS    IN    AMERICAN    EDITION. 


Frost,  House  v.,  56 
Frith,  Com.  v.,  680 
Ft.  Wayne  v.  Coombes,  61 
FuUerton,  Clapp  v.,  57,  58 


GALLICK,  State  v.,  31 
Gauo,  Halfield  v.,  526 
Ganse,  Noblesville,  etc.,  Gravel  Road  Co. 

v.,  54 
Gardiner  v.  Gardiner,  58 
Gardner  v.  Hooper,  595 
Garnitt,  Carpenter  v.,  595 
Garrison  v.  Blanton,  57 
Gates  V.  Fleischer,  357 
Geddis,  State  v.,  58 
Gehrer  v.  State,  58 
George,  Chic,  etc.,  R.  Co.  v.,  53 
Getchen  v.  Hill,  356 
Gilbert  v.  Guild,  61 
Gittner,  Boydston  y.,  54 
Glasscock,  Bass  Furnace  Co.  v.,  52 
Glover,  Leake  v.,  61 
Goodell  V.  Harrington,  58 
Goodwin  v.  State,  56,  61,  62 
Goodyear  v.  Vosburgh,  56 
Gonzalez,  People  v.,  55 
Gould,  Wyman  v.,  58 
Grace,  McDaniel  v.,  595 
Gramm  v.  Boener,  357 
Grant  v.  Thompson,  56,  57 
Graus,  St.  Louis  Mut.  Life  Ins.  Co.  v.,  677 
Gray,  People  v.,  31 
Green,  Com.  v.,  739 
Greenfield,  People  v.,  55 
Grover,  Howard  v.,  357 
Guardian  Ins.  Co.,  Higbee  v.,  54,  61,  62 
Guetig  V.  State,  61,  62 
Guild,  Gilbert  v.,  61 
Guiteau,  U.  S.  v.,  66,  62 
Guiterman  v.  Liverpool,  etc..  Ins.  Co.,   60 
Guy  V.  Meads,  27 


HACKETT  V.  People,  30 
Hagadorn  v.  Conn.  Mut.  Life  Ins.  Co., 
59 
Haile  v.  State,  740 
Hainsle  v.  Pay  son,  62 
Haire  i'.  Reese,  357 
Hale  V.  Hill,  678 
Halfield  V.  Gano,  526 
Hallahan  v.  N.  Y.,  etc.,  R.  Co.,  61 
Hall,  Dexter  v.,  56,  61 
Hall,  People  v.,  56 
Halsey  v.  Sinsebaugh,  27 
Hankins,  Sutherland  v.,  57 
Hanley  v.  Merrill,  54 
Harbon,  Hinds  v.,  61 
Hardy  v.  Merrill,  57 
Hardy,  Wright  v.,  54 
Hargrave  v.  Hargrave,  603 
Harrington,  Goodell  v.,  58 
Harrington,  Nelson  v.,  357 
Harris,  Buff"um  v.,  52 
Harris  v.  Panama  R.  Co.,  56 


Harris  A.  Smiler,  case  of,  471,  474 

Harris  v.  State,  729 

Hartwell,  Phelps  v.,  58 

Haskell,  Commonwealth  v.,  678,  680 

Hastings  v.  Rider,  58 

Hathaway  v.  Ins.  Co.,  57 

Hathorn  v.  Richmond,  357 

Hathorne  v.  King,  58 

Hauks,  Smothers  v.,  357 

Haven  v.  Wendell,  27 

Hay  V.  State,  31 

Hay,  Kelsey  v.,  357 

Hayden,  State  v.,  57 

Haynes  v.  Baum,  595 

Head  v.  Hargrave,  62 

Head  v.  Head,  603 

Heald  i-.  Thing,  52,  58 

Heath  v.  Slocum,  52 

Heath  v.  White,  595 

Helluson,  Vander  Denckl  v.,  52 

Henderson,  Oldham  v.,  596 

Henry,  Simond  v.,  357 

Herman,  State  v.,  603 

Hewing,  Reele  v.,  357 

Hewlett  V.  Wood,  57,  58 

Hewson,  United  States  v.,  680 

Hey,  Holtzman  v.,  356 

Hickman  v.  State,  58 

Higbie  v.  Guardian  Mut.  Life  Ins.  Co.,  54, 

61,  62 
Higgins,  Quinn  v.,  61 
Higgins,  Turner  v.,  54 
Higgins  V.  Dewey,  61 
Hill,  Getchen  v.,  356 
Hill,  Hale  v.,  678 
Hill  V.  State,  30 
Hillman,  City  of  Aurora  v.,  60 
Hinds  V.  Harlon,  61 
Hinkle,  State  v.,  56 
Hoag,  Pierson  v.,  56 
Hodgson,  People  v.,  31 
Hoes  V.  Van  Alstine,  61 
Hofi'man,  Rhine  v.,  603 
Hoffman,  Rice  v.,  595,  596 
Holcombe  v.  State,  57 
Holtzman  v.  Hey,  356 
Hook  V.  Stovel,  54 
Hooper,  Gardner  v.,  595 
Hope,  Eastern  Trans,  v.,  60 
Hopp  V.  People,  729 

Hopper,  Am.  Seaman's  Fund  Soc.  i\,  679 
Hopps  I'.  People,  680 
Hopt  V.  People,  740 
Horton,  Stackhouse  v.,  59 
Hotchkiss,  Wheeler  v.,  595 
House  I'.  Frost,  56 
House,  Potts  v.,  57 
Housekeeper,  State  v.,  356 
Hovey  v.  Chase,  678 
Howard  v.  Grover,  357 
Howard  v.  McDonough,  27 
Howard,  Small  ?^,  357 
Howard,  Wilmot  v.,  357 
Howe,  United  States  v.,  62 
Howlett  V.  Taylor,  58 
Hubbard,  Church  v.,  61 


CITATIONS    IN    AMERICAN    EDITION. 


767 


Hubbard,  R.  v.,  31 

Hudniit,  Terre  Haute  v.,  CO 

Hudson  River  R.  R.  Co.,  Russell  v.,  27 

Hudson  V.  State,  31 

Huffer,  Indianapolis  v.,  53 

Huling,  State  v.,  (380 

Humphries  v.  Johnson,  62 

Hundley,  State  v.,  739,  742 

Hunter,  Allen  v.,  56 

Hunter  i-.  Whitworth,  595 

Hurley,  Linton  v.,  54 

Huxford  V.  State,  60 

Hyde  v.  Woolfolk,  52 


IDE,  Needham  r.,  58 

X     Indianapolis  v.  Huffer,  53 

Infritz  i\  People,  60 

Ingals,  Barnes  v.,  61 

Ingham,  Morrissey  v.  55 

Inhabitants  of  Fayette  v.  Inhabitants  of 

Chesterville,  58 
Imperial  Fire  Ins.  Co.,  Woodruff  v.,  60 
In  re  Carmichael,  678 
Jn  re  Roelker  Sprague,  62 
Ins.  Co.,  Butler  v.,  57 
Ins.  Co.,  Hathaway  v.,  57 
Irish  V.  Smith,  53,  54 


JACKSON  V.  Johnson,  595 
f/     Jagigo  Schichick,  case  of,  472 
James  J.  Slocum,  case  of,  471,  475 
Jameson  v.  Drinkald,  60 
Jenkins,  Withers  v.,  595 
Joe  r.  State,  56 
Johnson,  Dale  v.,  52,  61 
Johnson,  Humphries  v.,  62 
Johnson,  Jackson  v.,  595 
Johnson,  Nelson  v.,  52 
Johnson,  Roberts  v.,  54 
Johnson,  State  v.,  680,  729,  740 
Johnston,  Carew  v.,  678 
Johns,  Smith  v.,  27 
Jones  V.  Com.,  740 
Jones  V.  State,  31 
Jones  V.  Tucker,  52,  55 
Jones  V.  White,  54,  55 
Jones,  State  v.,  510 
Jonquill  &  Sterling,  Alexander  v.,  53 
Joseph  Wood,  case  of,  471,  472,  474 


KEEN  AN  V.  Commonwealth,  740 
Kellogg,'  Milwaukee,  etc.,  R.  R.  Co. 
v.,  61 
Kelly  V.  State,  740 
Kelsey  v.  Hay,  357 
Kennedy  v.  People,  58 
Key  V.  Thompson,  54 
Kidd,  Tnlis  v.,  56 
Kilgore,  State  v.,  31 
Kilgrove  v.  Cross,  57 
Kilpatrick  v.  Com.,  31 
Kilpatrick,  Ward  v.,  GO 
King,  Hathorne  v.,  58 


King  V.  Lutfe,  603 

King,  People  r.,  740 

Kings  Co.  Fire  Ins.  Co.,  Pendar  i'.,  52 

Kirby,  State  v.,  510 

Klinger,  State  v.,  57 

Knapp,  People  v.,  32 

Knapp,  State  v.,  54 

Knight,  State  v.,  55 

Knole  ;••  State,  61 

Knox  V.  Clark,  61 

Kretz,  Von  Sachs  v.,  53 

Kried  v.  Com.,  729 


LAKE,  People  r.,  58,  59 
Lake  i'.  People,  55 
Lainer,  Zugasti  v.,  60 
Lambert  v.  Slate,  32 
Lamphor  v.  Phipor,  357 
Lancashire  Ins.  Co.,  S penal ey  v.,  62 
Lanergau  v.  People,  739 
Lapham  v.  Atlas  Ins.  Co.,  60 
Lathrop,  Conn.  Mutual  Life  Ins.  Co.  v.,  56, 

57 
Lattin,  Stater.,  598 
Le  Blanc,  Com.  v.,  598 
Lee,  People  v.,  31 
Leach  v.  Prebster,  57 
Leggate,  Smoot  v.,  595 
Leighten  v.  Sargent,  356 
Lewis,  People  v.,  740 
Life  Ins.  Co.  v.  Terry,  680 
Lincoln  v.  Teuntiro  M'fg.  Co.,  56 
Linton  v.  Hurley,  54 
Litch  V.  Al.  Mut.  Ins.  Co.,  60 
Litch  i,'.  McDaniel,  54 
Liverpool,  etc.,  Ins.  Co.,  Guiterman  v.,  60 
Lloyd,  Mrs.  E.  E.,  State  of  Va.  r.,  case  of,  52 
Logan,  Steamboat  Clipper  Co.  v.,  60 
Louisville,  etc.,  R.  Co.  v.  Falery,  54 
Louisville,  etc.,  R.  Co.  v.  Wood,  54 
Love,  State  v.,  510 
Lower  v.  Franks,  357 
Luffer,  King  v.,  603 
Liming  v.  State,  46,  53 
Lynes,  Com.  v.,  54 


MACONNEKEY  v.  State,  739 
Mageroan,  Shotte  v.,  603 
Maine,  People  v.,  32 
Manning  v.  Ball,  678 
Marely  v.  Schultz,  27 
Marshall,  Foster  v.,  595 
Marshall's  Case,  740 
Martin,  West  v.,  357 
Mason,  Davis  v.,  61 
Mattason  v.  N.  Y.,  etc.,  R.  Co.,  55 
Mattocks  V.  Stearns,  595 
May  V.  Bradley,  58 
Mayor  of  New  York  v.  Second  Ave.  R.  R. 

27 
McAllister  v.  State,  59 
McCandless  r.  McWha,  357 
McCauts,  State  v.,  740 
McCIoskley  v.  State,  57 


768 


CITATIONS    IN    AMERICAN    EDITION. 


McDaniel  v.  Grace,  595 

McDaniel  v.  State,  54 

McDonough,  Howard  v.,  27 

McElroy's  case,  679 

McEvoy,  Stale  v.,  31 

McEweii  V.  Bigelow,  61 

•McFall,  Penn  v.,  740 

McGlue,  U.  S.  v.,  55,^742 

McGonigal,  State  v.,  742 

McGregor  v.  Ariuill,  62 

McGruire  r.  People,  598 

McHiigh  V.  State,  32 

McKee  v.  Nelson,  60 

McLain  v.  Comm.,  55 

M'Lenson,  S.  &  N.  Ala.  R.  Co.  v.  53 

McNiel  V.  Davidson,  52 

McPlierson  v.  State,  32 

McWLa,  McCandless  ;;.,  357 

McWliorter.  State  v.,  729 

Mead,  Guy  v.,  27 

Meakin,  Rex  v.,  739 

Mechanics'  Bk.  v.  Williams,  595 

Meckle  v.  State,  46 

Melian,  Bennett  v.,  53 

Mercer  r.  Sheldon,  595 

Merchants,  Cowles  v.,  58 

Merchants'  Bank,  Deshon  v.,  58 

Merrill,  Hardy  v.,  54,  57 

Mertz  V.  Detweiler,  54 

Mig.,  etc..  Ore  Co.,  Parsons  v.,  60 

Miller,  State  v.,  53 

Mills  V.  Com.,  526 

Mills  V.  Winter,  60 

Milwaukee,  etc.,  R.  Co.  v.  Kellogg,  61 

Milwaukee,  etc.,  R.  Co.,  Watson  v.,  52 

Minneapolis,  etc.,  R.  Co.,  Tierney  v.,  54 

Mitchell  V.  Com.,  526 

Mitchell  V.  State,  32,  56    • 

Mobile  Life  Ins.  Co.  v.  Walker,  52 

Mockabee  v.  Comm.,  31 

Mohr,  Tolum  v.,  62 

Molloy,  United  States  v.,  62 

Monroe  v.  Van  Meter,  595 

Montgomery,  People  v.,  62 

Montgomery  v.  State,  30 

Montgomery  v.  Scott,  54 

Moon  V.  State,  32 

Moore,  Norton  v.,  57 

Moore  v.  State,  55,  526 

Moore  v.  United  States,  61 

Moore  v.  Westervelt,  60 

Morford,  Baird  v.,  356 

Morreson  v.  Porter,  61 

Morrill  v.  Legarden,  61 

Morris,  Dalz  ;,'.,  60 

Morris,  Dnffield  v.,  57,  679 

Morris,  Rutherford  v.,  57 

Morrissey  r.  Ingham,  55 

Morse  v.  Crawford,  57 

Mosely,  Wilkinson  v.,  53,  54 

Mosier,  Com.  v.,  680 

Mosly,  R.  v.,  31 

Moster,  Com.  v.,  677 

Moulton  V.  Scruton,  56 

Mullin  V.  Cattrell,  679 

MuUins,  Com.  v.,  598 


Murphy,  People  v.,  53,  526 
Murray,  Comm.  v.,  31 
Murray,  R.  v.,  603 


\TAPIER,  V.  Ferguson,  54,  55 

ri     Nash,  State  v.,  31 

Nashua,  Sanderson  v.,  55 

Needham  v.  Ide,  58 

Neilson  v.  Chicago,  etc.,  52,  61 

Nelson  v.  Harrington,  357 

Nelson  v.  Johnson,  52 

Nelson,  McKee  v.,  60 

Nelson  v.  Sun  Mutual  Ins.  Co.,  52 

Nesbit  V.  State,  32 

Nestle,  Blan chard  v.,  678 

Newcomer,  Van  Deusen  v.,  54 

Newlin,  State  v.,  57 

Nicholls,  Fisher  v.,  357 

Nickels  v.  Biuns,  679 

Nicoll  V.  Webb,  27 

Noblesville,    etc.,    Gravel    Road    Co.    v. 

Ganse,  54 
Norris  v.  State,  57 

North  Brancepeth  Coal  Co.,  Salvin  v.,  56 
Norton  v.  Moore,  57 
Nugent,  Almond  v.,  357 
N.  Y.  Central  R.  Co.,  Filer  v.  54 
N.  Y.,  etc.,  R.  Co.,  Hallahan  v.,  61    ' 
N.  Y.,  etc.,  R.  Co.,  Matteson  v.,  55 
N.  Y.  Cen.  R.  Co.,  Sloan  v.,  53 


O'BRIEN,  Citizens'  Gas  Light  Co.  v.,  54 
O'Brien  v.  People,  57,  58,  742 
Ocean  Nat.  Bank  v.  Caryle,  27 
Odill,  People  v.,  739 
OflFord,  Rex  v.,  680 
Ogden  V.  Parsons,  60 
O'Herrin  v.  State,  742 
Oldham  v.  Henderson,  596 
Owens,  State  v.,  526 


PADDOCK  V.  Con.  Ins.  Co.,  60 
Page  V.  Parker,  52 
Page  V.  State,  61 
Page,  Webb  v.,  62 
Pa.  Ins.  Co.,  Stennett  v.,  61 
Panama  R.  Co.,  Harris  v.,  56 
Parker,  Com.  v.,  526 
Parker,  Page  v.,  52 
Parkinson  v.  Atkinson,  62 
Parnell  v.  Commonwealth,  59 
Parsons  v.  Wig.,  etc.,  Ore  Co.,  60 
Parsons,  Ogden  v.,  60 
Parsons  v.  State,  729 
Passmore's  Appeal,  61 
Patten  v.  Wiggen,  357 
Patterson,  State  v.,  32 
Payson,  Haisle  v.,  62 
Peacock,  Frere  v.,  679 
Pearson,  Wilkinson  v.,  57 
Peel,  R.  v.,  31 
Penn  Co.  v.  Conlaw,  61 
Penn  v.  McFall,  740 


CITATIONS    IN    AMERICAN    EDITION. 


769 


People,  Abbott  v.,  53 
People  V.  Augsburgh,  61 
People  V.  Belencia,  740 
People  V.  Bernal,  598 
People,  Blake  v.,  53 
People  V.  Brotherton,  56 
People,  Cowley  v.,  61,  62 
People  V.  Daly,  729 
People,  Evans  i\,  54,  526 
People  V.  Fiuley,  59 
People  V,  Gonzales,  55 
People  V.  Greenfield,  55 
People  V.  Gray,  31 
People,  Hackett  v.,  30 
People  V.  Hall,  56 
People  V.  Hodgson,  31 
People,  Hopp  v.,  729 
People,  Hopps  v.,  680 
People,  Hopt  v.,  740 
People,  Infritz  v.,  60 
People,  Kennedy  v.,  58 
People  V.  King,  740 
People  V.  Knapp,  32 
People,  Lake  v.,  55,  58,  59 
People,  Lanergan  v.,  739 
People  V.  Lee,  31 
People  V.  Lewis,  740 
People  V.  Maine,  32 
People,  MeGuire  v.,  598 
People  V.  Montgomery,  62 
People  V.  Miirpliy,  53,  526 
People,  O'Brien  v.,  57,  58,  742 
People  V.  Odill,  739 
People,  Real  v.,  58 
People,  Roberts  v.,  739,  742 
People  V.  Robinson,  55 
People  V.  Sanford,  57 
People  V.  Schuyler,  56 
People  V.  Sessions,  526 
People,  Shaw  v.,  31 
People  V.  Simpson,  31,  32 
People  V.  Taylor,  32 
People,  Templeton  v.,  62 
People  V.  Thurston,  59,  62 
People,  Tracey  v.,  31 
People  V.   Wasson,  32 
People  V.  Williams,  740 
People,  Woodin  v.,  54 
People  V.  Wreden,  57 
People,  Uptone  v.,  57 
People  V.  Ybarra,  31 
Peoples,  Willis  v.,  680 
Pepperoll,  Townsend  v.,  58 
Perkins  v.  Augusta  Ins.  Co.,  60 
Perkins,  R.  v.,  32,  598 
Perkins  v.  Stickney,  61 
Perkins,  Williams  v.,  596 
Perry,  Smith  v.,  603 
Phair,  State  v.,  52 
Phelps  V.  Hartwell,  58 
Phelps  V.  Terry,  61 
Philpot,  Benny  v.,  603 
Phipor,  Lampher  v.,  357 
Pidcock  V.  Porter,  54,  57 
Pierce  v.  State,  60 
Pierson  v.  Hoag,  56 
49 


Pike,  R.  v.,  32 

Pike,  State  v.,  57,  60,  729 

Pindar  v.  Kings  Co.  Fire  Ins.  Co.,  52 

Pinney  v.  Calull,  56 

Piper,  Comin  v.,  54 

Pirttle  V.  The  State,  740 

Pitts  i:  State,  55 

Plunkett  i-.  Bowman,  61 

Polin  V.  State,  57 

Folk  V.  State,  54,  56 

Poller  V.  Warner,  357 

Pook  V.  State,  53 

Poole  V.  Richardson,  57,  58 

Foots  V.  House,  57 

Poppleton,  Williams  v.,  54 

Porter,  Chamberlain  v.,  357,  358 

Porter,  Morrison  v.,  61 

Porter,  Pidcock  v.,  54,  57 

Porter  v.  Requonnoe,  etc.,  Co.,  53 

Portland  Put.  Co.,  Stacy  Co.  v.,  60 

Portsmouth,  Wiley  v.,  54 

Potter,  Cook  v.,  54 

Poulton,  Rex  i-.,  592 

Powell,  Price  v.,  60 

Powell  V.  State,  57 

Prebster,  Leach  v.,  57 

Prentice,  Sean  v.,  357 

Price  V.  Powell,  60 

Princep  v.  Dyce  Sombre,  59 


QUAIFE  V.  Chicago,  etc.,  R.  Co.,  56 
Quimby,  WilHs  v.,  53,  56,  61 
Quinn  v.  Higgins,  54 


RAINBOLT,  Van  Huss  v.,  57 
Raisler  v.  Springer,  53 
Rawlins  v.  Adams,  595 
Ray  V.  Ray,  61 
Ray  V.  State,  53 
Raymond,  Schwenger  v.,  62 
Rawle  V.  Tryson,  56 
Reading,  Rex  v.,  603 
Reagan,  Doe  v.,  53,  57 
Real  V.  People,  58 
Reane,  Browning  v.,  678 
Reddingfield,  R.  v.,  31 
Reed  v.  Dick,  60 
Reed  v.  State,  58 
Reele  v.  Hewing,  357 
Rees,  Stewart  i>.,  595 
Reese,  Haire  v.,  357 
Reeves,  Regina  v.,  592 
Reg.  V.  Burton,  680 
Regina  v.  Davis,  742 
Regina  v.  Reeves,  592 
Regina  v.  Richards,  59 
Regina  v.  Shaw,  679 
Regina  v.  Southey,  59 
Regina  v.  Still,  54 
Reniger  v.  Fogassa,  739 
Requonnoe,  etc.,  Co.,  Porter  v.,  53 
Reume's  Case,  739 
Rex  V.  Crntchley,  592 
Rex  V.  Enoch,  592 


770 


CITATIONS    IN    AMERICAN    EDITION. 


Rex  V.  Meakiii,  739 

Rtx  V.  Oflord,  (380 

Hex  V.  Perkins,  598 

Rex  V,  Foulton,  592 

Rex  V.  Reading,  603 

Rex  V.  Townley,  6S0 

Reynolds  v.  State,  30,  31 

Rliiiie  V.  Hoffman,  603 

Rice,  Buckley  v.,  53 

Rice  V.  Hoffman,  595,  596 

Rich,  Commonwealth  v.,  58 

Richards,  Campbell  v.,  61 

Richards,  Regina  v.,  59 

Richardson,  Carrington  v.,  595 

Richardson,  Poole  v.,  57,  58 

Richardson,  Spear  v.,  56 

Richardson  v.  State,  55 

Richmond,  Hawthorn  v.,  357 

Rider,  Hastings  v.,  58 

Ritchie  v.  West,  357 

Roberts  v.  Johnson,  54 

Roberts  v.  People,  739,  742 

Roberts  v.  State,  680,  729 

Roberts's  Will,  61 

Robinson  v.  Adams,  57 

Robinson,  Peoples.,  55 

Rodd,  Charter  Oak  Life  Ins.  Co.  v.,  57 

Roelker  Sprague,  in  re,  62 

Rogers,  Commonwealth  v.,  57,  58,  61,  680, 

729 
Rogers,  Crittenden  i\,  27 
Romaine,  State  v.,  603 
Royce  v.  Smith,  680 
Rush  i\  State,  54 
Russell,  Campbell  v.,  60 
Russell  c.  Crittenden,  61 
Russell  V.  Hudson  River  R.  R.  Co.,  27 
Rutherford  v.  Morris,  57 
R.  r.  Allerton,  603 
R.  V.  Bernadotti,  31 
R,  V.  Hubbard,  31 
R.  V.  Mosby,  31 
R.  V.  Murray,  603 
R.  r.  Peel,  31 
R.  I'.  Perkins,  32 
R.  V.  Pike,  32 
R.  V.  Reddingfield,  31 
R.  V.  Scaife,  32 
K.  V.  State,  31 
R.  V.  Woodcock,  31 
R.  V.  Wycherly,  526 


SADLER,  Sutton  v.,  679 
Salmon  Falls  Mfg.  Co.,  Bradley  v.,  53 
Salvin  v.  North  Brancepeth  Coal  Co.,  56 
Sanchez  v.  The  People,  59 
Sanders  v.  State,  62 
Sanderson  v.  Nashua,  55 
Sanford,  People  v.,  57 
Sargent,  Leighton  v.,  356 
Scaife,  R.  v.,  32 
Scattergood  v.  Wood,  60 
Schichick  Jugigo,  case  of,  472 
Schlacken  v.  State,  740 
Schlencker  v.  State,  57 


Schneider  v.  Barney,  61 

Schneider,  Commonwealth  v.,  678 

Schoeppe,  Dr.  Paul,  case  of,  23 

Schrock,  Bloomington  v.,  46 

Schultz,  Marely  v.,  27 

Schuyler,  People  v.,  56 

Schwenger  v.  Raymond,  62 

Scott  c.  Commonwealth,  680 

Scott,  Montgomery  v.,  54 

Scruton,  Moulton  v.,  56 

Sean  v.  Prentice,  357 

Sears  v.  Shafer,  58 

Second  Ave.  R.  R.,  Mayor  of  N.  Y.  t'.,  27 

See,  Williams  v.,  57 

Seeman,  Talbot  v.,  61 

Sessions,  People  v.,  526 

Sewell,  State  v.,  742 

Shafer,  Sears  v.,  58 

Shaw,  Regina  v.,  679 

Shaw  V.  People,  31 

Shed  V.  Augustine,  61 

Sheldon  v.  Booth,  60 

Sheldon,  Mercer  v.,  595 

Sheldon  v.  Warner,  56 

Shelton,  State  v.,  60 

Sherr  v,  Wiley,  27 

Shotle  V.  Magervan,  603 

Simond  v.  Henry,  357 

Simpson,  People  v.,  31,  32 

Simpson  v.  State,  598 

Sinsebaugh,  Halsey  ?;.,  27 

Sisson  V.  Conger,  58 

Slagle,  State  v.,  56,  526 

Slais  V.  Slais,  59 

Slaler  v.  Baker,  357,  358 

Slater  v.  Wilcox,  52,  56 

Slicker,  Castner  v.,  61 

Sloan  V.  N.  Y.  Cen.  R.  Co.,  53 

Slocum,  Heath  v.,  52 

Slocum,  James  J.,  case  of,  471,  475 

Small  V.  Com.  of  Pa.,  31 

Small  V.  Howard,  357 

Small,  Wogan  v.,  57 

Smalley  v.  City  of  Appleton,  54 

Smiler,  Harris  A.,  case  of,  471,  474 

Smith,  Anthony  v.,  55 

Smith  V.  Com.,  729,  742 

Smith  V.  Duval,  740 

Smith,  Irish  v.,  53,  54 

Smith  V.  Johns,  27 

Smith  V.  Perry,  603 

Smith,  Royce  v.,  680 

Smith,  State  v.,  54,  526 

Smoot  V.  Leggate,  595 

Smothers  v.  Hauks,  357 

Snyder,  Dougherty  v.,  61 

Southey,  Regina  v.,  59 

Span  V.  State,  680 

Spear  v.  Richardson,  56 

Spenaley  v.  Lancashire  Ins.  Co.,  62 

Spencer,  State  v.,  677 

Spining,  Bishop  v.,  61 

Springer,  Raisler  v.,  53 

Stackhouse  v.  Horton,  59 

Stacy  V.  Portland  Put.  Co.,  60 

Stanley,  State  r.,  62 


CITATIONS    IN    AMERICAN    EDITION. 


771 


Stanton  v.  Wetherwas,  678,  679 

Starrs,  Delaware  &  Co.  v.,  60 

State,  Abrams  v.,  526 

State  V.  Ah  Lee,  32 

State,  Anderson  v.,  729 

State,  Ann  v.,  526 

State,  Armor  v.,  740 

State  V.  Babb,  53 

State  V.  Baber,  56 

State  V.  Bailey,  62 

State,  Baily  v.,  739 

State,  Babiwin  v.,  57 

State,  Batten  v.,  54 

State,  Beasley  v.,  739 

State,  Bird  v.,  52 

State  ('.  Blackburn,  31 

State,  Blackwell  v.,  598 

State,  Bolin  v.,  32 

State  V.  Bowman,  55 

State,  Boyd  v.,  54 

State,  Bradley  v.,  742 

State,  Bradly  v.,  729 

State,  Brailly  v.,  680 

State,  Bucbanan  v.,  62 

State,  Campbell  v.,  32,  53 

State,  Carter  v.,  46,  739,  742 

State,  Chase  v.,  57 

State  V.  Clark,  54 

State,  Cluck  v.,  742 

State  V.  Colbath,  740 

State  V.  Cole,  62 

State,  Coles  v.,  57 

State  V.  Cook,  54,  55 

State,  Cooper  v.,  54,  55 

State  V.  Cooper,  54,  55,  526 

State,  Cornwell  v.,  742 

State  V.  Crenshaw,  54 

State  V.  Cross,  54,  61 

State,  Cunningham  v.,  729 

State,  Davis  t\,  54,  56,  62 

State,  Dawson  v.,  742 

State  V.  Dickinson,  526 

State,  Dillard  v.,  55 

State  V.  DiUahunt,  742 

State,  Dillis  v.,  62 

State,  Donelly  v.,  32 

State,  Doolittle  v.,  54 

State,  Dove  v.,  57 

State  V.  Draper,  31 

State,  Dunn  v.,  31 

State  V.  Durrand,  31 

State  V.  Edwards,  598 

State,  Epp  v.,  46,  62 

State  V.  Erb,  57 

State,  Estes  i;.,  739 

State,  Farrell  v.,  740 

State  V.  Felter,  680,  729  ' 

State  V.  Felts,  56 

State,  Fisher  v.,  742 

State  V.  Fitzgerald,  526 

State,  Flanagan  v.,  598 

State  V.  Folwell,  53 

State  V.  Gallick,  31 

State  V.  Geddis,  58 

State,  Gehrke  v.,  58 

State,  Goodwin  v.,  56,  61,  C2 


State,  Guetig  v.,  61,  62 

State,  Haile  v.,  740 

State,  Harris  v.,  729 

State,  Hay  i\,  31 

ytate  V.  Hayden,  57 

State  {'.  Herman,  603 

State,  Holconibe  v.,  57 

State  V.  Housekeeper,  356 

State,  Hudson  v.,  31 

State  17.  Huling,  680 

State,  Hickman  v.,  58 

State  a.  Hinkle,  56 

State  V.  Hundley,  739,  740,  742 

State  V.  Huxford,  60 

State,  Joe  v.,  56 

State  i;.  Johnson,  680,  72.\  740 

State  V.  Jones,  31,  510 

itate,  Kelly  v.,  740 

State  V.  Kilgore,  31 

State  V.  Kirby,  510 

State  V,  Klinger,  57 

State  r.  Knapp,  54 

State  V.  Knight,  55 

State,  Knoll  t'.,  55,  61 

State,  Lambert  v.,  32 

State  V.  Lattiu,  598 

State  ?;.  Love,  510 

State,  Luning  v.,  46,  53 

State,  Maconnekey  v.,  739 

State,  McAllister  v.,  59 

State  V.  McCauts,  740 

State,  McClaskley  i-.,  57 

State,  McDaniel  v.,  54 

State  V.  McEvoy,  31 

State  V.  McGonigal,  742 

State,  McHugh  v.,  32 

State,  McPherson  v.,  32 

State  V.  McWhorter,  729 

State,  Meckle  v.,  46 

State  V.  Miller,  53 

State,  Mitchell  v.,  32,  56 

State,  Montgomery  v.,  30 

State,  Moon  v.,  32 

State  V.  Moore,  55,  526 

State  r.  Nash,  31 

State,  Nesbit  v.,  32 

State  V.  Newlin,  57 

State,  Norris  v.,  57 

State,  O'Herrin  v.,  742 

State  V.  Owens,  526 

State,  Page  v.,  61 

State,  Parsons  v.,  729 

State  V.  Patterson,  32 

State  V.  Phair,  52 

State,  Pierce  v.,  60 

State  V.  Pike,  57,  60,  729 

State,  Pitts  v.,  55 

State,  Polin  v.,  57 

State,  Polk  v.,  54,  56 

State,  Pook  ;;.,  53 

State,  Powell  w.,  57 

State,  Rash  v.,  54 

State,  Ray  v.,  53 

State,  Reed  v.,  58 

State,  Reynolds  v.,  30.  31 

State,  Rickerson  v.,  55 


772 


CITATIONS    IN    AMERICAN    EDITION, 


State,  R.  v.,  31 

State,  Roberts  i\,  680,  729 

State  V.  Romaine,  603 

State,  Sanders  v.,  62 

State,  Schlacken  v.,  740 

State,  Schlencker  v.,  57 

State  V.  Sewell,  742 

State  V.  Shelton,  60 

State,  Simpson  v.,  598 

State  V.  Slagle,  56,  526 

State  I'.  Smith,  54,  526 

State,  Span  v.,  680 

State  V.  Spencer,  677 

State  V.  Stanley,  62 

State,  Stevens  v.,  680 

State,  Still  v.,  30 

State,  Stuart  v.,  739 

State,  Sumner  v.,  62 

State  V.  Terrall,  55 

State,  Thomas  i;.,  55 

State  V.  Thompson,  739 

State,  Uroe  v.,  31 

State  V.  Vansent,  32 

State  of  Va.,  Mrs.  E.  E.  Lloyd,  case  of, 

25 
State,  Walker  v.,  32 
State,  Ward  v.,  32 
State,  Webb  v.,  57 
State,  Wesley  v.,  680 
State,  West  i'.,  31 
State  r.  White,  740 
State  V.  Whittier,  598 
State  V.  Williamson,  31 
Stater.  Wilson,  31,  526 
State,  Wilson  v.,  526 
State,  Winfield  v.,  32 
State  V.  Wood,  31,  54 
State,  Wright  v.,  30 
Steamboat  Clipper  Co.  v.  Logan,  60 
Stearns,  Mattocks  v.,  595 
Stennett  v.  Va.  Ins.  Co.,  61 
Stevens  Point,  Strong  v.,  62 
Stevens  v.  State,  680 
Stewart  v.  Rees,  595 
Stickney  v.  Bronson,  27 
Stickney,  Perkins  v.,  61 
Still,  Regina  v.,  54 

St.  Louis  Mut.  Life  Ins.  Co.  v.  Graus,  677 
Stocking,  Bierce  v.,  56 
Stokel,  Hook  v.,  54 
Stonan  v.  Waldo,  56 
Stone,  Coryell  v.,  56 
Stone  V.  Chicago,  etc.,  R.  Co.,  62 
Stone  V.  Evans,  358 
Stoudenmeir  v.  Williamson,  46 
Stout,  Allen  v.,  53 
Stowe  V.  Bishop,  61 
Strieker,  Com.  v.,  603 
Strong  V.  Stevens  Point,  62 
Stuart  V.  State,  739 
Sturtevant,  Com.  v.,  54,  55 
Sullivan  v.  Cowen,  54 
Sumner*  V.  State,  62 
Sun  Mutual  Ins.  Co.,  Nelson  v.,  52 
Sutlierland  v.  Hankins,  57 
Sutton  V.  Sadler,  679 


Swift,  Brantley  v.,  61 

S.  &  N.  Ala.  R.  Co.  v.  M'Lenson,  53 


TALBOT  V.  Seeman,  61 
Taunton  M'fg  Co.,  Lincoln  v.,  56 
Taunton,  Williams  v.,  56 
Taylor,  Howlett  v.,  58 
Taylor,  People  v.,  32 
Tegarden,  Morrill  v.,  61 
Tefft  V.  Wilcox,  357 
Templeton  v.  People,  62 
Teny,  Life  Ins.  Co.  v.,  680 
Terre  Haute  v.  Hudnut,  60 
Terrell,  State  v.,  55 
Terry,  Phelps  v.,  61 
The  Black  Warrior,  Turner  v.,  56 
Tlie  People,  Sanchez  v.,  59 
The  State  of  Alabama,  Bos  well  v.    677 
The  State,  Anderson  v.,  677 
The  State,  Clark  v.,  57 
The  State,  Pirttle  v.,  740 
The  State,  Wood  v.,  57 
Thing,  Heald  v.,  52,  58 
Thomas  v.  State,  55 
Thompson,  Grant  v.,  56,  58 
Thompson,  Kay  v.,  54 
Thompson,  State  v.,  739 
Thul,  Atchison,  etc.,  v.,  62 
Thurston,  People  v.,  59,  62 
Tierney  v.  Minneapolis,  etc.,  R.  Co.,  54 
Titus,  Briggs  v.,  595 
Tobin,  Western  Ins.  Co.  v.,  60 
Tolum  V.  Mohr,  62 
Toomes,  Estate  of,  52,  58 
Town  of  Ackley,  Armstrong  v.,  54 
Townley,  Rex  v.,  680 
Townsend  v.  Pepperell,  58 
Townshend,  Brooke  v.,  57 
Tracy  r.  People,  31 
Travis  v.  Brown,  52 
Tryson,  Rawble  v.,  56 
Tucker,  Jones  v.,  52,  55 
Tugasti  V.  Laines,  60 
Tulis  V.  Kidd,  56 
Turner  *'.  The  Black  Warrior,  56 
Tweedy,  Ferguson  v.,  595 


UNION  Pacific  R.  Co.  v.  Clopper,  60 
United  States  v.  Hewson,  680 
United  States  v.  Howe,  62 
United  States  ?;.  MoUoy,  62 
United  States,  Moore  v.,  61 
U.  S.  V.  Drew,  742 
U.  S.  V.  Forbes,  739 
U.  S.  V.  Guiteau,  56 
U.  S.  V.  McGlue,  55  742' 
Upchurch  v.  Anderson,  595 
Uptone  V.  People,  57 
Urol  V.   State,  31 
Utley  V.  Burns,  357 


\y 


/"AN  Alstine,  Hoes  v.,  61 
Vananken's  case,  57 


CITATIONS    IN    AMERICAN    EDITION. 


773 


Van  Bnren,  Elliott  v.,  53,  54 

Van  Cleve,  Den  v.,  598 

Vander  Denckl  v.  Helluson,  52 

Van  Deusen  v.  Newcomers,  54 

Van  Duger  v.  Van  Duger,  595 

Vanhoover  v.  Berglioff,  356,  357 

Van  Huss  v,  Rainbolt,  57 

Van  Meter,  Monroe  v.,  595 

Vanseut,  State  v.,  32 

Von  Sachs  r.-Kretz,  53 

Von  Valkeuburgli  v.  Von  Valkenburgh, 

62 
Vosburgli,  Goodyear  u.,  56 


WALDO,  Stonarou.,  56 
Wale  V.  Dewitt,  46 
Walker  v.  Forbes,  61 
Walker,  Mobile  Life  Ins.  Co.  v.,  52 
Walker  v.  State,  32 
Walker  v.  Walker,  57 
Walsh  V.  Wash.,  etc.,  Ins.  Co.,  60 
Ward  V.  Kilpatrick,  60 
Ward  V.  State,  32 
Warner,  Polter  v.,  357 
Warner,  Sheldon  v.,  56 
Wash.,  etc.,  Ins.  Co.,  Walsh  v.,  60 
Washburn  V.  Caddhy,  46 
Washington  v.  Cole,  55 
Wasson,  People  v.,  32 
Watson  V.  Anderson,  59 
Watson  V.  Milwaukee,  etc.,  R.  Co.,  52,  61 
Watson  V.  Watson,  596 
Webb,  NicoU  v.,  27 
Webb  V.  Page,  62 
Webb  V.  State,  57 
Welch  V.  Brook,  55 
Wells  V.  World  Disp.  M.  Asso.,  357 
Welsh,  Burns  v.,  60 
Wendell,  Haven  v.,  27 
Wenger  v.  Calder,  357 
Wesley  v.  State,  680 
West  I'.  Martin,  357 
West,  Ritchie  v.,  357 
West  V.  State,  31 
Western  Ins.  Co.  v.  Tobin,  60 
Westervelt,  Moore  v.,  60 
Wetherwas,  Stanton  v.,  678,  679 
Wharton,  Mrs.  E.  G.,  case  of,  23 
Wheeler  v.  Anderson,  679 
Wheeler  v.  Hotchkiss,  595 
White,  Heath  v.,  595 
White,  Jones  d.,  54,  55 
White,  State  v.,  740 
Whittier,  State  v.,  598 
Whitworth,  Hunter  v.,  595 
Wicks  V.  Clarke,  595 


Wiggen,  Patten  v.,  357 

Wilcox,  Slater  v.,  52,  56 

Wilcox,  Teilt  v.,  357 

Wiley  V.  Portsmouth,  54 

Wiley,  Sherr  v.,  27 

Will,  Arnold's,  58,  59 

Will,  Forman's,  677,  679 

Will,  Roberts's,  61 

Williams,  Com.  v.,  31 

Williams's  estate,  Wright  v.,  61 

Williams  v.  Lee,  57 

Williams,  Mechanics'  Bank  v.,  595 

Williams,  People  i-.,  740 

Williams  v.  Perkins,  596 

Williams  v.  Poppleton,  54 

Williams  v.  Taunton,  56 

Williamson,  State  v.,  31 

Williamson,  Stoudenmeier  v.,  46 

Willis  V.  Com.,  740 

Willis  V.  People,  680 

Willis  V.  Quimby,  53,  56 

Wilkinson  v,  Moseley,  53,  54 

Wilkinson  v.  Pearson,  57 

Wilmot  V.  Howard,  357 

Winfield  v.  State,  32 

Winkler  v.  Winkler,  595 

Wilson  V.  Babb,  603 

Wilson,  Commonwealth  v.,  58 

Wilson  V.  State,  31,  526 

Winne  v.  Winne,  595 

Winslow,  Bogle  v.,  357 

Winter,  Mills  v.,  60 

Withers  v,  .Jenkins,  595 

Wogan  V.  Small,  57 

Wood,  Hewlett  v.,  57,  58 

Wood,  Joseph,  case  of,  471,  472,  474 

Wood,  Louisville,  etc.,  R.  Co.,  54 

Wood,  State  v.,  31,  54,  57 

Woodcock,  R.  v.,  31 

Woodin  V.  People,  54 

Woodman,  Boardman  v.,  57,  61 

Woodruff  V.  Imperial  Fire  Ins.  Co.,  60 

Woods,  Bowman  v.,  46 

Wool  folk,  Hyde«.,  52 

World  Disp.  M.  Asso.,  Wells  v.,  357 

Wreden,  People  v.,  57 

Wright  V.  Hardy,  54 

Wright  V.  State,  30 

Wright  V,  Williams's  estate,  61 

Wycherley,  R.  v.,  526 

Wyman  v.  Gould,  58 


YARDLEY  V.  Cuthbertson,  61 
Ybarro,  People  v.,  31 
Yong  V.  Com.,  31 


INDEX. 


ABDOMEN,  wounds  of  the,  344 
sadden  death  from  blows  on  the,  289, 
344 
Abnormal  conditions  of  body,  302 
Abortion,  513 

causes  of,  513 

by  mechanical  means,  514 

by  instruments,  515 

from  drugs,  516 

from  injections,  523 

signs  of,  in  the  living  and  dead,  524 

feigned,  525 

law  relative  to,  526 

proofs  required,  527 

medical  responsibility  in  cases  of,  529 
[Abortion,  526] 
Abortives,  specific,  520 
Absorption,  poisoning  by,  118,  125 
Abstinence,  effects  of,  481 
Acceleration  of  death  from  wounds,  295, 

301 
Accidental  wounds,  261 
Acetate  of  barium,  113 

of  lead,  145 

of  copper,  150 

of  morphine,  181 
Acetic  acid,  108 
Acid,  sulphuric,  94 

sulphates,  98 
,        nitric,  98 

hydrochloric,  102 

oxalic,  103 

oxalate  of  potassium,  108 

tartaric  and  acetic,  108 

arsenious,  121 

anienic,  136 

carbolic,  168 

meconic,  183 

prussic,  187 

carbonic,  440 

sulphurous,  450 

hydrosulphuric,  459 

poisons,  88,  95 
Aconite,  poisoning  with,  230 

tincture  of,  231 

root  mistaken  for  horseradish,  232 

analysis  of,  232 

leaves  and  seeds  of,  233 
Aconitia,  233 
Aconitine,  233 

fatal  dose  of,  234 

nitrate  of,  234 


Aconitine — 

Friedliinder's,  235 

symptoms  of,  232,  234,  235 

English  (Morson's),  234,  235 

Merck's  (German),  235 

analysis,  237 
Aconitum  Napellus,  230 

ferox,  230 

Fischeri,  230 
j3^1thusa  cynapium,  226 
Affiliation,  evidence  in  cases  of,  621 
Agaricus  campestris,  206 

phalloides,  209 
Age,  medical  questions  on,  598 

for  civil  and  criminal  responsibility, 
598 

for  procreative  power,  630,  638 

impotency  depending  on,  631 

of  the  newborn  child,  rules  for  deter- 
mining, 581 
Air  in  veins  a  cause  of  death,  343 

confined,  sufl'ocation  from,  457 

of  drains  and  sewers,  composition  of, 
462 
Alcohol,  poisoning  with,  195 

analysis  of,  196 
Alienation,  mental  (see  Insanity),  675 
Alkaline  poisons,  109 
Almond  flavor,  192 
Almonds,  bitter,  essential  oil  of,  192 
Aloes,  noxious  elfects  of,  163,  517 
Amanita  citrina,  death  from,  207 

pantherina,  208 

CjEsarea,  208 

muscaria,  208 
Ambidextrous  persons,  wounds  by,  261 
Amenorrhoea,  488 

a  cause  of  insanity,  639 
Amentia,  684 
Ammonia,  poisoning  with,  110 

vapor  of,  fatal  eflFects  of,  110 
Ammoniated  mercury,  144 
Ammonio-chloride  of  mercury,  144 
Ammonium  carbonate,  111 

snlphocyanate,  190 

sulphide  of,  462 
Amnii  liquor,  stains  of,  530 
Amorphous  phosphorus,  118 
Analysis,  articles  preserved  for,  25 

fallacies  connected  with,  25 

chemical  reports  of,  28 
Anamirta  cocculus,  204 

(775) 


776 


INDEX. 


Anrlrogyni  and  ancTrogynfe,  636 
Antimoxy,  tartarated,  poisoning  by,  153 
chronic  poisoning  by.  155 
detection  of,  in  tlie  tissues,  157 
cliloride  of,  158 
Antipyretics,  186 
Apnoea,  64,  375 
Apoplexy,  65,  87,  330 

meningeal,  332 
Aqua  fortis,  98 
Areolae  of  tlie  breasts,  480 
Arrowroot,  detection  of,  558 
Arsenates,  alkaline,  136 
Arsenetted  hydrogen,  137 

tests  for,  132 
Aesexic,  white,  121 
eating,  75  ■ 
symptoms  of  acute  poisoning  caused 

by,  121 
chronic  poisoning  with,  122 
post-mortem  appearances,  123 
death  from  external  application  of,  125 
fatal  dose  of,  125 
analysis  as  a  solid,  126 
in  solution,  127 
Marsh's  process  for,  128 
in  organic  mixtures  and  tissues,  129 
Reinsch's  process  for,  129,  133 
not  a  constituent  of  the  body,  134 
acid,  136 
sulphides  of,  136 
chloride  of,  137 
[Arsenic,  search  for,  in  body,  24] 
Arsenious  acid  (see  Arsemc),  12l 
Arseuite  of  copper,  135 

symptoms  caused  by,  135 
in  paper-hangings,  136 
Arsenites,  alkaline,  134 
Arterial  and  venous  blood,  284 
Arteries,  wounds  of,  342 
Artificial  inflation  of  the  lungs,  549 
Asphyxia,  death  from,  64,  375 
syncopal,  66 
various  forms  of,  375 
from  mechanical  causes,  425 
from  gases,  438 
Assailant,  marks  of  blood  on  the,  268 
Assizes,  trial  at  the,  35 
Atelectasis  of  the  lungs,  544,  567 

a  cause  of  stillbirth,  545 
Alropa  belladonna,  210 
Atropine,  210 
Auscultation  in  pregnancy,  491,  593 


BALLOTTEMENT  IN  PREGNANCY,  492 
Balls,  apertures  produced  by,  359 
deflection  of,  362 
Barber's  poisoned  wheat,  205 
Barium,  salts  of,  113 

carbonate  and  acetate  of,  114 
Barristers,  nominal  duties  of,  48 
Bastardy,  adulterine,  621 
Battle's  vermin-killer,  218 
Bearsfoot  (Hellebore),  167 
Beer,  poisoned   204 


[Being  "born,"  592] 
Belladonna,  210 

symptoms  and  effects,  210 
appearances,  212 
analysis,  212 
Bestiality,  672 
Bichloride  of  mercury,  138 
Binoxalate  of  potash,  108 
Birth,  concealment  of  proofs  of,  in  crim- 
inal law,  510 
date  of,  589 
partial  and  entire,  591 

proofs  of,  in  civil  law,  593 
[Birth,  concealment  of,  510] 
Births,  monstrous,  600 

plural,  600 

premature,  607 

protracted,  612 

posthumous,  622 
Bitter  almonds,  oil  of,  192 
Black  hellebore,  167 

snake  root,  518 
Bladder,  ruptures  of  the,  349 
Bleeding,  cicatrices  fi-om,  316 
Blistering  fly,  poisoning  by,  171 
Blisters,  marks  of,  318 

from  burns,  369 
Blood,  on  weapons,  265,  273 

on  clothing  and  furniture,  267,  284 

marks  of,  in  death  from  wounds,  267 

tests  for,  271 

optical  examination  of,  273 

crystals,  273 

corpuscles  or  cells,  274 

corpuscles  of,  275 

human  and  animal,  276 

on  linen,  280 

arterial  and  venous,  283 

menstrual,  284 

loss  of,  a  cause  of  death,  286 

efl'usion  of,  from  disease  or  violence, 
331 

in  cases  of  abortion,  530 

in  stomachs  of  newborn  children,  560 

effusions  of,  in  newborn  children,  594 
Blood-stains,  examination  of,  270 

spectral  examination  of,  272 

detection  of,  on  weapons,  265,  273 

microscopical  examination  of,  274 

date  of,  280 

on  linen,  280 

distinguished    from    rust   and    fruit 
stains,  282 

washed,  detection  of,  282 

in  cases  of  abortion,  530 

in  rape,  671 

human,     distinguished     from     other 
kinds,  278 
Blows  or  falls,  injuries  produced  by,  249 
Blue  vitriol,  150 

rocket,  230 
Bodies,  exhumation  of,  23 
Body,  inspection  of  the,  in  cases  of  pois- 
oning, 21 

cooling  of  the,  in  death,  67 

putrefaction  of  the,  70 


INDEX. 


777 


Body- 
position  of  the,  in  death  from  wounds, 

264 

marks  of  blood  on  the,  2G7 

burning  of  the,  374 

destruction  of  the,  by  fire,  372 

specific  gravity  of  the,  3S7 

position  of  tlie,  in  deatli  from  hang- 
ing, 407 
[Body,  searcli  for  arsenic  in,  24] 

[examination  of,  '^3] 

[zinc  found  in,  24] 
Bones,  fractures  of  the,  352 

brittleness  of  the,  353 
BoolvS,  quotations  from,  45 
[Bool<s  as  evidence,  40] 
Born  alive,  signification  of,  536 
Btain,  wounds  of  the,  327,  335 

membranes  of  the,  334 
Brandy,  poisoning  with,  195 
Breasts,  changes  in  pregnancy,  489 
Brick-kilns,  vapor  of,  4r)3 
Broom-tops  as  an  abortive,  517 
[Bronze-powder,  poisoning  by,  151] 
Brucine,  effects  of,  221 

tests  for,  222 
Buggery,  672 

Bullets,  examination  of,  365 
Buoyancy  of  the  body,  living  and  dead, 

387 
Burking,  death  by.  437 
Burnett's  fluid,  poisoning  with,  159 
Burning,  homicidal,  371 

wood,  vapors  of,  448 
Burns  and  scalds,  366 

cicatrices  from,  319 

canse  of  death  from,  367 

on  the  living  and  dead  body,  368 

the  result  of  accident,   homicide,  or 
suicide,  371 

by  corrosive  liquids,  373 

from  lightning,  465 
Butler's  vermin-killer,  218 
Butter  of  antimony,  158 


CADAVERIC  rigidity,  67,  265 
\J     CjBsarean  extraction,  596 
[Cadaveric  rigidity.  Prof.  Reese,  68] 
Calabar  bean,  205 
Calomel,  143 

Camphor,  poisoning  with,  202 
Canalis  venosus,  closure  of  the,  556 
Canella,  163,  517 
Cautharides,  eflFects  of,  171 

detection  of,  172 
Cantharidin,  173 
Capacity,  testamentary,  711 

test  of,  712 
Caput  succedaneum,  577 
Carbolic  acid,  168 

symptoms  and  appearances,  169 

analysis,  170 

fatal  dose  of,  169 
Carbonates  of  potassium  and  sodium,  109 
of  ammonium.  111 


Carbonates — 

of  barium,  113 
of  lead,  147 
Carbonic  Acid,  suffocation  by,  440 
symptoms  caused  by,  442 
appearances  in  death  from,  443 
analysis,  443 

combustion  in  mixtures  of,  444 
ditiusion  of,  444 
of  lime  and  brick-kilns,  452 
Carbonic  oxide,  446,  449,  453 
Carburetted  hydrogen,  453 
Caries  from  phosphorus,  116 
Carnal  knowledge,  647 
Carotid  arteries,  wounds  of,  342 
Castor-oil  seeds,  poisoning  with,  165 
Catamenia  (see  Menstruation),  640 
Causes  of  death,  63 
Caustic  alkalies,  100 
Cement-kilns,  vapors  of,  453 
Cephalhsematoma,  564 
Certificates  of  insanity,  rules  regarding, 

696 
Cesspools,  effluvia  of,  461 
Charcoal  vapor,  effects  of,  446 
[Chemical  analysis,  poisoning,  93] 
Cheese,  poisoning  with,  84,  174 
Chest,  wounds  of  the,  338,  344 
Child,  legal  definition  of  a,  511 
newborn,  uterine  age  of,  531 
from  the  sixth  to  the  ninth  month, 

532 
evidence  from  development  of,  609 
inspection  of  the  body  of,  535 
changes    in    the    body  of    the,    after 
birth,  556 
Child-murder  (see  Infanttcide),  531 
Children,  suppostitious,  624 

posthumous,  662 
[Children,  evidence  of,  598] 
Chloral  hydrate,  200 

symptoms  and  appearances,  201 
analysis  of,  202 
fatal  dose  of,  202 
Chlorate  of  potassium,  112 
Chloride  of  barium,  113 
of  arsenic,  137 
of  mercury,  138 
of  antimony,  158 
of  zinc,  159 
of  iron,  160 
Chloriodide  of  potassium  and  mercury  as 

a  test,  183 
Chlorodyne,  poisoning  with,  185 
Chloroform,  190 

poisoning  with,  198 
vapor,  199  . 
under  operations,  306 
[Chloroform,  efl'ects  of,  due  to  knowledge 

of  person  inhaling  it,  200] 
Cholera  mistaken  for  poisoning,  83 
(Jholesterin,  561 
Chromate  of  lead,  161 
Chrome  yellow,  161 
Chromium,  preparations  of,  160 
Chronic  poisoning,  88 


778 


INDEX. 


Chronic  poisouing — 

by  phospliorus,  115 
by  arseiiiu,  122 
by  mercury,  139 
by  lead,  148 
by  copper,  150 
by  antiiuony,  155 

insanity, 692 
Cicatrices  from  surgical  operations,  312 

from  disease,  314 

from  vaccination,  316 

growth  of,  313 

colored  (see  Tattooixg),  319 
Cicatrix,  nature  of  a,  210 

permanency  of,   312,  313 

age  or  date  of,  313 

from  a  wound  or  disease,  314 

imputed,  314 

alleged  changes  in  a,  315 

from  bleeding  and  other  causes,  316 

from  a  burn,  318 
Cicatrization  of  wounds,  310 
Cieuta  virosa,  224 
Circulation,  cessation  of  the,  in  death,  66 

foetal,  changes  in  the,  556 
Circumstantial  evidence,  in  wounds,  263 

in  hanging,  406 
Citrate  of  iron  mistaken  for  blood,  283 
Classification  of  poisons,  78 
Climacteric,  menstrual,  641 
Clothing,  blood  on,  275 
Coal  vapor,  effects  of,  450 

-gas,  suffocation  by,  453 
Cobra  poison,  action  of,  71 
Cocaine,  186 
Cocculus  Indicus,  204 
Code  Napoleon,  618 
Coke  vapor,  effects  of,  450 
Colchicine,  167 

Colchicum,  poisoning  with,  167 
Cold,  death  from,  476 

infanticide  by,  575 
Colic,  painter's,  148 
Colica  pictonum,  148 
Colocynth,  effects  of,  163 
Colostrum  of  milk,  558 
Colored  cicatrices,  320 
Color-tests  for  strychnine,  219 
Coma,  death  from,  65 
Combustion,  human,  alleged,  371 

in  carbonic  acid  and  air,  442 

spontaneous,  371 
Commissions  of  lunacy,  706 
Compos  mentis,  706 
Compression  of  the  brain,  330 
Concealment  of  pregnancy.  494 

of  delivery,  499 

of  birth,  510 

of  disease,  748 

of  habits,  749 

material,  749 
[Concealment  of  birth,  510] 
Conception,  date  of,  605 
Concussion  of  the  brain,  328 

and  intoxication,  329 
Confectionery,  poisoned,  135 


Congenital  disease  in  newborn  children, 

568 
Congestion  of  the  lungs,  544 
Conia,  or  coniine,  224 
Conium  maculatum,  222 
Contused  wounds,  248,  258 
Contusions  on  the  living  and  dead,  244 
Cooling  of  the  body  in  death,  67 
Copper,  poisoning  by  salts  of,  150 
detection  of  arsenic  in,  133 
arsenite  of,  128,  136 
tests  for,  151 
in  articles  of  food,  152 
detection  of,  in  the  tissues,  152 
in  preserved  peas,  152 
Copperas,  poisoning  with,  160 
Cord,  umbilical,  death  from  laceration  of 
the,  565 
length  of  the,  583 
strangulation  by  the,  581 
mark  of  the,  in  hanging,  399 
in  strangulation,  419 
Corn,  poisoned,  205 
Coroners'  inquests,  33 

Act,  33,  589 
Corpora  lutea,  507 

Corrosion  distinguished  from  ulceration,  94 
Corrosive  liquids,  burns  from,  373 
Corrosive  poisons,  78 

CoREOSiVE  SUBLIMATE,  symptoms  of  poison- 
ing with,  138 
from    external    application, 

139 
post-mortem       appearances, 
140 
chronic  poisoning  by,  140 
tests  for,  141 
in  organic  liquids,  142 
in  the  tissues,  143 
Cottonwood,  tincture  of,  518 
Counsel,  license  of,  37 

privileges  of,  48 
Counter-stroke,  nature  of,  331 
Courtesy,  tenancy  by,  593 
Cranium,  fractures  of  the,  328 

accidental,  in  the  newborn  child, 
577 
Creasote,  168 
Cretins,  688 
Criminal  abortion,  513 
Criminal  responsibility  in  insanity,  717 
in  drunkenness,  738 
somnambulism,  743 
in  deafness  and  dumbness,  744 
Cross-examination,  44 
Croton-oil,  poisoning  with,  165 
Crying,  evidence  of  live  birth,  592 
Crypsorchides,  virility  of,  633 
Cupping,  cicatrices  from,  316 
Cuts  and  stabs,  251 
Cyanide  of  potassium,  191 

symptoms  and  appearances,  191 
analysis,  191 
Cyanide  of  silver,  189 
Cytisine,  237 
Cytisus  laburnum,  237 


INDEX. 


779. 


DALP.Y'S  carminative,  180 
Date  of  birth,  591 
of  cicatrices,  313 
of  effusions  of  blood,  333 
of  conception,  tiUS 
Datura  stramonium,  215 
Daturine,  215 

Dead,   wounds    and    contusions    on   the, 
242,  244 
body,  examination  of  the,  21 
burning  of  the,  371 
Deadly  nightshade,  210 
Deaf  and  dumb,  744 
Deafness  and  dumbness,  feigned,  745 
Death,  signs  of,  66 

sudden,  causes  of,  66 

violent,  causes  of,  66 

muscular  irritability  after,  68 

reality  of,  67 

apparent,     in      newborn      children, 

545,  567 
acceleration  of,  in   personal  injuries, 

292,  301 
from  surgical  operations  on  wounded 
persons,  303,  306 
Debility,  death  of  a  newborn  child  from, 

564 
Decay,  food  rendered  poisonous  by,   173 
Declarations  of  dying  persons,  21 
Defloration,  signs  of,  658 
Deformities,  evidence  from,  620 
Deformity,  sexual,  626 

from  wounds  of  the  face,  336 
from  fractures,  356 
Delirium  mistaken  for  insanity,  685 
Delirium  tremens,  following  wounds,  304 

in  drunkards,  741 
[Delirium  tremens,  insanity  produced  by, 

good  defence,  742J 
Delivery,  499 

concealed,  499 

in  the  living,  500 

at  a  remote  period,  501 

feigned  and  unconscious,  502 

during  sleep,  503 

signs  of,  in  the  dead,  505 

date  of,  506 

protracted,  death  of  the  child  from, 

564 
sudden,  in  the  erect  posture,  578 
violence  inflicted  on  the  child  during, 

578 
locomotion  and  exertion  after,  579 
De  lunatico  inquirendo,  706 
Delusion  in  insanity,  686 

in  reference  to  wills,  714 
[Delusion  in  mind  criterion  of  absence  or 

presence  of  insanity,  699] 
Dementia  natitralis  and  accidentalis,  677 
Dementia,  687 
senile,  715 
Deposits,  arsenical,  128 
Derangement,  mental,  675 
Destructive  things,  74 
Development  of  child,  evidence  from,  607 
De  ventre  inspiciendo,  writ  of,  497 


Dialysis  of  poisons,  97 

Diaphragm,  wounds  and  ruptures  of  the, 

343 
Diffusion  of  gases,  444 
Digitalin,  228 
Digitalis  purpurea,  228 

poisoning  witli,  228 
Dipsomania,  738 
Direction  of  wounds,  259 
in  the  chest,  338 
Discliarge  of  lunatics,  703 
Disease,  concealment  of,  748 

influence  of,  on  poisons,  77 

on  wounds,  292 

on  virility,  632 
Diseased  flesh,  poisonous,  173 
Diseases  tending  to  shorten  life,  748 
Dislocations,  355 

Distillation-process  for  arsenic,  130 
Docimasia  pulmonaris,  543 

circulationis,  556 
Doubtful  sex,  627,  646 
Drains  and  sewers,  noxious  gases  of,  461 
Dress,   examination   of   the,    in   wounds, 

258 
Dripping  poisoned  witli  lead,  149 
Drowning,  cause  of  death  from,  375 

death  from  secondary  causes  in,  378 

appearances  in,  378 

medical  proofs  of,  382 

buoyancy  of  the  body  in,  387 

marks  of  violence  in  cases  of,  388 

homicidal  or  suicidal,  390 

in  shallow  water,  391 

from  partial  immersion,  393 

a  cause  of  death  in  newborn  children, 
573 
Drugs  used  as  abortives,  517 
Drunkards,  civil  and  criminal   responsi- 
bility of,  738 

restraint  of,  738 
Drunkenness,    concussion   mistaken    for,, 
329 

responsibility  in  cases  of,  738 

in  life  insurance,  751 
Ductus  arteriosius,  closure  of,  556 

venosus,  556 
Dumb,  responsibility  of  the,  744 
Dura  mater,  the,  334 
Dyes,  red,  mistaken  for  blood,  281 
[Dying  declarations,  30] 

[law  regarding,  30,  31,  32] 
Dying  declarations,  rules  respecting,  21 
Dying  persons,  wills  made  by,  715 
Dynamo-machines,  death  from  touching, 
470 


EARTHENWARE,  wounds  from,  248 
Eccentricity  mistaken    for    insanity, 
687 
in  wills,  714 
Ecchymoses,    punctiform,    in   suffocation, 

431 
[Ecchymoses,  cadaveric,  245] 
Ecchymosis,  from  violence,  243 


780 


INDEX. 


Eccliymosis — 

changes  of  color  in,  244 

production  of,  after  deatli,  244 

not  always  a  result  of  violence,  245 

in  hanging,  396 

in  strangulation,  413 

natural  marks  resembling,  586 

caused  by  lightning,  468 
[Eccliymosis,  cadaveric,  difficult  to  distin- 
guish from  putrefaction,  246j 
Ecbolics,  516,  520 
Eczema  from  arsenic,  122 
Effluvia  from  drains  and  sewers,  461 
Etfusion  of   blood   (see   Extra vasatiok), 

330 
Ehaterium,  517 

Electricity,  action  of  (see  Lightning),  464 
[Electrocution,  post-mortem  in,  470] 
Embryo,  examination  of  the,  508 
P^merald  green,  poisoning  with,  135 
Emetic,  tartar,  poisoning  with,  153 
Einmenagogues  in  abortion,  516 
Enemata,  poisonous,  81 
Epispadia,  636 
Epithelial  scales,  559 
Epsom  salts,  death  from,  112 
Ergot  of  rye  as  an  abortive,  520 
Erysipelas  following  wounds,  303 
Eserine,  205 

Essence  of  mirbane,  192 
Essential  oil  of  almonds,  192 
Ether,  nitrous,  197 

poisoning  with,  197 
Evidence,  medical,  37 

rules  respecting,  49 

technical,  50 

of  opinion,  51 

exaggerated,  51 

notes,  when  and  how  used,  26 

circumstantial,  in  wounds,  263 
Evidence  of  poisoning  in  the  living,  80 

in  the  dead,  86 
[Evidence  of  children,  598] 
Examination  in  chief,  44 

cross,  44 

of  wounds,  240 

of  the  dress  in  wounded  persons,  252 

of  weapons,  265,  282 

of  firearms,  365 

of  a  man  in  child-murder,  588 

of  lunatics,  695,  706 
[Examination  of  body,  23] 
[Exceptions  to  rules  of  evidence,  57] 
Excessive  smoking,  753 
Excitement  a  cause  of  extravasation,  332 
Exhaustion,  deatli  from,  289 
Exhumation  of  bodies,  23 
Experts,  medical,  21 
[Expert  in  cases  of  insanity,  a  competent, 

58] 
[Experts  and  expert  testimony,  52] 

[compensation  of,  61] 

[hypothetical  questions,  61] 
Exposure,    death    of    newborn    children 

from,  575 
Extent  of  wounds,  258 


Extract,  Goulard's,  147 

of  opium,  180 
Extravasation  of  blood  on  the  brain,  330 

date  of,  333 
Eyebrows,  wounds  of  the,  336 


FACE,  wounds  of  the,  336 
Facts,    specification  of,   in  insanity, 
700 
Falls,  injuries  from,  249 
Family  likeness,  evidence  from,  619 
Fasting,  long,  effects  of,  481 

pretended,  486 
[Fasting,  prolonged,  487] 
Fat  poisoned  by  lead  glaze,  149 
Fatuity,  687 

Features,  evidence  from  the,  660 
Fecundity  in  women,  642 
Fees  to  medical  witnesses,  51 
Feigned  poisoning,  84 

wounds,  253 

strangulation,  423 

pregnancy,  493 

menstruation,  4b9 

delivery,  502 

abortion,  525 

insanity,  690 

deafness  and  dumbness,  745 
Fern  leaves  in  abortion,  517 
Ferric  chloride,  160 
Ferrous  sulphate,  160 
Fever,    death    from,     after    wounds    and 

operations,  297,  305 
Fibres  on  weapons,  266 
Firearms,  examination  of,  365 
Fish,  poisonous,  84 
[Fisk,  James,  Jr.,  case  of,  285] 
Flagellation,  death  from,  289 
Fleming's  tincture  of  aconite,  231 
Flesh,  diseased,  poisoning  by,  84 
Flogging,  military,  death  from,  289 
Flour  poisoned  with  lead,  149 
Fly-paper,  135 
Fly-water,  135 

Foetal  circulation,  changes  in  the,  caused 
by  respiration,  556 

stomach,  contents  of  the,  557 

heart,  sounds  of  the,  491 

changes  in  the,  after  breathing, 
556 
Foeticide  (see  Abortion),  513 
Foetus,   characters   of   the,   to   the   sixth 
month,  508 

from  sixth  to  the  ninth  month,  532 

age  of  the,  determined  by  size  of  the 
external  ear,  534 
Food,  poisonous,  84,  173,  176 

poison  detected  in,  84 

copper  contained  in,  151 

putrescent,  177 

death  from  privation  of,  480 
Fool's  parsley,  effects  of,  226 
Foramen  ovale,  closure  of  the,  556 
Fowler's  mineral  solution,  134 
Foxglove,  poisoning  with,  228 


INDEX. 


781 


Fractures,  352 

spontaneous,  353 

in  the  living  and  dead,  354 

locomotioH  after,  355 

of  tlie  skull,  334,  577 

of  the  spine,  33(5 

accidental,  in  the  drowned,  389 

in  newborn  children,  577 
Fragilitas  ossium,  353 
Fright,  death  from,  294 
Frost-erythema,  478 
Fruit-stains  resembling  blood,  282 
Fungi,  poisoning  with,  206 
Furniture,  blood  on,  267 


(^ALL-BLADDER,  wound  and  ruptures 
I     of  the,  347 
Gamboge,  etiects  of,  163 

in  abortion,  517 
Game,  poisoned,  173,  178 
Gangrene,  effects  of,  70 
[Garfield,  President,  case  of,  285] 
Garrote  robberies,  420 
Gas,  suffocation  by,  454,  456 

■water-,  456 
Gaseous  poisons,  438 

Gelatinized  perforation  of  the  stomach,  93 
Gelsemium,  poisoning  by,  164 
Genitals,  wounds  of  the,  350 
German  aconitine,  236 
Gestation,  natural  period  of,  603 

duration  of,  from  one  intercourse,  603 

short  periods  of,  607 

protracted,  612 

mistakes  in  the  mode  of  computation 
of,  607 

period  of,  not  fixed  by  law,  617 
Gin,  poisoning  with,  196 
Glanders,  poison  of,  71 
Glandul?e,  Pacchioni,  302 
Glandular  cicatrices,  315 
Glass,  wounds  caused  by,  248 

powdered,  effects  of,  75 
Godfrey's  cordial,  180 
Gonorrhoea  in  rape,  655 
Gonorrhoeal  discharges,  654 
Goulard's  extract,  147 
Goulard-water,  147 
Green  vitriol,  160 

hellebore,  167 
Grievous  bodily  harm,  240  • 

Griffith's  mixture,  518 
Guaiacum  test  for  blood,  271 
Guelder  rose,  230 
Gunpowder,  wounds  from,  363 

vapor  of,  450 
Gunshot  wounds,  nature  of,  358 
near  or  distant,  359 
homicidal  or  suicidal,  361 
accidental,  361 


nABIT,  its  influence  on  poisons,  75 
Habits,  concealment  of,  in  life  insur- 
ance, 749 


Habitual  intemperance,  741,  751 
Hfematin,  properties  of,  272 
theniin,  crystals  of,  273 
Hi-emoglobin,  271 
Hemorrhage,  death  from,  286 
internal,  death  from,  287 
cerebral,  331 

death  of  the  newborn  child  from,  565 
Hair  on  weapons,  206 

the  coloi'  of,  in  paternity,  620 
Hair-washes,  148 
Hallucinations  in  insanity,  682 
in  drunkenness,  740 
in  sleep,  743 
Hanging,  death  from,  394 

appearances  in  death  from,  397 
evidences  of,  from  mark  of  the  cord, 

400 
of  the  dead  body,  402 
marks  of  violence  ou  the  body  in,  402 
homicidal,  404 

circumstantial  evidence  in  cases  of,  406 
evidence  from  position  of  body  in,  407 
Hartshorn,  poisoning  with,  111 
Head,  wounds  of  the,  327 

injuries  to  the,  in  newborn  children, 
576 
Heart,  wounds  of  the,  340 

rupture  of  the,  341 
("Heart,  wounds  of,  not  directly  fatal,  339] 
Heat-apoplexy,  479 
Heat,  excessive,  death  from,  479 
[Heat,  intense,  characteristic  of  true  sun- 
stroke, 480] 
Hellebore,  poisoning  with,  167 
Hevella  esculenta,  206 
Hemlock,  poisoning  with,  222 

water-dropwort,  225 
Henbane,  poisoning  with,  209 
[Hendrickson,  Jolm,  Jr.,  case  of,  93] 
Hepatization  of  the  lungs,  544 
Hereditary  transmission  of  insanity,  690 
Hermaphrodites,  legal  rights  of,  627 
Hermaphroditism,  626 
Hernia,  phrenic,  344 
Hiera  picra,  163,  517 
Holly,  noxious  effects  of,  230 
Homicidal  Monomania,  723 
symptoms  of,  723 
varieties  of,  724 
legal  tests  of,  726 
medical  tests  of,  730 
medical  evidence  of,  733 
wounds,  256 

burning   mistaken   for   spontaneous, 
371 
Horseradish  and  aconite,  233 
Hunger,  death  from  (see  Starvation),  480 
Hydrate  of  chloral,  poisoning  with,  200 
Hydrochloric  acid,  102 

symptoms    and    appearances   in 

poisoning  with,  102 
analysis  of,  102 
stains  of,  on  clothing,  103 
Hydrocyanic  acid,  187 
Hydrogen,  arsenetted,  137 


782 


INDEX. 


H3''dro,£;en  test  for  arsenic,  128 
Hypkostatic  Test,  543 

objections  to  the,  from  sinking  of 

the  lungs,  544 
erroneous  inferences  from,  547 
etfects  of  putrefaction  on  the,  548 
artificial  inflation,  549 
general    conclusions     respecting 
the  employment  of,  553 
Hymen,    evidence   derived    from    the,  in 
rape,  649 
as  a  sign  of  virginity,  658 
Hyoscyamine,  210 
Hyoscine,  210 

Hyoscyamus,  poisoning  with,  210 
Hypospadia,  636 
[Hypothetical  questions,  experts,  61] 


IDENTITY  of  substances,  24 
personal,  from  cicatrices,  310 

mistaken,  311 

sexual,  646 
Idiocy,  688 

Idiosyncrasy  in  poisoning,  76 
Idiots,  rape  on,  663 
Illusions  in  insanity,  682 

in  drunkenness,  741 
Imbeciles,  wills  made  by.  709 
Imbecility,  688 

senile,  690 
Immaturity  of  the  foetus,  575 

of  the  partus  in  cases  of  legitimacy,  610 
Impediments,  canonical,  to  marriage,  643 
Impotency,  causes  of,  629 

from  age,  629 

from  local  disease  and  malformation, 
629 

from  general  disease,  636 

as  a  ground  for  divorce,  635 
Impulse  to  crime,  733 
Imputed  poisoning,  84 

wounds,  255 

cicatrices,  314 

strangulation,  423 
Inanition,  death  from,  480 
Incapacity,  sexual  (see  Impotency),  629 
Incendiarism,  propensity  to,  737 
Incised  wounds,  247 
Incoherency,  690 
Incompetency,  mental,  medical    tests  of, 

712 
Indian  tobacco,  227 
Indigo,  sulphate  of,  95 
Infans,  598 
Infanticide,  531 

inspection  of  the  body  in,  535 

proofs  of  life  before  respiration  in,  536 

after  respiration,  539 

static  test  in,  541 

Ploucquet's  test  in,  542 

legal  proofs  of,  554 

proofs  of  live  birth  in,  555 

natural  causes  of  death  in,  563 

violent  causes  of  death  in,  569,  581 

examination  of  women  in  cases  of,  588 


Infantile  leucorrhcea.  655 
Infants,  action  of  opium  on,  180 
rape  on,  648 
in  law,  598 
Inflation,  artificial,  of  the  lungs,  549 
Inheritance,    medical    questions    relating 

to,  591 
Injections,  poisoning  by,  81 
Inquests,  coroners',  33 
[Insane  homicide,  criminal  responsibility 
of,  728] 
produced   by  delirium  tremens  good 
defence,  742] 
Insane,  responsibility  of,  717 
Insanity,  medical  definitions,  675 
moral  and  intellectual,  676 
legal  definitions  of,  709 
hallucinations  and  illusions  in,  682 
lucid  intervals  in,  683 
various  forms  of,  684 
hereditary  transmission  of,  690 
feigned,  690 

post-mortem  appearances  in,  692 
rules  for  applying  restraint,  694 
signing  certificates  of,  696 
interdiction  in  cases  of,  705 
evidence  of,  from  written  documents, 

709 
plea  of,  in  criminal  cases,  717 
homicidal,  720 
puerperal,  735 
in  life  insurance,  754 
[Insanity,  primary  delusional,  686] 
[Insanity,  delusion    in  mind  criterion  of 

absence  or  presence  of,  679] 
[Insanity,  a  competent  expert  in  cases  of, 

58] 
Insect  powders,  218 
Insemination,  603 

Inspection  of  the  body  in  poisoning,  23 
in  wounds,  240 
in  child-murder,  535 
Insurance  (see  Life  Iksukance),  746 

murders,  755 
Intellectual  insanity,  676 
Intemperance,  habitual,  738,  751 

definition  of,  751 
[Intense  heat  characteristic  of  true  sun- 
stroke, 480] 
Intercourse,  duration  of  gestation   after, 
603 
»    carnal,  legal  proofs  of,  648 
Interdiction  in  insanity,  705 
Intervals,  lucid,  in  insanity,  683 

validity   of    acts    performed    during, 
t83 
Intestines,  wounds  and  ruptures  of  the, 

348 
Intoxication  mistaken  for  concussion,  329 
[Intoxication,  excessive,  mental  unsound- 
ness   superinduced    by,    may    excuse, 
739  j 
Iodic  acid  test,  183 
[Iodine,     symptoms,     appearances,     and 

analysis,  119] 
Iodoform,  200 


INDEX. 


783 


Iron-filings,  75,  518 

Iron-mould  mistaken  for  blood,  281 

Iron,  muriated  tincture  of,  1(50 

salts  of,  poisoning  with,  160 
Irritant  poisons,  78,  94 
Irritants,  meclianical,  75 

non-metallic,  94 

metallic,  121 

vegetable,  163 

animal,  171 


JALAP,  eflfects  of,  163 
Japaconitine,  234 
Jasmine,  yellow,  164 
Juuiperus  Sabina,  164 

in  abortion,  519 
Jury  of  matrons,  497 


IT-IDNEYS,  ruptures  of  the,  347 
L     Kleptomania,  737 


LABOR,  premature,  induction  of,  529 
Laburnum,  237,  517 
seeds,  237 
Lacerated  wounds,  248 
Lactation,  a  cause  of  puerperal  insanity, 

73 1 
Larynx,  spasm  of  the,  567 
Latent  disease  in  wounds,  292 
Laudanum,  poisoning  with,  180 
Laurel-water,  poisoning  with,  82 
[Law  regarding  dying    declarations,    30, 

31,  32] 
Lead;  poisoning  by  acetate  of,  145 
tests  for  the  salts  of,  147 
detection  of,  in  the  tissues,  147 
carbonate  of,  147 
chronic  poisoning  by,  148 
oxide  of,  148 
chromate  of,  161 
meconate  of,  185 
Lead  glaze,  poisonous  effects  of,  149 
Lead  palsy,  148 
Legal  tests  of  insanity,  727 
Legitimacy,  legal  presumption,  602 

period   of   gestation  in   reference   to, 

604 
disputed,  from  shortness  of  gestation, 
607 
from  long  periods  of  gestation,  612 
viability  in  reference  to,  610 
proofs   of,  from  the   state  of  the  off- 
spring, 648 
in  what  cases  admitted,  617 
inferred  from  parental  likeness,  619 
superfoetation  in  relation  to,  623 
[Legitimacy,  603] 
Leucorrhoea,  infantile,  655 
Levant  nut,  204 
License  of  counsel,  38 
Life,  legal  and  medical,  536,  555 
tests  of,  66,  593 


Life- 
diseases  tending  to  shorten,  748 
Life  insurance,  746 

principles,  746 
presumption  of  death  in,  746 
medical  responsibility  in,  747 
policies  vitiated  by  fraud,  747 
suicide  in  respect  to,  754 
murders  in  respect  to,  755 
insanity  in,  754 
Lightning,  death  from,  464 

post-mortem  appearances,  465 

action  for  damage  from,  476 
Likeness,  parental,  619 
Lime-kilns,  vapors  of,  452 
Liquids,  corrosive,  burns  by,  372 
Liquor  amnii,  530 

arsenicalis,  134 
Litharge,  poisoning  with,  140 
Live  birth  in  civil  suits,  593 

proofs  of,  in  child-murder,  554 
summary  regarding,  562 
Liver,  wounds  of  the,  346 
Lobelia,  poisoning  with,  227 
Lobelacrin,  228 

Lochia,  evidence  from  the,  500,  736 
Lockjaw  from  wounds,  302 
Locomotion  after  severe  injuries,  335,  340 

after  fractures,  355 

after  delivery,  579 
Long  fasting,  effects  of,  480 
[Lloyd,  Mrs.  E.  E.,  case  of,  25] 
Lucid  intervals,  682 
Lucifer  matches,  119 
Lunacy,  675 

commissions  of,  706 

acts,  breaches  of  the,  699 
Lunatics,  wounds  inflicted  by,  258 

restraint  applied  to,  694 

discharge  of,  703 

as  witnesses,  705 

testamentary  capacity  of,  711 

interdiction  of,  705 

examination  of  alleged,  706 

wills  made  by,  714 
Lungs,  wounds  of  the,  338 

examination     of    the,     in     newborn 
children,  539 

specific  gravity  of  the,  541 

atelectasis  of  the,  544 

variably  affected  by  respiration,  546 

putrefaction  of,  548 

artificial  inflation  of,  549 
Lung-tests,  543 
Lypemania,  687 


MADNESS,  675 
Magnetic  sleep,  rape  during,  664 
Majority,  questions  relative  to,  598 

when  attained,  599 
Malapraxis,  309,  356 
[Malapraxis,  law  of,  356] 
Malformation,  death  of  child  from,  566 
sexual,  626 
a  cause  of  impotency,  629 


781 


INDEX. 


[Malpractice,  physician  or  surgeon  liable 
to  damages  for,  357] 
[ignorant,  356] 
[negligent,  35(5] 
Mania,  (iS4 

suicidal,  687 
hoDQicidal,  720 
puerperal,  735 
Mania  sine  delirio,  676 
Mairiage,  impediments  to,  643 
Marsh's  process  for  arsenic,  128 
Matches,  phosphorus,  poisoning  with,  119 
Material    concealment'  in  life    insurance, 

749 
Matrons,  jury  of,  497 

Maturity  of  the  newborn  child,  signs  of,  533 
Meadow  saffron,  165 
Meat,  unwholesome,  84,  173 
Mechanical  injury,  death  from,  288 

irritants,  75 
Meconic  acid,  tests  for,  183,  185 
MHCouium,  560 
Medical  etiquette,  42 
evidence,  17,  48 

in  cases  of  insanity,  716 
experts,  20 
jurists,  duties  of,  18 
privilege,  38 

respousibility   in   wounds,  208,  308, 
327 
in  cases  of  insanity,  696 
in  delivery,  529 
in  child-inurder,  588 
in  life  insurance,  747 
secrets,  38 
witnesses'  act,  34 
witnesses,  37 

presence  of,  in  court,  46 
[Medical  privilege,  42] 
Medicines  and  poisons  contrasted,  72 

poisons  substituted  for,  82 
Medico-legal  reports,  27 

for  coroners'  inquests,  33 
Melancholia,  684,  687 
■Melted  metals,  burns  from,  367 
Mejiibranes,  child  born  in  tlie,  511 
[Memorandum,  purpose  of,  26] 

[witness  must  know  facts  contained 

in,  27] 
[as  evidence,  26] 
Meningeal  apoplexy,  332 
Menses  (see  Menstecatiox),  488 

suppression  of,  in  pregnancy,  4S8 
Menstrual  blood,  characters  of,  284,  530, 
671 
climacteric,  641 
Menstruation,    suppression    of,  a  sign  of 
pregnancy,  488 
feigned,  489 

appearances  of,  after  death,  525 
age  at  which  it  appears,  638 
appearance  of,  in  infants,  640 
age  at  which  it  ceases,  641 
absence  of,  in  sterility,  638 
fallacies   in    calculating   pregnancies 
from,  617 


Menstruation — 

in  hermaphrodites,  628 

pregnancy  before,  639 
after  cessation,  641 

suppressed,  crimes  committed  during, 
639 
Mental  alienation,  675 
[Mental    unsoundness    superinduced    by 
excessive  intoxication  may  excuse,  739] 
Mentha  pulegium,  518 
Merck's  aconitine,  236 
Mekcuey,  poisoning  by  the  salts  of,  138    i 

ammonio- chloride  of,  or  white  precip- 
itate, 144 

chronic  poisoning  by,  140 

metallic,  effects  of,  138 

oxide  of,  ]44 

perch loride  of,  138 

sulphates  and  nitrates  of,  145 
Metallic  irritants,  121 
Mezereon,  230 

[Microscopes  of  1200  to  1800  diameters, 
blood  of  man  and  animals  distinguished 
by  means  of,  278] 
Microscopical  evidence,  276,  561 
Milk,  detection  of,  558 

poisonous,  178 
Mind,  unsoundness  of,  675 
Mineral  green,  poisoning  with,  135 

solution,  Fowler's.  134 
^Minium  (red  lead),  poisoning  with,  147 
Minor  (see  Mixoeitt),  598 
Minority,  questions  relating  to,  598 
Mirbane,  essence  of,  192 
Misanthropy,  682 
Miscarriage,  legal  meaning  of,  513 
Moles,  nature  of,  509 

on  the  skin,  318 

in  cases  of  identity,  318 

abortion  of,  529 
Mole-pregnancy,  509 
Monkshood,  poisoning  with,  230 
Monomania,  685 

homicidal,  720 

suicidal,  687 
[Monomania,  mind  destroyed  on  one  sub- 
ject, 6S0] 
Monorchides,  virility  of,  633 
Monsters,  legal  definition  of,  600 

do  not  inherit,  601 

destructicm  of,  not  permitted,  601 

sexual,  626 
Monstrosity,  death  of  the  child  from,  566 

sexual,  626 
Moral  insanity,  676,  721 
[Moral  insanity,  conflict  and  opinions  of 

Courts,  677] 
Morphine  and  its  salts,  181 

tests  for.  182 
Mortality  of  wounds,  290 
Motive  for  crime,  730 
Muco-pui'ulent  discharges  in  rape,  657 
Mucous    discharges,    cliaracters    of,   654, 

657 
Muriate  of  iron,  160 
MuEiATic  Acid,  poisoning  with,  102 


INDEX. 


785 


Muscarine,  209 

Mushrooms,  poisoning  with,  206 

Mussels,  poisoning  with,  84 


\T^VI  mistaken  for  marks  of  violence, 

ri     586 

as  proofs  of  identity,  318 
in  the  newborn  child,  535 

Narcotics,  effects  of,  on  the  brain,  716 

Navel-string  (see  Umbilical  Cokd),  556, 
565 

Neck,  twisting  of  the,  579 

Necrosis,  from  phosphorus,  116 

Needles  and  pins,  action  of,  75 

.Neurine,  178 

Meurotic  poisons,  78,  178 

Newborn  child,  legal  meaning  of,  531 

Nicotiana  tabacum,  203 

Nicotine,  poisoning  with,  203 

Nightshade  (see  Belladonna),  210 

Nitrate  of  potassium.  111 

Nitre,  death  from.  111 
sweet  spirits  of,  197 

Nitric  acid,  poisoning  with,  98 

effects  of  the  vapor  of,  98 
appearances  and  fatal  dose,  99 
analysis  and  dialysis  of,  100 
detection  on  clothing,  101 

Nitrobenzene,  poisoning  with,  194 

Nitroglycerine,  194 

[Nitro-hydrochloric  acid,  103] 

Nitrous  ether,  spirit  of,  197 

Noma  pudendi,  652 

Non-metallic  irritants,  94 

Non  compos  mentis,  678,  706 

[Non  compos  mentis,  judicial  interpretation 
of,  678] 

Notes,  use  of,  in  evidence,  26 

Noxious  substances,  legal  meaning  of,  74, 
525 

Nulliparity,  506 

Nullity,  suits  of,  643 

Nux  vomica,  poisoning  with,  215 


OEDEMA  of  the  lungs,  544 
(Enanthe  crocata,  225 
Oil  of  croton,  165 

vitriol,  94 

bitter  almonds,  192 

savin,  164 

tansy,  520 
Operation,  Cjesarean,  596 
Operations,  surgical,  death  from,  304,  309 
Opinion  evidence,  51 
[Opinion  evidence  in  criminal  cases,  54] 

[evidence,  59,  53] 
Opium,  symptoms  caused  by,  179 

appearances  in  death  from,  180 

fatal  dose  of,  180 

process  for  detecting,  182 

eating,  808 

habit,  181 
Orbit,  wounds  of  the,  336 
Ordeal  bean,  205 
50 


Orpiraent,  poisoning  by,  136 
Ossification  in  the  newborn  child,  533 
Overlaying  of  children,  435 
Ovum,  examination  of  the,  505,  507 
Oxalate  of  potassium,  acid,  108 
Oxalic   acid,  symptoms  and   appearances 
caused  by,  103 

fatal  dose  of,  105 

analysis  of,  106 

dialysis  of,  106 


PAINTER'S  COLIC,  148 
Palsy  from  lead,  148 
Paper-hangings,  detection  of  arsenic  in, 

136 
Papier  Moure,  135 
Paraplegia,  virility  in  cases  of,  637 
Paregoric  elixir,  180 
Parental  likeness,  619 
Paris  green,  135 
Parity,  506 

Parturition,  (see  Delivery),  499 
Partus,  the  newborn  child,  531 
Paternity,  questions  on,  619 
Peach-nut  oil,  192 
Pearlash,  poisoning  with,  109 
Peas,  copper  in,  152 
Pederastia,  672 
Penis,  absence  of  the,  632 

duplex,  635 
Pennyroyal,  517 

as  an  abortive,  518 
Perchloride  of  mercury,  138 

of  iron,  160 
Perforation   of  the  stomach   from   poison 
and  disease,  92 
spontaneous,  93 
Personal  injuries,  239 

death  from  slight,  295 
Petroleum,  171 
Pharmacy  act,  poisons  scheduled  under, 

72,  523 
Phosphorus,  poisoning  by,  114 

symptoms,  115 

chronic  poisoning  by,  116 

appearances,  116 

vapor,  effects  of,  116 

fatal  dose  of,  117 

detection  of,  117 

red  or  amorphous,  action  of,  118 
Phrenic  hernia,  344 
Physostigma  venenosum,  205 
Physostigmine,  205 
Pia  mater,  the,  335 
Picrotoxin,  effects  of,  204 
Pigments,  poisonous,  135 
Pilacotia,  517 

Pins  and  needles,  administration  of,  75 
Ploncquet's  test,  542 
Plural  births,  600 
Poison,  definition  of,  71 

law  respecting  the  administration  of, 
74 

influence  of  habit  on,  75 
of  idiosyncrasy  on,  76 


786 


I^'DEX. 


Poison — 

neurotic,  79 

irritant  and  corrosive,  78 

effects  modified  bv  disease,  77 

substituted  for  medicine,  82 

in  food,  84 

slow  and  rapid  death  from,  SO 

gaseous,  438 

non-detection  of.  in  the  dead  bodv, 

89 
scheduled  under  Pharmacy  Act,  72, 
523 
Poisoned  game,  178 

grain,  204 
Poisoxi.NG,  evidence  of,  in  the  living,  80 
disease  mistaken  for,  88 
feigned  and  imputed,  84 
evidence  of,  in  the  dead,  86 
acute  and  chronic,  87 
post-mortem  appearances  in,  89 
ulceration,   corrosion,  and  softening, 

in  cases  of,  90,  91 
rules  for  investigating  cases  of,  22,  85 
'         infanticide  by,  588 
[Poisoning,  chemical  analysis,  93] 
Poisonous  food,  84 

fungi  or  mushrooms,  206 
gases,  438 
Poisons,  classification  of,  78 

sale  of,  72 
Policies,  insurance,  746 

void  by  fraud,  747 
suicide,  754 
Poppies,  syrup  of,  ISO 
Pork,  diseased,  poisoning  with,  175 
Pork-pies  and  brawn,  poisoning  with,  177 
Porphyridium  crueutum,  276 
Posthumous  births,   622 
Post-mortem  insjjections,  rules  for,  21 
[Post-mortem  in  electrocution,  470] 
Potash  and  its  carbonates,  poisoning  with, 
109 
acid  oxalate  of,  108 
nitrate  of,  111 
chlorate  of,  112 
sulphate  of,  112 
arsenite  of,  134 
arsenate  of,  136 
bichromate  of,  160 
Potassium,  cyanide  of,  191 
Pri^cipitate,  white  and  red,  144 
Pkegna>"cy,  signs  of.  488 
feigned,  493,  497 
plea  of,  in  bar  of  execution,  497 
concealment  of,  494 
unconscious,  495 
in  the  dead,  496 
proof  of,  in  abortion,  529 
longest  duration  of,  612 
before  menstruation,  639 
following  rape,  666 
earliest  age  for,  640 
latest  age  for,  641 
crimes  perpetrated  during,  736 
Premature  births,  607 

labor,  induction  of,  529 


Premature — 

puberty,  640 
Presence  in  court,  46 
[President  Garfield,  case  of,  285] 
[Primary  delusional  insanity,  686] 
Privet,  230 

[Privileged  communication,  470] 
[Privilege,  medical,  42] 
Procreative  power,  age  for,  in  the  male, 
630 
in  the  female,  638 
Procurators,  fiscal,  34 
[Professional  secrets,  39] 
Projectiles,  365 
Prostitutes,  rape  on,  662 
Protracted  births,  612 

gestation,  612 
Peussic  acid,  symptoms,  187 
appearances,   188 
fatal  doses  of,  188 
analysis,  188 

tests  for  the  vapor  of,  189 
detection  in  the  tissues  of,  191 
Pseudaconitine,  223 

Ptyalism,  mercurial  (see  Salivation),  140 
Puberty  in  males,  630 
in  females,  638 
premature,  639 
Pudendum,  marks  of  violence  on,  649 
Puerperal  mania,  735 
Pugilistic  violence,  death  from,  245,  290, 

331 
Pulmonary  tests,  543 
Punctiform  ecchymoses,  429 
Punctured  wounds,  248 
Purulent  discharges  in  alleged  rape,   653, 

657 
Putrefaction,  effects  of,  69 

changes  in  the  viscera  caused  by,  69 
gases  of,  69 
of  the  lungs,  548 
Putrescent  food,  173 
Pytemia  following  wounds,  308 
Pyromania,  737 
Pyrogallic  acid,  170 


QUICKENING,  a  sign  of  pregnancy,  490 
Quicksilver  (see  Mekcukt),  137 
Quotations  from  books,  45 
[Quotations  from  books,  46] 
Quinine,  186 


I)  ABIES,  poison  of,  71 
i-     Rape,  definition  of,  647 

proofs  of,  in  children  under  pu- 
berty, 648 
vulval  and  vaginal,  649 
evidence  from  marks  of  violence 

in,  649 
loss  of  phvsical  evidence  in  cases 

of,  650, '666 
purulent  discharges  in,  653 
false  charges  of,  654,  671 
on  girls  after  puberty,  657 


INDEX. 


78' 


Rape — 

on  adults,  663 

uuder  narcotics,  663 

on  idiots,  663 

during  sleep,  664 

pregnancy  toUowing,  666 

microscopical  evidence,  667 

evidence  of,  in  the  dead  body,  671 

by  females  on  males,  672 
Recurrent  mania,  685 
Red  dyes  resembling  blood,  282 
[Red  corpuscles,  consensus  of  opinion  con- 
cerning, 279] 
Red  lead  in  snuff,  149 

phosphorus,  118 

paint  mistaken  for  blood,  282 

precipitate,  144 
Redness  of  the  stomach  in  poisoning,  89 
morbid,  90 

of  the  skin  from  burns,  369 
Reduction-process   (arsenic),  126 
Re-examination,  45 
Regularity  in  wounds,  259 
Reinsch's  process  for  arsenic,  129 
Reports,  medico-legal,  27 
[Reese,  Prof.,  cadaveric  rigidity,  68] 
Resorcin,  170 
Respiration,  cessation  of,  in  death,  66 

signs  of,  in  the  newborn  child,  539 
imperfect,  540 
before  birth,  551 
placental,  567 
Responsibility,  medical,  529,  588 
Restraint  in  insanity,  694 
Rigidity,  cavaderic,  67 
Rigor  mortis,  67 
Rue  in  abortion,  518 
Rules  for  delivery  of  evidence,  48 
Rust  mistaken  for  blood,  283 
Ruta  graveolens,  518 
Rye,  ergot  of,  action,  520 


SAFFRON  as  an  abortive,  520 
Salivation,  arsenical,  123 
mercurial,  138 
Sal  volatile,  HI 
Sale  of  poisons,  72 
Salt  of  sorrel,  108 
Saltpetre,  action  of,  111 
Sanguineous  tumors  in  newborn  children, 

564 
Sausages,  poisonous,  84,  177 
Savin,  poisoning  with,  176 
as  an  abortive,  519 
oil  of,  520 
Scalds  and  burns,  366 
Scalp,  wounds  of  the,  327 
Scalp-tumors  in  newborn  children,  564 
Scammony,  163 
Scars  (see  Cicatrices),  312 
[Secrets,  professional,  39,  40,  41] 
Schweinfurt  green,  135 
Sclieele's  green,  135 

prussic  acid,  187 
[Schoeppe,  Dr.  Paul,  case  of,  23,  180] 


Scirrhus  of  the  lungs,  544 
Secale  cornutum,  520. 
Secondary   causes   of   death   in   wounds, 
297 
in  drowning,  378 
Self-delivery,  violence  in,  579 
Self-inflicted  wounds,  253 
Senile  dementia,  690,  715 
Sewer  gases,  noxious  effects  of,  461 
Sex,  distinction  of,  626 

mixed  and  doubtful,  626 
civil  rights  depending  on,  627 
Sexual  identity,  646 
Sexual  malformation,  varieties,  626 

influence  of,  on  electoral  rights. 

628 
a  cause  of  impotency,  629 
proof  of,  in  cases  of  divorce,  644 
Shell-fish,  poisoning  by,  174 
Shock,  death  from,  288 
Shot,  wounds  from,  362 
Sium  latifoliura,  227 
Skilled  witnesses,  30,  35 
Skin,  action  of  poisons  through  the,  125 
Skull,  fractures  of  the,  335 

accidental  fractures  of,  in  parturition, 
577 
Sleep,  delivery  during,  504 
rape  during,  664 
homicide  during,  743 
Slow  poisoning,  ^7,  140 
Small-shot,  wounds  produced  by,  362 
Smoking,  inveterate,  753 
Smothering,  death  from,  435 
accidental  cases  of,  435 
newborn  children,  570 
Snuff  poisoned  with  lead,  149 
Soap-leys,  poisoning  by,  109 
Soda  and  its  carbonate,  poisoning  by,  109 
Sodomy,  672 
Softening  of  the  stomach  from  poison  and 

disease,  93 
Somnambulism,  responsibility  in  cases  of, 
743  .  , 

Sorrel,  salt  of,  108  ' 

Spanish  flies,  poisoning  with,  171 
Spasm,  cadaveric,  265 

of  the  larynx,  death  from,  567 
Specific  gravity  of  the  human  body,  387 
Spectral  analysis  of  blood,  272 
Speculum,  misuse  of  the,  516 
Spermatic  stains,  668 

Spermatorrhoea,  a  cause  of  impotency,  635 
Spermatozoa,  age  at  which  they  appear, 
631 

examination  of  stains  for,  668 

illustrations  of,  670 
Spinal  marrow,  injuries  to  the,  336 

poisons,  79,  215 
SpiuH,  concussion  of  the,  336 

fractures  of  the,  336 
Spirits,  poisoning  with,  195  [ 
Spirit  of  hartshorn.  111 

of  salt,  102 
Spleen,  ruptures  of  the,  347 
Spontaneous  combustion,  alleged,  371 


788 


INDEX, 


Spontaneous  perforation  of  the  stomach. 
93 
fractures,  353 
Stabs  and  cuts,  251 
Stains,  acid,  on  clothing,  97,  101 

of  blood  on  linen  and  weapons,  280 

283 
of  meconium,  561 
of  amniotic  liquid,  530 
Starch,  detection  of,  557 
Starvation,  death  from,  480 
symptoms  of  acute,  480 
chronic,  482 

appearances  in  death  from,  483 
voluntary,  486 
infanticide  by,  575 
Stas's  process  for  strychnine,  220 
Static  test,  the,  in  infanticide,  541 
Stealing,  propensity  for,  737 
Sterility  in  males,  629 
in  females,  638 
causes  of,  643 
Stillbirths,  573 
Stomach,  redness  of  the,  89 
ulceration  of  the,  90 
perforation  of  the,  93 
softening  of,  93 

wounds  and  ruptures  of  the,  348 
foetal,  contents  of  the,  560 
Stramonium,  poisoning  with,  214 
Strangulation,  cause  of  death,  410 
Strangulation,  post-mortem  appearances, 
411 
proofs  of,  on  the  dead  body,  415 
accidental. and  suicidal,  417 
homicidal,  419 
evidence  of,  from  marks  of  violence, 

419 
Imputed  homicidal,  423 
■destruction  of  newborn  child  by,  581 
accidental,  by  umbilical  cord,  582 
marks  on  child  resembling,  585 
Strychnine,  poisoning  with,  215 

symptoms  and  appearances,  215,  217 
fatal  dose  of,  217 
analysis  of,  218 

detection  in  organic  mixtures,  220 
not  found  in  the  body,  221 
Subacetate  of  lead,  147 

of  copper,  150 
Subchloride  of  merciiry,  143 
Sublimate,  corrosive,  138 
Subpoenas,  rules'respecting,  36 
[Succi,  the  Italian,  fasted  forty-five  days, 

487] 
Sudden  death,  23,  66,  87 

causes  of,  66 
Suffocation,  425 

cause  of  death  in,  428 
post-morten  appearances,  429 
evidence  of  death  from,  432 
accidental  cases  of,  433 
of  children,  434 
homicidal,  434 
from  gases,  438 
by  carbonic  acid,  440 


Suffocation — 

by  charcoal  vapor,  446 

by  carbonic  oxide,  445 

by  coal  vapor,  450 

by  vapors  of   lime  and  brick   kilns, 

453 
by  confined  air,  457 
by  coal-gas,  453 
by  water-gas,  456 
by  nitrous  oxide,  458 
by  sulphuretted  hydrogen,  459 
by  sewer  gases,  461 
of  newborn  children,  570 
Sugar,  detection  of,  558 

of  lead,  poisoning  with,  145 
Sugillation  (Ecchymosis),  243 
Suicidal  wounds,  260 

mania,  687 
Suicide  and  insanity,  713 
in  life  insurance,  754 
Sulphate  of  indigo,  95 
of  potash,  112 
of  copper,  150 
of  zinc,  159 
of  iron,  160 
of  atropine,  213 
Sulphide  of  arsenic,  137 

of  ammonium,  462,  574 
Sulphomolybdic  acid,  183 
Sulphoviuate  of  sodium,  113 
Sulphuretted  hydrogen,  elfects  of,  459 
appearances  in  death  from,  459 
detection  of,  462 
Sulphuric   acid,    symptoms   and   appear- 
ances caused  by,  94 
fatal  dose  of,  95 

fatal  period  in  poisoning  with,  96 
analysis  of,  96 
dialysis  of,  97 

detection  of,  on  clothing,  97 
burns  from,  373 
Sulphurous  acid,  action  of,  450 
Sunstroke,  death  from,  479 
[Sunstroke,  true,  intense  heat  character- 
istic of,  480] 
Superconception,  621,  624 
Superfoetation,  623 
Supposititious  children,  624 
Surgical  operations,  responsibility  for,  304 
Syncopal  asphyxia,  63 
Syncope,  death  from,  63 
Syphilis,  a  cause  of  abortion,  513 

in  cases  of  rape,  655 
Syphilitic  cicatrices,  315 
Syrup  of  poppies,  180 


TANSY,  oil  of,  520 
Tartar  emetic,  poisoning  with,  153 
symptoms   and   appearances 

in  poisoning  with,  153 
chronic  poisoning  by,  155 
tests  for,  156 
Tartarated  antimony,  153 
Tartaric  acid,  108 
Tartarized  antimony,  153 


INDEX. 


789 


Tattooing,  process  of,  319 
Tattoo-marks,  319 

durability  of,  320 

coloring  material  in,  320 

removal  of,  322 

on  the  dead,  324 

personal  identity  from,  325 
Technical  evidence,  51 
Tenancy  by  curtesy,  593 
[Tenancy  by  the  curtesy,  595] 
Teratology  (see  Moxsters),(300 
Testamentary  capacity,  711,  715 
Test,  hydrostatic,  the,  543 
Testicles,  period   at  which  they  descend, 
532 

non  descent  of  the,  633 

supernumerary,  635 
Testimonial  competency,  598 

in  cases  of  insanity,  705 
[Testimony,  experts  and  expert,  52] 
Tetanus  from  wounds,  302 
Tlieft,  insane  propensity  to,  737 
Thorn-apple,  poisoning  with,  214 
Throat,  wounds  of  the,  258 
Thugs,  poisoning  by,  215 

strangulation  by,  420 
Tinfoil,  spurious,   149 
Tobacco,  poisoning  with,  203 

Indian,  227 

smoking,  excessive,  753 
Toucher  in  pregnancy,  492 
Toxicomania,  685 
Toxiphobia,  685 
Toys,  poisoned,  136 
Traumatic  tetanus,  302 
Trial  at  the  assizes,  35 
Trichina  spiralis  in  pork,  177 
Trichinosis,  177 
Trichomonas,  671 
Trommer's  test,  558 
Tumors,  sanguineous,  564 
Tunica  arachnoides,  334 
Twisting  of  the  neck,  death  from,   579 


ULCERATION  of  the  stomach,  90 
distinguished  from  corrosion,  93 
Ultimum  tempus  pariendi,  G17 
Umbilical    cord,    evidence    of    live    birth 
from,  556 
laceration  of  the,  565 
death  from  compression    of  the, 

565 
strangulation  by  the,  581 
Unconsciousness,  acts  in  a  state  of,  743 
Unconscious  pregnancy,  495 
delivery,  503 
intercourse,  664 
Unnatural  ofiences,  672 
Unskilful  treatment,  death  from,  298,  307 
Unsoundness  of  mind,  675 
Uranium,  162 
Urine,  poisions  in,  84 
Uterine  age  of  foetus,  531 
Uterus,  changes  in  the,  from  pregnancy, 
492 


yACCINE  cicatrices,  317 
T      Vagina,  wounds  of  the,  350 

purulent    discharges    from   the, 
653 
Vaginismus,  cases  of,  645 
Vaginitis  in  infants,  653 
Vaginus  uterinus,  593 

vaginalis,  593 
Vapors  of  chloroform,  199 

of  ether,  197 

of  gunpowder,  450 

of  charcoal,  effects  of,  446 

of  coal  and  coke,  450 

of  lime,  brick,  and  cement  kilns,  453 
Vegetable  irritant  poisons,  163 
Veins,  wounds  of,  342 

death     from    entrance    of    air    into, 
during  operations,  344 
Venereal  diseases  in  cases  of  rape,  655 
Venous  and  arterial  blood,  283 
Ventre,  inspiciendo,  de,  writ  of,  497 
[Veratria,    delicate    test    for    dilute    sul- 
phuric acid,  96] 
Veratrine,  167 

symptoms,  analysis,  168 
Veratrum  viride,  167 
Verdigris,  150 

Vermin  powder  or  killer,  218 
Vertebrae,  fractures  of  the,  336 
iii  drowning,  390 

injuries  to  the,  in  hanging,  406 
in  cases  of  child-murder,  579 
Vesications  from  burns  and  scalds,  368 
Vesicular  mole,  509 
Viability,  in  reference   to  infanticide,  531 

in  monstrosity,  600 

in  legitimacy,  609 

in  concealment  of  birth,  512 
[Viability,  Parliament  of  Paris,  610] 

[Code  Napoleon,  610] 

[Scotch  law,  610] 
Vienna  green,  135 
Violation  (see  Rape),  647 
Violet  powder,  arsenic  in,  125 
Viper  poison,  71 
Virginity,  signs  of,  658 
Virgo  intacta,  658 
Virility,  proofs  of,  631 
Viscera,  preservation  of  the,  25 

effects  of  putrefaction  on  the,  69 
Vitriol,  oil  of,  poisoning  by  (see  Sulphukic 
Acid),  94 

blue,  poisoning  by,  150 

white,  159 

green,  160 
Vomica,  nux,  poisoning  with,  215 
Vulva,  wounds  of  the,  350 
Vulva,  rape,  649 


WADDING,  wounds  from,  363 
Water-gas,  suffocation  by,  456 
Wall-papers,  arsenical,  effects  of,  136 
Water- hemlock,  221 
Water-parsnip,  227 
Waters,  potable,  poisoned  with  lead,  148 


790 


INDEX, 


Weapons  used  in  producing  wounds,  247 

definition  of,  251 

use  of  several,  262 

evidence  from  position  of,  265 

found  in  the  hands  after  death   265 

blood  and  other  substances  ou,  265 
[Wharton,  Mrs.  E.  G-.,  case  of,  23] 
[Wharton-Vanness  case,  85] 
Wheat,  poisoned,  205 
Whiskey,  poisoning  with,  195 
White  arsenic,  121 

precipitate,  poisoning  with,  144 

lead,  147 

vitriol,  159 

hellebore,  167 
Wills  of  the  insane,  law  regarding,  711 

proofs  of  eccentricity  in,  714 
Wills  in  senile  dementia,  715 

in  extremis,  715 

made  in  drunkenness,  716 
Wine,  antimonial,  153 

of  colcliicum,  166 
Witnesses,  medical,  37 

skilled,  36 

admitted  in  court,  46 

rules  respecting  the  examination  of, 
44 

lunatics  as,  705 
Wolfsbane,  poisoning  by,  230 
Wood,  smouldering,  death  from,  449 
Worm  lozenges,  140 
Wo[:>-DS,  definition  of,  239 

eflFects  of  jjutrefaction  on,  70 

danger  to  life,  239 

producing  grievous  Ixidily  harm,  240 

examination  of,  240 

description  of,  241 

vital  and  post-mortem,  241 

without  hemorrhage,  243 

produced  by  weapons,  247 

iijcised  and  punctured,  247,  248 

lacerated  and  contused,  248 

from  glass  or  earthenware,  248 

from  blows  or  falls,  248 

through  the  dress,  252 

self-inflicted  or  imputed,  253 

evidence  from  situation,  256 

homicidal,  256 

in  what  position  inflicted,  257 

nature  and  extent  of,  258 

direction  and  shape  of;  259 

of  the  throat,  259 

suicidal  and  accidental,  260 

by  right  or  left  hand,  261 

presence  of  seveial,  262 

two  or  more  mortal,  262 

produced   simultaneously  or   at    dif- 
f«-rent  times,  263,  294' 

circumstantial  evidence  in,  263 

foreign  substances  in,  266 

direct  cause  of  death,  285 


Wounds — 

fatal,  from  hemorrhage,  286 
after  long  periods,  296 
from  unskilful  treatment,  298 
■  from  imprudence  or  neglect,  299 
from  abnormal  conditions,  302 
from  erysipelas,  303 
from  delirium  tremens,  304 
from  surgical  operations,  304 
from    chloroform    under    opera- 
tions, 306 
from  pyaemia,  308 
from  mechanical  injury,  288 
from  shock,  288 
from  improper  treatment,  299 
from  unhealthy  state  of  body,  300 

death  from  many,  289 

mortality  of,  290 

death  from  latent  diseases  in  cases  of, 
294 

which  of  two  caused  death,  294 

death  from  poison  after,  295 

death  from  slight,  296 

secondary  causes  of  death  from,  297, 
302 

acceleration  of  death  from,  301 

tetanus  following,  302 

cicatrization  of,  310 

of  the  head,  327 

of  the  face,  336 

of  the  spine  and  spinal  marrow,  336 

of  the  chest,  338 

of  the  lungs,  338 

of  the  heart,  339 

of  the  arteries  and  veins,  342 

struggling  after  severe,  342 

and  ruptures  of  the  diaphragm,  343 

of  the  abdomen,  345 

of  the  liver,  346 

of  the  spleen,  347 

of  the  kidneys,  347 

of  the  intestines,  348 

of  the  stomach,  348 

of  the  urinary  bladder,  349 

of  the  genitals,  350 

gunshot,  358 

from  wadding  and  gunpowder,  363 

caused  by  lightning,  465 

on  the  newborn  child,  576 
[Wounds  of  heart  not  directly  fatal,  339] 


YELLOW  arsenic,  poisoning  with,  136 
jasmine,  164 
Yew,  poisoning  with,  518 


ZINC,  poisoning  by  the  salts  of,  159 
Zoosperms  (see  Spermatozoa),  670 
[Zinc,  found  in  body,  24] 


LEA  BROTHERS  &  CO.'S 

CLASSIFIED    CATALOGUE 


OF 


o  iTlEDicAL  f^^  Surgical 

< 


In  asking  the  attention  of  the  profession  to  the  works  advertised  in  the  following  pages, 
the  publishers  would  state  that  no  pains  are  spared  to  secure  a  continuance  of  the  confi- 
dence earned  for  the  publications  of  the  house  by  their  careful  selection  and  accuracy  and 
finish  of  execution. 

The  printed  prices  are  those  at  which  books  can  generally  be  supplied  by  booksellers 
throughout  the  United  States,  who  can  readily  procure  for  their  customers  any  works  not 
kept  in  stock.  Where  access  to  bookstores  is  not  convenient  books  will  be  sent  by  mail  by 
the  publishers  postpaid  on  receipt  of  the  printed  price,  and  as  the  limit  of  mailable  weight 
has  been  removed,  no  difficulty  will  be  experienced  in  obtaining  through  the  post-office 
any  work  in  this  catalogue.  No  risks,  however,  are  assumed  either  on  the  money  or 
on  the  books,  and  no  publications  but  our  own  are  supplied,  so  that  gentlemen  will  in 
most  cases  find  it  more  convenient  to  deal  with  the  nearest  bookseller. 

LEA   BKOTHEES  &  CO. 

Nos.  706,  708  &  710  Sansom  St.,  PHrLADELPHiA,  October,  1892. 


cc  

w  Practical  Medical  Periodicals. 

f^    THE   AMERICAN    JOURNAL   OF   THE    MEDICAL       >.     To  one  address, 
^  SCIENCES,  Monthly,  $4.00  per  annum.  l    ^^^^'^s'q 

THE  MEDICAL  NEWS,  Weekly,  $4.00  per  annum.      ^       per  annum. 

THE  MEDICAL  NEWS  VISITING  LIST  (4  styles,  see  page  3),  $1.25. 
CO  With  either  or  both  above  periodicals,  in  advance,  75c. 

THE  YEAR-BOOK  OF  TREATMENT  (see  page  16),  $1.50.    With  either 
JOURNAL  or  NEWS,  or  both,  75c.    Or  JOURNAL,  NEWS,  VISIT- 
Q  ING  LIST  and  YEAR-BOOK   $8.50,  in  advance. 

D  

p  Subscription  Price  Reduced  to  $4.00  Per  Annum. 

^        THE  MEDICAL  NEWS. 

f^     rpHAT  The  News  fulfils  the  wants  of  men  in  active  practice  is  made  clear  by  the 
HP      -L      steady  growth  of  its  subscription  list.     This  increase  of  readers  has  rendered  possi- 

Hble  a  reduction  in  the  price  of  The  News  to  Four  Dollars  per  year,  so  that  it  is  now 
by  far  the  cheapest  as  well  as  the  best  large  weekly  journal  published  in  America. 

By  means  of  The  Medical  News  every  physician  is  now  able  at  a  minimum  outlay 
to  insure  his  own  receipt  of  the  earliest  and  most  authoritative  information  on  all  subjects 

(Continued  on  next  page.) 


a 


2 


2    Lea  Brothers  &  Co.'s  Periodicals — ^Am.  Journal,  Medical  News. 

THE   MEDICAL   NEWS— Continued. 

of  interest  to  the  great  medical  world.  The  foremost  writers,  teachers  and  practitioners 
of  the  day  furnish  original  articles,  clinical  lectures  and  notes  on  practical  advances; 
the  latest  methods  in  leading  hospitals  are  promptly  reported ;  a  condensed  summary  of 
progress  is  gleaned  each  week  from  a  large  exchange  list,  comprising  the  hest  journals 
at  home  and  abroad ;  a  special  department  is  assigned  to  abstracts  requiring  full  treat- 
ment for  proper  presentation ;  editorial  articles  are  secured  from  writers  able  to  deal 
instructively  with  questions  of  the  day ;  books  are  carefully  reviewed ;  society  proceedings 
are  represented  by  the  pith  alone ;  regular  correspondence  is  furnished  by  gentlemen  in 
position  to  know  all  occurrences  of  importance  in  the  district  surrounding  important 
medical  centres,  and  minor  matters  of  interest  are  grouped  each  week  under  news  items. 
Everything  is  presented  with  such  brevity  as  is  compatible  with  clearness,  and  in  the 
most  attractive  manner.  In  a  word  The  Medical,  Xews  is  a  crisp,  fresh,  weekly  news- 
paper and  as  such  occupies  a  well-marked  sphere  of  usefulness,  distinct  and  comple- 
mentary to  the  ideal  monthly  magazine.  The  American  Journal  or  the  Medical 

SCIESCES. 

Tk  American  Journal  of  tiB  Medical  pcience^ 

Pnblislied  Montlily,  at  Four  Dollars  Per  Ann-am 

The  American  Journae  enters  in  1893  upon  its  seventy-fourth  year,  still  main- 
taining the  foremost  place  among  the  medical  periodicals  of  the  world,  A  vigorous 
existence  during  two  and  a  half  generations  of  men  amply  proves  that  it  has  always 
adapted  itself  to  meet  fully  the  requirements  of  the  time. 

Being  the  medium  chosen  by  the  best  minds  of  the  profession  during  this 
period  for  the  presentation  of  their  ablest  papers.  The  American  Journai,  has  well 
earned  the  praise  accorded  it  by  an  unquestioned  authority — "from  this  file  alone,  were 
all  other  publications  of  the  press  for  the  last  fifty  years  destroyed,  it  would  be  possible  to 
reproduce  the  great  majority  of  the  real  contributions  of  the  world  to  medical  science 
during  that  period."  Original  Articles,  Keviews  and  Progress,  the  three  main  departments 
into  which  the  contents  of  The  Joiirnae  are  divided,  will  be  found  to  possess  still  greater 
interest  than  in  the  past.  The  brightest  talent  on  both  sides  of  the  Atlantic  is  enlisted  in 
its  behalf  and  no  effort  will  be  spared  to  make  The  Journal  more  than  ever  worthy  of 
its  position  as  the  representative  of  the  highest  form  of  medical  thought. 


COMMUTATION  RATE. 

Taken  together.  The  Journal  and  JS^ews  form  a  peculiarly  useful  combination, 
and  afford  their  readers  the  assurance  that  nothing  of  value  in  the  progress  of  medical 
matters  shall  escape  attention.  To  lead  every  reader  to  prove  this  personally  the  com- 
mutation rate  has  been  placed  at  the  exceedingly  low  figure  of  $7.50. 


SPECIAL  OFFERS. 

The  Medical  News  Visiting  List  (regular  price,  $1.25,  see  next  page,)  or  The 
Year-Book  of  Treatment  (regular  price,  $1.50,  see  page  16,)  will  be  furnished  to  advance- 
paying  subscribers  to  either  or  both  of  these  periodicals  for  75  cents  apiece  ;  or  Journal, 
Kews,  Visiting  List  and  Year- Book,  $8.50. 


Subscribers  can  obtain,  at  the  close  of  each  volume,  cloth  covers  for  The  Journal  (one 
annv/iUy),  and  for  The  News  {one  annually),  free  by  mail,  by  remitting  Ten  Cents  for  The 
Journal  cover,  and  Fifteen  Cents  for  The  News  cover. 


JJ]^"The  safest  mode  of  remittance  is  by  bank  check  or  postal  money  order,  drawn  to 
the  order  of  the  undersigned  ;  where  these  are  not  accessible,  remittances  for  subscriptions 
may  be  sent  at  the  risk  of  the  publishers  by  forwarding  in  registered  letters.     Address, 

LEA  BROTHERS  &  CO.,  706,708  &  710  Sansom  Street,  Philadelphia. 


Lea  Brothers  &  Co.'s  Publications — Period.,  Manuals,  Diet. 


THB  MEDICAL  NEWS  VISITING  LIST  FOB  1893 

Is  published  in  four  styles,  Weekly  (dated  for  30  patients);  Monthly  (undated,  for  120 
patients  per  month)  ;  Perpetual  (undated,  for  30  patients  weekly  per  year)  ;  and  Per- 
petual (undated,  for  60  patients  weekly  per  year).  The  60-patient  Perpetual  insists 
of  256  pages  of  assorted  blanks.  The  first  three  styles  contain  32  pages  of  important 
data  and  17  6  pages  of  assorted  blanks.  Each  style  is  in  one  wallet-shaped  book,  leather- 
bound,  with  pocket,  pencil,  rubber,  and  catheter-scale.     Price,  each,  |1.25.     Shortly. 

SPECIAL  COMBINATIONS  WITH  VISITING  LIST. 

The  Amer.  Journal  (|4)  with  Visiting  List  ($1.25),  or  Year-Book  (|)1.50),  for 
The  Medical  News  ($4)      "  "  "         "        "  "  " 

The  Journal  and  News  ($7,50)       "  "         "        "  "  "         " 

The  Journal,  News,  Visiting  List  and  Year-Book  (see  page  16) 


This  list  is  all  that  could  be  desired.  It  con- 
tains a  vast  amount  of  useful  information,  especi- 
ally for  emergencies,  and  gives  good  tables  of  doses 
and  therapeutics. — Canadian  Practitioner. 

For  convenience  and  elegance  it  is  noi  surpass- 
able. — Obstetric  Gazette. 

The  Medical  News  Visiting  List  for  the  year  1892 
contains  certain  improvements  as  compared  with 
previous  issues.  It  is  difficult  to  imagine  any 
ordinary  emergency  occuring  in  medical  practice 
that  is  not  treated  of  in  this  useful  work. — Mon- 
treal Medical  Journal,  December,  1891. 

The  new  issue  maintains  its  previous  reputation. 


;4.75 
4.75 
8.25 
8.50 

It  adapts  itself  to  every  style  of  book-keeping; 
there  is  space  for  all  kinds  of  professional  records; 
it  is  furnished  with  a  ready  reference  thumb-letter 
index,  and  has  a  most  valuable  text.— Medical 
Record. 

The  Bledical  News  Visiting  List  for  1892  will  be 
found  to  be  one  of  the  best  of  Its  kind.  A  special 
index  facilitates  speedy  reference.  Besides  the 
usual  table  of  doses,  incompatibles,  poisons  and 
antidotes,  it  contains  directions  for  examination 
of  urine,  ligation  of  arteries,  and  a  brief  resume 
of  the  accepted  treatment  of  the  diseases  most 
often  met  with.— TAe  Canadian  Prac,  Jan.  IG,  1892. 


THE   STUDENTS'  QUIZ   SERIES. 

UNDER  this  title  Messrs  Lea  Brothers  &  Co.  will  publish  in  time  for  the  fall 
sessions  of  the  Medical  Colleges,  a  series  of  teaching  works  in  form  of  quettion 
and  answer,  embracing  the  subjects  essential  to  a  thorough  medical  education.  Written 
by  a  corps  of  qualified  medical  teachers  and  specialists  in  New  York  and  edited  by  Bern 
B.  Gallaudet,  M.  D.,  Demonstrator  of  Anatomy,  College  of  Physicians  and  Surgeons, 
New  \''ork,  this  series  is  assured  of  adoption  throughout  the  country  as  an  authoritative 
and  convenient  means  of  imparting  and  receiving  instruction.  The  advantages  accruing  to 
the  teacher  and  student  are  obvious,  but  these  volumes  will  furthermore  te  of  great  value 
to  the  practitioner  who  may  desire  to  possess  for  instant  reference  brief  and  pithy  statements 
of  the  essentials  of  the  various  medical  sciences.  The  series  ■will  comprise  the  following 
thirteen  volumes  issued  in  the  most  attractive  and  convenient  form  with  illustrations 
wherever  desirable.  Owing  to  the  large  sale  assured,  the  prices  have  been  fixed  at  the 
very  low  rate  of  $1  per  volume  except  in  case  of  the  Anatomy  and  Surgery  which, 
being  double  sized,  are  placed  at  $1.75  each. 


ANATOMY  {Double  Number)  — By  Fred.  J. 
Beockway,  M.  D.,  A.asistant  Demonstrator  of 
Anatomy,  College  of  Physicians  and  Surgeons, 
New  York,  and  A.  O'Malley,  M.D.,  Instructor 
in  Surgery,  New  York  Polyclinic.    $1.75. 

PH  YSIOLOC  Y— By  F.  A.  Manning,  M.D., 
Attending  Surgeon,  Manhattan  Hospital,  N.  Y. 

m. 

CHEMISTRY  AND  PHYSICS  — By  Joseph 
Struthers,  Ph.  B.,  Columbia  College  School  of 
Mines,  N.Y.,  and  D.  W.  Ward,  Ph.  B.,  Columbia 
College  Sjhool  of  Mines,  N.  Y.,  and  Chas.  H. 
Willmarth,  M.  S.,  N.  Y.    $1. 

HISTOLOGY,  PATHOLOGY  AND  BAC- 
TERIOLOGY—By  Bennett  S.  Beach,  M.  D., 
Lecturer  on  Histology,  Pathology  and  Bacte- 
riology, New  York  Polyclinic.    $1. 

MATERIA  MEDICA  AND  THERAPEU- 
TICS-By  L.  F.  Warner,  M.  D.,  Attending 
Physician,  St.  Bartholomew's  Dispensary,  N.Y. 
U. 

PRACTICE  OF  MEDICINE— By  Edwin  T. 
Doubledat,  M.  D.,  Member  N.  Y.  Pathological 
Society,  and  J.  D.  Nagel,  M.  D  ,  Member 
N.Y.  County  Medical  Association.    $1. 

SURGERY  (Double  Number)— By  R.  A.  Sands, 
M.  D ,  Assistant   Demonstrator  of  Anatomy, 


CENITO  -  URINARY  AND  VENEREAL 
DISEASES— By  Charles  H.  Chetwood,  M.D., 
Visiting  Surgeon,  Demiit  Dispensary,  Depart- 
ment of  Surgery  and  Genito-Urinary  Diseases, 
New  York.    $L 

DISEASES  OF  THE  SKIN— By  Charles  C. 
Ransom,  M.  D  ,  Assistant  Dermatologist,  Van- 
derbilt  Clinic,  New  York.    $1. 

DISEASES  OFTHEEYE,  EAR,  THROAT 
AND  NOSE— By  Frank  E.  Miller,  M.D., 
Throat  Surgeon,  Vanderbilt  Clinic,  New  York, 
and  James  P.  McEvoy,  M.D.,  Throat  Surgeon, 
Bellevue  Hospital,  Out-Patient  Department, 
New  York,  and  J.  E.  Weeks,  M.  D.,  Lect.  on 
Ophthalmology  and  Otology,  Bellevue  Hospi- 
tal Medical  College.    New  York.    S^l. 

OBSTETRICS  — By  Charles  W.  Hayt,  M.D., 
House  Physician,  Nursery  and  Child's  Hospi- 
tal, New  York.    $1. 

GYNECOLOGY— By  G.  W.  Bratenahl,  M.  D., 
Assistant  in  Gynecology,  Vanderbilt  Clinic, 
New  York,  and  Sinclair  Tousey,  M.  D.,  Assist- 
ant Surgeon,  Out-Patient  Department,  Roose- 
velt Hospital,  New  York.    SI. 

DISEASES  OF  CHILDREN-By  C.  A.  Eiiodes, 
M.  D.,  Instructor  in  Diseases  of  Childr<  n,  New 
York  Pest-Graduate  Medical  College.    SI. 


College  of  Physicians  and  Surg.,  N.  Y.    $1.75. 
For  special  circular  with  full  information  and  specimen  pages  address  the  publishers. 

TSE  MEDICAL  NEWS  PHYSICIANS'  LEDGEB, 

Containing  300  pages  of  fine  linen  "  ledger  "  paper,  ruled  so  that  all  the  accounts  of  a 
large  practice  may  be  conveniently  kept  in  it,  either  by  single  or  double  entry,  for  a  loiig 
period.  Strongly  bound  in  leather,  with  cloth  sides,  and  with  a  patent  flexible  back, 
which  permits  it  to  lie  perfectly  flat  when  opened  at  any  place.     Price,  $4,00. 


Lea  Brothers  &  Co.'s  Publications — Dictionaries. 


THE    STANDARD. 

THE 

DATionaL  niGDieAL  TimionmY 


INCLUDING 


English,  French,  German,  Italian  and  Latin  Technical  Terms  used  in  Medicine  and 
the  Collateral  Sciences,  and  a  Series  of  Tables  of  Useful  Data. 


John  %  Billing?,  JJ.D,  LL.D.,  Ediq.  and  Harv.,  D.C.L.,  W\^, 

Member  of  the  National  Academy  of  Sciences,  Surgeon  V.  S.  A.,  etc. 
WITH  THE  COLLABORATION  OF 


Pkof.  W.  O.  ATWATER. 
FRANK  BAKER,  M.  D., 
.  S.  M.  BURNETT,  M.  D., 
W.  T.  COUNCILMAN,  M.  D., 


JAMES  M.  FLINT,  M.  D., 
J.  H.  KIDDER,  M.  D., 
WILLIAM  LEE,  M.D., 
R.  LORINI,  M.D., 


WASHINGTON  MATTHEWS,  M.D., 
C.  S.  MINOT,  M.D. 
H.  C.  YARROW,  M.  D., 


In  two  very  handsome  royal  octavo  volumes  containing  1574  pages, 
with  two  colored  plates. 

Per  Voliitne— Cloth,  $6;   I^eatJier,  $7;    Half  Morocco,  Marbled  Edges,  $8.50.    For  Sale 
by  Subscription  only.    Specimen  pages  on  application.    A.ddress  the  Publishers, 


Its  scope  is  one  which  will  at  once  satisfy  the 
student  and  meet  all  the  requirements  of  the  med- 
ical practitioner.  Clear  and  comprehensive  defi- 
nitions of  words  should  form  the  prime  feature  of 
any  dictionary,  and  in  this  one  the  chief  aim 
seems  to  be  to  give  the  exact  signification  and  the 
ditferent  meanings  of  terms  in  use  in  medicine 
and  the  collateral  sciences  in  language  as  terse  as 
is  compatible  with  lucidity.  The  work  is  remark- 
able, too,  for  its  fulness.  The  enumerations  and 
subdivisions  under  each  word  heading  are  strik- 
ingly complete,  as  regards  alike  the  Englisii  tongue 
and  the  languages  chiefly  employed  by  ancient 
and  modern  science.  It  is  impossible  to  do  justice 
to  the  dictionary  by  any  casual  illustration.  It 
presents  to  the  English  reader  a  thoroughly 
scientific  mode  of  acquiring  a  rich  vocabulary  and 
offers  an  accurate  and  ready  means  of  reference  in 
consulting  works  in  any  of  the   three    modern 


continental  languages  which  are  richest  in  med- 
ical literature.  To  add  to  its  usefulness  as  a  work 
of  reference  some  valuable  tables  are  given. 
Another  feature  of  the  work  is  the  accuracy  of  its 
definitions,  all  of  which  have  been  checked  by 
comparison  with  many  other  standard  works  in 
the  different  languages  it  deals  with.  Apart  from 
the  boundless  stores  of  information  which  may  be 
gained  by  the  study  of  a  good  dictionary,  one  is 
enabled  by  the  work  under  notice  to  read  intelli- 
gently any  technical  treatise  in  any  of  the  four 
chief  modern  languages.  There  cannot  be  two 
opinions  as  to  the  great  value  and  usefulness  of 
this  dictionary  as  a  book  of  ready  reference  for  all 
sorts  and  conditions  of  medical  men.  So  far  as 
we  have  been  able  to  see,  no  subject  has  been 
omitted,  and  in  respect  of  completeness  it  will  be 
found  distinctly  superior  to  any  medical  lexicon 
yet  published. — The  London  Lancet,  April  5,  1890. 


HARTSSORNB,  SEBWMT,  A.  31.,  M.  D.,  LL,  2>., 

Lately  Professor  of  Hygiene  in  the  University  of  Pennsylvania. 

A  Conspectus  of  the  Medical  Sciences ;  Containing  Handbooks  on  Anatomy. 
Physiology,  Chemistry,  Materia  Medica,  Practice  of  Medicine,  Surgery  and  Obstetrics, 
Second  edition,  thoroughly  revised  and  greatly  improved.  In  one  large  royal  12mo. 
volume  of  1028  pages,  with  477  illustrations.    Cloth,  |4.25 ;  leather,  $5.00. 


LUDLOW,  J.L.,3LD., 

Consulting  Physician  to  the  Philadelphia  Hospital,  etc. 

A  Manual  of  Examinations  upon  Anatomy,  Physiology,  Surgery,  Practice  of 
Medicine,  Obstetrics,  Materia  Medica,  Chemistry,  Pharmacy  and  Therapeutics.  To  which 
is  added  a  Medical  Formulary.  Third  edition,  thoroughly  revised,  and  greatly  enlarged.  In 
one  12mo.  volume  of  816  pages,  with  370  illustrations.     Cloth,  $3.25 ;  leather,  $3.75. 

The  arrangement  of  this  volume  in  the  form  of  question  and  answer  renders  it  espe- 
cially suitable  for  the  office  examination  of  students,  and  for  those  preparing  for  graduation. 


SOBLYN,  MICffAItn  I).,  M.  J>. 

A  Dictionary  of  the  Terms  Used  in  Medicine  and  the  Collateral 
Sciences.  Kevised,  with  numerous  additions,  by  Isaac  Hays,  M.  D.,  late  editor  of 
The  American  Journal  of  the  Medical  Sciences.  In  one  large  royal  12mo.  volume  of  520 
double-columned  pages.     Cloth,  $1.50;  leather,  $2.00. 

It  is  the  best  book  of  definitions  we  have,  and  ought  always  to  be  upon  the  student's  table. — Southern 
Medical  and  Surgizac  Journal. 


Lea  Brothers  &  Co.'s  Publications — Anatomy,  Dictionary, 


GBAT,  SJEJVBT,  F,  B,  S,, 

Lecturer  on  Anatomy  at  St.  George's  Hospital,  London. 

Anatomy,  Descriptive  and  Surgical.  Edited  by  T.  Pickering  Pick, 
F.  K.  C.  S.,  Surgeon  to  and  Lecturer  on  Anatomy  at  St.  George's  Hospital,  London, 
Examiner  in  Anatomy,  Royal  College  of  Surgeons  of  England.  A  new  American  from 
the  eleventh  enlarged  and  improved  London  edition,  thoroughly  revised  and  re-edited 
by  William  W.  Keen,  M.  D.,  Professor  of  Surgery  in  the  Jefierson  Medical  College  of 
Philadelphia.  To  which  is  added  the  second  American  from  the  latest  English  edition  of 
Landmarks,  Medical  and  Surgical,  by  Luther  Holden,  F.  R.  C.  S.  In  one  imperial 
octavo  volume  of  1098  pages,  with  685  large  and  elaborate  engravings  on  wood.  Price  of 
edition  in  black:  Cloth,  $6;  leather,  $7;  half  Russia,  $7.50.  Price  of  edition  in  colors 
(see  below):  Cloth,  $7.25;  leather,  $8.25 ;  half  Russia,  $8.75. 

This  work  covers  a  more  extended  range  of  subjects  than  is  customary  in  the  ordinary 
text-books,  giving  not  only  the  details  necessary  for  the  student,  but  also  the  application  of 
those  details  to  the  practice  of  medicine  and  surgery.  It  thus  forms  both  a  guide  for  the 
learner  and  an  admirable  work  of  reference  for  the  active  practitioner.  The  engravings 
form  a  special  feature  in  the  work,  many  of  them  being  the  size  of  nature,  nearly  all 
original,  and  having  the  names  of  the  various  parts  printed  on  the  body  of  the  cut,  in 
place  of  figures  of  reference  with  descriptions  at  the  foot.  In  this  edition  a  new  departure 
has  been  taken  by  the  issue  of  the  work  with  the  arteries,  veins  and  nerves  distinguished 
by  diflerent  colors.  The  engravings  thus  form  a  complete  and  splendid  series,  which  will 
greatly  assist  the  student  in  forming  a  clear  idea  of  Anatomy,  and  will  also  serve  to  refresh 
the  memory  of  those  who  may  find  in  the  exigencies  of  practice  the  necessity  of  recall- 
ing the  details  of  the  dissecting-room.  Combining,  as  it  does,  a  complete  Atlas  of 
Anatomy  with  a  thorough  treatise  on  systematic,  descriptive  and  applied  Anatomy, 
the  work  will  be  found  of  great  service  to  all  physicians  who  receive  students  in  their 
offices,  relieving  both  preceptor  and  pupil  of  much  labor  in  laying  the  groundwork  of  a 
thorough  medical  education. 

For  the  convenience  of  those  who  prefer  not  to  pay  the  slight  increase  in  cost  necessi- 
tated by  the  use  of  colors,  the  volume  is  published  also  in  black  alone,  and  maintained 
in  this  style  at  the  price  of  former  editions,  notwithstanding  its  largely  increased  size. 

Landmarks,  Medical  and  Surgical,  by  the  distinguished  Anatomist,  Mr.  Luther  Holden, 
has  been  appended  to  the  present  edition  as  it  was  to  the  previous  one.  This  work  gives 
in  a  clear,  condensed  and  systematic  way  all  the  information  by  which  the  practitioner  can 
determine  from  the  external  surface  of  the  body  the  position  of  internal  parts.  Thus 
complete,  the  work  will  furnish  all  the  assistance  that  can  be  rendered  by  type  and 
illustration  in  anatomical  studv. 


The  most  popular  work  on  anatomj'  ever  written. 
It  is  sufficient  to  say  of  it  tliat  this  edition,  thanks 
to  its  American  editor,  surpasses  all  other  edi- 
tions — Jour,  of  the  Avier.  Med.  Ass'n,  Dec.  31,  1887. 

A  work  which  for  more  than  twenty  years  has 
had  the  lead  of  all  other  text-books  on  anatomy 
throughout  the  civilized  world  comes  to  hand  in 
such  beauty  of  execution  and  accuracy  of  text 
and  illustration  as  more  than  to  make  good  the 
large  promise  of  the  prospectus.  It  would  be  in- 
deed difficult  to  name  a  feature  wherein  the  pres- 
ent American  edition  of  Gray  could  be  mended 
or  bettered,  and  it  needs  no  prophet  to  see  that 
the  royal  work  is  destined  for  many  years  to  come 
to  hold   the  first  place  among  anatomical  text- 


books. The  work  is  published  with  black  and 
colored  plates.  It  is  a  marvel  of  book-making. — 
American  Practitioner  and  News,  Jan.  21, 1888. 

Gray's  Anatomy  is  the  most  magnificent  work 
upon  anatomy  which  has  ever  been  published  in 
the  English  or  any  other  language. — Cincinnati 
Medical  News,  Nov.  1887. 

As  the  book  now  goes  to  the  purchaser  he  is  re- 
ceiving the  best  work  on  anatomy  that  is  published 
in  any  language. —  Virginia  Med.  Monthly,  Dec.  1887. 

Gray's  standard  Anatomy  has  been  and  will  be 
for  years  the  text-book  for  students.  The  book 
needs  only  to  be  examined  to  be  perfectly  under- 
stood.— Medical  Press  of  Western  New  York,  Jan. 
1888. 


Also  for  sale  separate — 
HOLDBW,  LTJTJSLBB,  F,  B.  C.  S., 

Swgeon  to  St.  Bartholomeio' s  and  the  Foundling  Hospitals,  London. 
Landmarks,  Medical  and  Surgical.     Second  American  from  the  latest  revised 
English  edition,  with  additions  by  W.  W.  Keen,  M.  D.,  Professor  of  Artistic  Anatomy  in 
the  Penna.  Academy  of  Fine  Arts.     In  one  12mo.  volume  of  148  pages.     Cloth,  $1.00. 


DVHi^GLISOW,  BOBLMY,  31.  D., 

Late  Professor  of  Institutes  of  Medicine  in  the  Jefferson  Medical  College  of  Philadelphia. 

MEDICAL  LEXICON ;  A  Dictionary  of  Medical  Science :  Containing 
a  concise  Explanation  of  the  various  Subjects  and  Terms  of  Anatomy,  Physiology,  Pathol- 
ogy, Hygiene,  Therapeutics,  Pharmacology,  Pharmacy,  Surgery,  Obstetrics,  Medical  J  uris- 
prudence  and  Dentistry,  Notices  of  Climate  and  of  Mineral  Waters,  Formulae  for  Officinal, 
Empirical  and  Dietetic  Preparations.  With  the  Accentuation  and  Etymology  of  the  Terms, 
and  the  French  and  other  Synonymes,  so  as  to  constitute  a  French  as  well  as  an  English 
Medical  Lexicon.  Edited  by  Richard  J.  Dunglison,  M.  D.  In  one  very  large  and 
handsome  royal  octavo  volume  of  1139  pages.  Cloth,  $6.50;  leather,  raised  bands,  $7.50; 
very  handsome  half  Russia,  raised  bands,  $8.00. 

It  has  the  rare  merit   that  it  certainly  has  no  rival   in  the  English  language  for  accuracy 
and  extent  of  references. — London  3Iedical  Gazette. 


6  Lea  Brothers  &  Co.'s  Publications — Anatomy. 

ALLBN,  HAJRRISON,  M.  J>., 

Professor  of  Physiology  in  the  University  of  Pennsylvania. 

A  System  of  Human  Anatomy,  Including  Its  Medical  and  Surgical 
Relations.  For  the  use  of  Practitioners  and  Students  of  Medicine.  With  an  Intro- 
ductory Section  on  Histology.  By  E.  O.  Shakespeare,  M.  D.,  Ophthalmologist  to 
the  Philadelphia  Hospital.  Comprising  813  double-columned  quarto  pages,  with  380 
illustrations  on  109  full  page  lithographic  plates,  many  of  which  are  in  colors,  and  241 
engravings  in  the  text.  In  six  Sections,  each  in  a  portfolio.  Price  per  Section,  $3.50 ; 
also  bound  in  one  volume,  cloth,  $23.00 ;  very  handsome  half  Russia,  raised  bands  and 
open  back,  $25.00.     For  sale  by  siibscription  only.     Apply  to  the  Publishers. 

It  is  to  be  considered  a  study  of  applied  anatomy  '  care,  and  are  simply  superb.  There  is  as  much 
in  its  widest  sense — a  systematic  presentation  of  of  practical  application  of  anatomical  points  to 
such  anatomical  facts  as  can  be  applied  to  the  the  every-day  wants  of  the  medical  clinician  as 
practice  of  medicine  as  well  as  of  surgery.  Our  ;  to  those  of  the  operating  surgeon.  In  fact,  few 
author  is  concise,  accurate  and  practical  in  his  general  practitioners  will  read  the  work  without  a 
statements,  and  succeeds  admirably  in  infusing  feeling  of  surprised  gratification  that  so  many 
an  interest  into  the  study  of  what  is  generally  con-  :  points,  concerning  which  they  may  never  have 
sidered  a  dry  subject.  The  department  of  Histol-  thought  before  are  so  well  presented  for  their  con- 
ogy  is  treated  in  a  masterly  manner,  and  the  sideration.  It  is  a  work  which  is  destined  to  be 
ground  is  travelled  over  by  one  thoroughly  famil-  '  the  best  of  its  kind  in  any  language. — Medical 
lar  with  it.    The  illustrations  are  made  with  great  ;  Record,  Nov.  25, 1882. 

CLAMKE,  W,  B,, F.M.C.S.  <&  LOCKWOOD, C, B., F,B. C.S, 

Demonstrators  of  Anatomy  at  St.  Bartfiolomew^ a  Hospital  Medical  School,  London. 
The  Dissector's  Manual.     In  one  pocket-size  12mo.  volume  of  396  pages,  with 

49  illustrations.     Limp  cloth,  red  edges,  $1.50.     See  Student^  Series  of  Manuals,  page  30, 

Messrs.ClarkeandLockwoodhave  written  a  book  I  intimate  association  with  students  could  have 
that  can  hardly  be  rivalled  as  a  practical  aid  to  the  given.  With  such  a  guide  as  this,  accompanied 
dissector.  Their  purpose,  which  is  "  how  to  de-  by  so  attractive  a  commentary  as  Treves'  Surgical 
scribe  the  best  way  to  display  the  anatomical  Applied  Anatomy  {i-a.iae  series),  no  student  could 
structure,"  has  been  fully  attained.  They  excel  in  fail  to  be  deeply  and  absorbingly  interested  in  the 
s  lucidity  of  demonstration  and  graphic  terseness  ;  study  of  anatomy. — iVeio  Orleans  Medical  and  Sur- 
of  expression,  which  only  a  long  training  and  :  gieal  Journal,  April,  1884. 

HIBST,  BABIONC,  M.D.,  <&  BIEBSOL,  GBO,  A.,  M.D. 

Professor  of  Obstetrics  in  the  University  Professor  of  Anatomy  and  Embryology  in 

of  Pennsylvania.  the  University  of  Pennsylvania. 

Huraan  Monstrosities.  Magnificent  folio,  containing  about  150  pages  of  text, 
illustrated  with  engravings,  and  39  full- page,  photographic  plates  from  nature.  In  four 
pans,  price,  each,  $5.  Parts  I.  and  11.  just  ready.  Part  III,  shortly.  Limited  edition,  for 
sale  by  subscription  only.     Address  the  Publishers. 

This,  the  second  part  of  what  bids  fair  to  be  the  ;  points  of  this  beautiful  work,  the  second  volume 
best  teratologieal  treatise  extant,  is  fally  up  to  the  !  of  which,  containing  the  description  of  mon^trosi- 
previous  volume   in  point   of  excellence.     The  i  ties,  is  even  more  attractive  than  the  first.    There 


plates  are  superbly  executed  and  the  illustrations 
have  been  made  with  the  specimens  in  the  most 
advantageous  positions  for  purposes  of  study. — 
The  Journal  of  the  American  Medical  Association, 
March  5,  1892. 

We  have  already  referred  at  length  to  the  salient 


are  more  p'.ates  and  less  space  devoted  to  the 
text  We  can  only  repeat  that  the  work  i*  one 
which  reflects  great  credit  upon  American  ob- 
stetric literature,  and  deserves  a  place  in  the 
library  of  every  specialist  and  student  of  anatomy. 
—Medical  Rtcord,  May  21, 1892. 


TBBVBS,  FBBDEBICK,  F.  B,  C,  S., 

Senior  Demonstrator  of  Anatomy  and  Assistant  Surgeon  at  the  London  Hospital. 
Surgical  Applied  Anatomy.     In  one  pocket-size  12mo.  volume  of  540  pages, 
with  61  illustrations.  Limp  cloth,  red  edges,  $2.00.     See  Students'  Series  of  Manuals,  p.  30. 

BELLAMY,  EDWABI>,  F,  B.  C.  S,, 

Senior  Assistant-Surgeon  to  the  Charing-Cross  Hospital,  London. 

The  Student's  Guide  to  Surgical  Anatomy :  Being  a  Description  of  the 
most  Important  Surgical  Eegion.s  of  the  Human  Body,  and  intended  as  an  Introduction  to 
Operative  Surgery.   In  one  12mo.  volume  of  300  pages,  with  50  illustrations.    Cloth,  $2.25. 

WILSON,  EBASMUS,  F.  B,  S, 

A  System  of  Human  Anatomy,  General  and  Special,  Edited  by  W.  H. 
GoBRECHT,  M.  D.,  Professor  of  General  and  Surgical  Anatomy  in  the  Medical  College  of 
Ohio.  In  one  large  and  handsome  octavo  volume  of  616  pages,  with  397  illustrations. 
Cloth,  $4.00;  leather,  $5.00.     

CLELAJVD,  JOSJ^,  M,  I^.,  F.  B,  S., 

Professor  of  Anatomy  and  Physiology  in  Queen's  College,  Galway. 

A  Directory  for  the  Dissection  of  the  Human  Body.  In  one  12mo, 
volume  of  178  pages.    Cloth,  $1.25. 

HARTSHGRNE'S  HANDBOOK  OF  ANATOMY  |  HORNER'S  SPECIAL  ANATOMY  AND  HISTOL- 
AND  PHYSIOLOGY.  Second  edition,  revised.  OGY.  Eighth  edition,  extensively  revised  and 
In  one  royal  12mo.  volume  of  310  pages,  with  220  modified.  In  two  octavo  volumes  of  1007  pages, 
woodcuts.    Cloth,  81.75.  I      with  320  woodcuts.    Cloth,  $6.00. 


Lea  Brothers  &  Co.'s  Publications — Phys.,  Physiol.,  Anat.,  Chem.     7 


dhapbr,  josjsr  c,  m,  n.,  ll.  d.. 

Professor  of  Chemistry  in  the  University  of  the  City  of  New  York. 
Medical  Physics.     A  Text-book  for  Students  and  Practitioners  of  Medicine.    In 
one  octavo  volume  of  734  pages,  with  376  woodcuts,  mostly  original.   Cloth,  $4. 


While  all  enlightened  physicians  will  agrpe  that 
a  knowledge  of  physics  is  desirable  for  the  medi- 
cal student,  only  those  actually  engaged  in  the 
teaching  of  the  primary  subjects  can  be  fully 
aware  of  the  difficulties  encountered  by  students 
who  attempt  the  study  of  these  subjects  without 
a  knowledge  of  either  physics  or  chemistry. 
These  are  especially  felt  by  the  teacher  of  physi- 
ology. 

It  is,  however,  impossible  for  him  to  impart  a 
knowledge  of  the  main  facts  of  his  subject  and 
establish  them  by  reasons  and  experimental  dem- 
onstration, and  at  the  same  time  nndertalie  to 
teach  nb  initio  the  principles  of  chemistry  or  phys- 
ics. Hence  the  desirability,  we  may  say  the 
necessity,  for  some  such  work  as  the  present  one. 


No  man  in  America  was  better  fitted  than  Dr. 
Draper  for  the  task  lie  undertook,  and  he  has  pro- 
vided the  student  and  practitioner  of  medicine 
with  a  volume  at  once  readable  and  thorough. 
Even  to  the  student  who  has  some  knowledge  of 
physics  this  book  is  useful,  as  it  shows  him  its 
applications  to  the  profession  that  he  has  chosen. 
Dr.  Draper,  as  an  old  teacher,  knew  well  the  ditfi- 
cultie  J  to  be  encountered  in  bringing  his  subject 
within  the  grasp  of  the  average  student,  and  that 
he  has  succeeded  so  well  proves  once  more  that 
the  man  to  write  for  and  examine  students  is  the 
one  who  has  taught  and  is  teaching  them.  The 
book  is  well  printed  and  fully  illustrated,  and  in 
every  way  deserves  grateful  recognition. — The 
Montreal  Medical  Journal,  July,  1890. 


POWER,  HENBY,  M.  B.,  F,  B.  C.  S., 

Examiner  in  Physiology,  Royal  College  of  Surgeons  of  England. 
Human  Physiology.     Second  edition.     In  one  handsome  pocket-size  12mo.  vol- 
ume of  509  pp.,  with  68  illustrations.    Cloth,  $1.50.    See  Students'  Series  of  Manuals,  p.  30. 

BOBEBTSON^,  J,  McGBEGOB,  M,  A,,  M,  B,, 

Muirhead  Demonstrator  of  Physiology,  University  of  Glasgow. 
Physiological  Physics.     In  one  12mo.  volume  of  537  pages,  with  219  illustra- 
tions.    Limp  cloth,  $2.00.     See  Students'  Series  of  Manuals,  page  30. 


The  title  of  this  work  sufficiently  explains  the 
nature  of  its  contents.  It  is  designed  as  a  man- 
ual for  the  student  of  medicine,  an  auxiliary  to 
his  text-book  in  physiology,  and  it  would  be  particu- 
larly useful  as  a  guide  to  his  laboratory  experi- 


ments. It  will  be  found  of  great  value  to  the 
practitioner.  It  is  a  carefully  prepared  book  of 
reference,  concise  and  accurate,  and  as  such  we 
heartily  recommend  it. — Journal  of  the  American 
Medical  Association,  Dec.  6, 1884. 


nALTOJsr,  JOMW  a,  m,  d., 

Professor  Emeritus  of  Physiology  in  the  College  of  Physicians  and  Surgeons,  New  York. 

Doctrines  of  the  Circulation  of  the  Blood.  A  History  of  Physiological 
Opinion  and  Discovery  in  regard  to  the  Circulation  of  the  Blood.  In  one  handsome 
12mo.  volume  of  293  pages.     Cloth,  $2. 


Dr.  Dal  ton's  work  is  the  fruit  of  the  deep  research 
of  a  cultured  mind,  and  to  the  busy  practitioner  it 
cannot  fail  to  be  a  source  of  instruction.  It  will 
inspire  him  with  a  feeling  of  gratitude  and  admir- 
ation for  those  plodding  workers  of  olden  times, 
who  laid  the  foundation  of  the  magnificent  temple 
of  medical  science  as  it  now  stands. — New  Orleans 
Medical  and  Surgical  Journal,  Aug.  1885. 

In  the  progress  of  physiological  study  no  fact 
was  of  greater  moment,  none  more  completely 


revolutionized  the  theories  of  teachers,  than  the 
discovery  of  the  circulation  of  the  blood.  This 
explains  the  extraordinary  interest  it  has  to  all 
medical  historians.  The  volume  before  us  is  one 
of  three  or  four  which  have  been  written  within  a 
few  years  by  American  physicians.  It  is  in  severail 
respects  the  most  complete.  The  volume,  though 
small  in  size,  is  one  of  the  most  creditable  con- 
tributions from  an  American  pen  to  medical  history 
that  has  appeared. — Med.  &  Surg.  Rep.,  Dec.  6, 1884. 


BELL,  F,  JEFFBET,  31.  A., 

Professor  of  Comparative  Anatomy  at  King's  Collene,  London. 

Comparative  Anatomy  and  Physiology.  In  one  12mo.  volume  of  561  pages, 

with  229  illustrations.  Limp  cloth,  $2.00.     See  Students'  Series  of  Manuals,  page  30. 

The  manual  is  preeminently  a  student's  book —  it  the  best  work    in    existence    in    the  English 

clear  and  simple  in  language  and  arrangement,  language  to  place  in  the  hands  of  the    medical 

It  is  well  and  abundantly  illustrated,  and  is  read-  student. — Bristol  Medico-Chirurgical  Journal,  Mar. 

able  and  interesting.    On  the  whole  we  consider  1886. 


ELLLS,  GEOBGE  VINEB, 

Emeritus  Professor  of  Anatomy  in  University  College,  London. 

Demonstrations  of  Anatomy.  Being  a  Guide  to  the  Knowledge  of  the 
Human  Body  by  Dissection.  From  the  eighth  and  revised  London  edition.  In  one  very 
handsome  octavo  volume  of  716  pages,  with  249  illustrations.   Cloth,  $4.25 ;  leather,  $5.25. 


BOBEBTS,  JOHJS^  B,,  A.  M,,  M.  B,, 

Lecturer  in  Anatomy  in  the  University  of  Pennsylvania. 
The  Compend  of  Anatomy.     For  use  in  the  dissecting-room  and  in  preparing 
for  examinations.     In  one  16mo.  volume  of  196  pages.     Limp  cloth,  75  cents. 

Wohler's  Outlines  of  Organic  Chemistry.    Edited  by  Fittig.    Translated 
by  Iba  Eemsen,  M.  D.,  Ph.  D.    In  one  12mo.  volume  of  550  pages.    Cloth,  $3. 


LEHMANN'S  MANUAL  OF  CHEMICAL  PHYS- 
IOLOGY. In  one  octavo  volume  of  327  pages, 
with  41  illustrations.    Cloth,  $2.25. 

CARPENTER'S  HUMAN  PHYSIOLOGY.  Edited 
by  Henby  Poweb.    In  one  octavo  volume. 


CARPENTER'S  PRIZE  ESSAY  ON  THE  USE  AND 
Abuse  of  Alcoholic  Liquors  in  Health  and  Dia- 
EASE.  With  explanations  of  scientific  words.  Small 
12mo.    178  pages.    Cloth,  60  cents. 


8        Lea  Brothers  &  Co.'s  Publications — Physiology,  Chemistry. 


CSAPIIAJ^,  SENHY  C,  M.  Z)., 

Professor  of  Institutes  of  Medicine  and  Medical  Juris,  in  the  Jefferson  Med.  Coll.  of  Philadelphia, 

A  Treatise  on  Human  Physiology.     In  one  handsome  octavo  volume  of 
925  pages,  with  605  fine  engravings.     Cloth,  $5.50 ;  leather,  $6.50. 


It  represents  very  fully  the  existing  state  of 
physiology.  The  present  work  has  a  special  value 
to  the  student  and  practitioner  as  devoted  more 
to  the  practical  application  of  well-known  truths 
which  the  advance  of  science  has  given  to  the 
profession  in  this  department,  which  may  be  con- 
sidered the  foundation  of  rational  medicine. — Buf- 
falo Medical  nnd  Surgical  Journal,  Dec.  1887. 

Matters  which  have  a  practical  bearing  on  the 
practice  of  medicine  are  lucidly  expressed;  tech- 
nical matters  are  given  in  minute  detail;  elabo- 
rate directions  are  stated  for  the  guidance  of  stu- 
dents in  the  laboratory.  In  every  respect  the 
work  fulfils  its  promise,  whether  as  a  complete 
treatise  for  the  student  or  for  the  physician ;  for 
the  former  it  is  so  complete  that  he  need  look  no 


farther,  and  the  latter  will  find  entertainment  and 
instruction  in  an  admirable  book  of  reference. — 

North  Carolina  Medical  Journal,  Nov.  1887. 

The  work  certainly  commends  itself  to  both 
student  and  practitioner.  What  is  most  demanded 
by  the  progressive  physician  of  to-day  is  an  adap- 
tation of  physiology  to  practical  therapeutics,  and 
this  work  is  a  decided  improvement  in  this  respect 
over  other  works  in  the  market.  It  will  certainly 
take  place  among  the  most  valuable  text-books. — 
Medical  Age,  Nov.  25, 1887. 

It  is  the  production  of  an  author  delighted  with 
his  work,  and  able  to  inspire  students  with  an  en- 
thusiasm akin  to  his  own. — American  Practitioner 
and  News,  Nov.  12, 1887. 


DALTOIf,  JOHJS^  C  M,  D., 

Professor  of  Physiology  in  the  College  of  Physicians  and  Surgeons,  New  York,  etc. 
A  Treatise  on  Human  Physiology.      Designed  for  the  use  of  Students  and 
Practitioners  of  Medicine.     Seventh  edition,  thoroughly  revised  and  rewritten.     In  one 
very  handsome  octavo  volume  of  722  pages,  with  252  beautiful  engravings  on  wood.    Cloth^ 
$5.00;  leather,   $6.00. 


From  the  first  appearance  of  the  book  it  has 
been  a  favorite,  owing  as  well  to  the  author's 
renown  as  an  oral  teacher  as  to  the  charm  of 
simplicity  with  which,  as  a  writer,  he  always 
succeeds  in  investing  even  intricate  subjects. 
It  must  be  gratifying  to  him  to  observe  the  fre- 
quency with  which  his  work,  written  for  students 
and  practitioners,  is  quoted  by  other  writers  on 
physiology.  This  fact  attests  its  value,  and,  in 
great  measure,  its  originality.  It  now  needs  no 
such  seal  of  approbation,  however,  for  the  thou- 
sands who  have  studied  it  in  its  various  editions 


have  never  been  in  any  doubt  as  to  its  sterling 
worth.— iV^.  F.  Medical  Journal,  Oct.  1882. 

Professor  Dalton's  well-known  and  deservedly- 
appreciated  work  has  long  passed  the  stage  at 
which  it  could  be  reviewed  in  the  ordinary  sense. 
The  work  is  eminently  one  for  the  medical  prac- 
titioner, since  it  treats  mostfully  of  those  branches 
of  physiology  which  have  a  direct  bearing  on  the 
diagnosis  and  treatment  of  disease.  The  work  ia 
one  which  we  can  highly  recommend  to  all  our 
readers. — Dublin  Journal  of  Medical  Science,  Feb.'83. 


FOSTER,  MICMABL,  M.  D,,  F.  M.  S., 

Prelector  in  Physiology  and  Fellow  of  Trinity  College,  Cambridge,  England. 
Text-Book  of  Physiology.     New  (fourth)  and   enlarged  American  from  the 
fifth  and  revised  English  edition,  with  notes  and  additions.     In  one  handsome  octavo  vol- 
ume of  1072  pages,  with  282  illustrations.     Cloth,  $4.50;  leather,  $5.50. 

The  appearance  of  another  edition  of  Foster's  !  the  author  largely  adopted  in  a  modified  form  in 
Physiology  again  reminds  us  of  the  continued  I  this  revision,  much  was  still  left  to  be  done  by  the 
popularity  of  this  most  excellent  work.  There  i  editorto  render  the  work  fully  adapted  to  the  wants 
can  be  no  doubt  that  this  text^book  not  only  con-  j  of  our  American  students,  so  that  the  American 
tinues  to  lead  all  others  in  the  English  language,  edition  will  undoubtedly  continue  to  supply  the 
but  that  this  last  edition  is  superior  to  its  prede-  I  market  on  this  side  of  the  Atlantic.  The  work 
cessors.  It  is  evident  that  the  author  has  devoted  I  has  been  published  in  the  characteristic  creditable 
B,  considerable  amount  of  time  and  labor  to  its  i  style  of  the  Lea's,  and  owing  to  its  enormous  sale, 
preparation,  nearly  every  page  bearing  evidences  j  is  offered  at  an  extremely  low  price. —  The  Medical 
of  careful  revision.  Although  the  work  of  the  j  and  Surgical  Reporter,  Jan.  9, 1892. 
American  editor  in  former  editions  has  been  by  | 

SIMOJV,  TF.,  FJi,  jy.,  M.  n^, 

Professor  of  Chemistry  and  Toxicology  in  the  College  of  Physicians  and  Surgeons,  Baltimore,  and 
Professor  of  Chemistry  m  the  Maryland  College  of  Pharmacy. 

Manual  of  Chemistry.  A  Guide  to  Lectures  and  Laboratory  work  for  Beginners 
in  Chemistry.  A  Text-book,  specially  adapted  for  Students  of  Pharmacy  and  Medicine. 
New  (third)  edition.  In  one  8vo.  volume  of  477  pages,  with  44  woodcuts  and  7  colored 
plates  illustrating  56  of  the  most  important  chemical  tests.     Cloth,  $3.25. 

nothing  to  be  desired.  As  a  student's  manual  this 
work  is  of  the  highest  order. —  The  Medical  News, 
February  20, 1892. 

While  possessing  all  the  usual  qualities  of  an 
excellent  textbook  for  the  student  or  laboratory, 
this  "Manual"  presents  the  unique  advantage  of 
furnishing  plates  showing  the  variously  shaded 
colors  of  certain  chemicals,  etc.,  and  their  re- 
actions. The  chapter  on  Urinalysis  is  excellent. 
This  '•Chemistry"  is  especially  valuable  to  medi- 
cal students  and  practitioners,  as  devoting  so 
much  of  detail  to  descriptions  of  analyses,  tests, 
etc.,  of  those  things  with  which  the  doctor  haa 
mostly  to  deal. —  Virginia  Medical  Monthly,  Jan- 
uary, 1892. 


Among  the  many  works  on  chemistry  offered 
for  the  use  of  the  medical  student,  there  is  prob- 
ably none  that  outrivals  Dr.  Simon's  work  in  prac- 
tical arrangement  and  thoroughness.  A  special 
feature  of  the  book,  and  one  that  deserves  the 
greatest  praise,  is  the  presence  therein  of  the 
beautiful  colored  plates  representing  fifty-six 
chemical  reactions.  To  say  that  they  are  splen- 
didly and  artistically  executed  hardly  does  them 
justice.  They  must  convey  to  the  mind  of  the 
student  lasting  impressions  of  the  color  changes 
that  he  has  noted  in  his  experiments  in  the  labor- 
atory, and  the  perusal  of  thij  work  must  recall 
them  vividly  to  recognition.  The  many  cuts  are 
well  selected,  and  the  make-up  of  the  book  leaves 


CLOWES,  FMAJVE:,  JD.  Sc,  London, 

Senior  Science- Master  at  the  High  School,  Newcastle-under-Lyme,  etc. 

An  Elementary  Treatise  on  Practical  Chemistry  and  Qualitative 
Inorganic  Analysis.  Specially  adapted  for  use  in  the  Laboratories  of  Schools  and 
Colleges  and  by  Beginners.  Third  American  from  the  fourth  and  revised  English  edition. 
In  one  12mo.  volume  of  387   pages,  with  55  illustrations.     Cloth,  $2.50. 


Lea  Brothers  &  Co.'s  Publications — Chemistry. 


FBANKIjAND.B.,!),  C.L,,F.It,S.,&JAPP,F.It.,F.I.  C, 


Professor  of  Oieviistry  in  the  Normal  School 
of  Science,  London. 


Assist.  Prof,  of  Chemistry  in  the  Normal 
School  of  Science,  London. 


Inorganic  Chemistry.     In  one  handsome  octavo  volume  of  677  pages  with  51 
woodcuts  and  2  plates.     Cloth,  $3.75  ;  leather,  $4.75. 

This  work  should  supersede  other  works  of  its  chemical  knowledge  is  behind  the  times,  would 
class  in  the  medical  colleges.  It  is  certainly  better  do  well  to  study  this  work.  The  descriptions  and 
adaptedthanany  work  upon  chemistry,with  which  demonstrations  are  mside  so  plain  that  there  is 
we  are  acquainted,  to  impart  that  clear  and  full  no  difficulty  in  understanding  them. — Cincinnati 
knowledge  of  the  science  which  students  of  raed-  Medical  News,  January,  1886. 
icine  should  have.    Physicians  who  feel  that  their 


FOWJSFS,  GEORGE,  Fh,  2>. 

A  Manual  of  Elementary  Chemistry;  Theoretical  and  Practical.  Em- 
bodying Watts'  Physical  and  Inorganic  Chemistry.  New  American,  from  tiie  twelfth  English 
edition.  In  one  large  royal  12mo.  volume  of  1061  pages,  with  168  illustrations  on  wood 
and  a  colored  plate.     Cloth,  $2.75 ;  leather,  $3.25. 


Fownes"  Chemistry  has  been  a  standard  text- 
book upon  chemistry  for  many  years.  Its  merits 
are  very  fully  known  by  chemists  and  physicians 
everywhere  in  this  country  and  in  England.  As 
the  science  has  advanced  by  the  making  of  new 
discoveries,  the  work  has  been  revised  so  as  to 
keep  it  abreast  of  the  times.  It  has  steadily 
maintained  its  position  as  a  text-book  with  medi- 


work  as  one  of  the  very  best  text-books  upon 
chemistry  extant. — Cincinnati  Med.  News,  Oct.  '85. 
Of  all  the  works  on  chemistry  intended  for  the 
use  of  medical  students,  Fownes'  Chemistry  is 
perhaps  the  most  widely  used.  Its  popularity  is 
based  upon  its  excellence.  This  last  edition  con- 
tains all  of  the  material  found  in  the  previous, 
and  it  is  also  enriched  by  the  addition  of  Watts' 


cal  students.  In  this  work  are  treated  fully:  Heat,  I  Physical  and  Inorganic  Chemistry.  All  of  the  mat- 
Light  and  Electricity,  including  Magnetism.  The  '  ter  is  brought  to  the  present  standpoint  of  ehemi- 
Influence  exerted  by  these  forces  in  chemical  I  cal  knowledge.  We  may  safely  predict  for  this 
action  upon  health  and  disease,  etc.,  is  of  the  most  '  work  a  continuance  of  the  fame  and  favor  it  enjoys 
important  kind,  and  should  be  familiar  to  every  j  among  medical  students. — New  Orleans  Medical 
medical    practitioner.      We    can    commend    the  \  and  Surgical  Journal, 'Ma.ich,  ISS6. 

ATTFIEZn,  JOSJV,  M.  A.,  Fh.  D.,  F,  I.  C,  F,  M.  S.,  Etc, 

Professcfr  of  Practical  Chemistry  to  the  Pharmaceutical  Society  of  Oreat  Britain,  etc. 

Chemistry,  General,  Medical  and  Pharmaceutical;  Including  the  Chem- 
istry of  the  U.  S.  Pharmacopceia.  A  Manual  of  the  General  Principles  of  the  Science, 
and  their  Application  to  Medicine  and  Pharmacy.  A  new  American,  from  the  twelfth 
English  edition,  specially  revised  by  the  Author  for  America.  In  one  handsome  royal 
12mo.  volume  of  782  pages,  with  88  illustrations.   Cloth,  $2.75;  leather,  $3.25. 

Attfield's  Chemistry  is  the  most  popular  book  i  again  it  is  a  good  laboratory  guide,  and  finally  it 
among  students  of  medicine  and  phaimacy.  This  |  contains  such  a  mass  of  well-arranged  information 
popularity  has  a  good,  substantial  basis.  It  rests  that  it  will  always  serve  as  a  handy  book  of  refer- 
upon  real  merits.  Attfield's  work  combines  in  the  ence.  He  does  not  allow  any  unutilizable  knowl- 
happiest  manner  a  clear  exposition  of  the  theory  I  edge  to  slip  into  his  book;  his  long  years  of 
of  chemistry  with  the  practical  application  of  this  [  experience  have  produced  a  work  which  is  both 


knowledge  to  the  everyday  dealings  of  the  phy^ 
sician  and  pharmacist.    His  discernment  is  shown 


scientific   and    practical,    and    which  shuts    out 
everythiiig  in    the   nature  of  a  superfluity,  and 


not  only  in  what  he  puts  into  his  work,  but  also  in    therein  lies  the  secret  of  its  success.      This  last 
what  he  leaves  out.     His  book  is  precisely  what  '  edition  shows  the  marks  of  the  latest  progress 
the  title  claims  for  it.   The  admirable  arrangement  ;  made  in  chemistry  and  chemical  teachiag.— New 
of  the  text  enables  a  reader  to  get  a  good  idea  of  i  Orleans  Medical  and  Surgical  Journal,  Nov.  1889. 
chemistry  without  the  aid  of  experiments,  and  | 

BLOXAM,  CSABLES  i.. 

Professor  of  Chemistry  in  King'g  College,  London. 

Chemistry,  Inorganic  and  Organic,  i^ew  American  from  the  fifth  Lon- 
don edition,  thoroughly  revised  and  much  improved.  In  one  very  handsome  octavo 
volume  of  727  pages,  with  292  illustrations.     Cloth,  $2.00;  leather,  $3.00. 


Comment  from  us  on  this  standard  work  is  al- 
most superfluous.  It  differs  widely  in  scope  and 
aim  from  that  of  Attfield,  and  in  its  way  is  equally 
beyond  criticism.  It  adopts  the  most  direct  meth- 
ods in  stating  the  principles,  hypotheses  and  facts 
of  the  science.  Its  language  is  so  terse  and  lucid, 
and  its  arrangement  of  matter  so  logical  in  se- 
quence that  the  student  never    has  occasion  to 


complain  that  chemistry  is  a  hard  study.  Much 
attention  is  paid  to  experimental  illustrations  of 
chemical  principles  and  phenomena,  and  the 
mode  of  conducting  these  experiments.  The  book 
maintains  the  position  it  has  always  held  as  one  of 
the  best  manuals  of  general  chemistry  In  the  Eng- 
lish language. — Detroit  Lancet,  Feb.  1884. 


LVFF,  AJRTMUM  P.,  JX.jD.,  B.  Sc„ 


Lecturer  on  Medical  Jurisprudence  and  Toxico'ogical  Chemistry,  St.  Mary's  Hospital  Medical 
School,  London. 


A  Manual  of  Chemistry. 

vol.  of  522  pp.,  with  36  engravings. 


For  the  use  of  students  of  medicine.    In  one  12mo. 
Cloth,  $2.00.     See  Students'  Series  of  Manuals,  p.  30. 


GBEENE,  WILLIAM  H,,  31.  2>., 

Demonstrator  of  Chemistry  in  the  Medical  Department  of  the  University  of  Pennsylvania. 
A  Manual  of  Medical  Chemistry.   For  the  use  of  Students.    Based  upon  Bow- 
man's Medical  Chemistry.   In  one  12mo.  volume  of  310  pages,  with  74  illus.    Cloth,  $1.75. 

It  is  a  concise  manual  of  three  hundred  pages,  the  recognition  of  compounds  due  to  pathologica. 
giving  an  excellent  summary  of  the  best  methods  conditions.  The  detection  of  poisons  is  treated 
of  analyzing  the  liquids  and  solids  of  the  body,  looth  with  sufficient  fulness  for  the  purpose  of  the  stu- 
for  the  estimation  of  their  normal  constituent  and  ,  dentor  practitioner. — Boston  Jl.  of  Chera.  June  '89. 


10 


Lea  Brothers  &  Co.'s  Publications — Chem,,  Pharm. 


VAVGSAN,  nCIOR  C,  Bh.  D.,  M.  D,, 

Prof,  of  Phys.  and  Path.  Vhem.  and  Assoc.  Prof,  of  Therap.  and  Mat.  Med.  in  the  Univ.  of  Mich. 

and  WOVY,  FBBDJEMICK  G,,  M.  J>. 

Instructor  in  Hygiene  and  Phys.  Chem.  in  the  Univ.  of  Mich. 

Ptomaines,  Leucomaines  and  Bacterial  Prqteids ;  or  the  Chemical 
Factors  in  the  Causation  of  Disease.  New  (second)  edition.  In  one  handsome 
12mo.  volume  of  389  pages.     Cloth,  $2.25, 

The  title  of  this  volume  brings  prominently  to  by  those  who  had  most  need  of  its  help,  namely, 
view  the  correct  pathology  of  a  host  of  diseases,  general  practitioners.  For  the  student  no  more 
Modern  chemistry  has  furnished  no  more  striking  ,  important  branch  of  chemistry  exists.  The  early 
evidence  of  its  value  than  the  discovery  of  these  demand  for  the  second  edition  of  a  work  on  so 
ultimate  causes  of  disease,  a  step  which  neees-  ,  new  a  department  of  science,  augurs  well  for  the 
sarily  precedes  any  rational  knovcledge  of  cure  or  ;  curriculum  in  those  colleges  which  have  already 

Erevention.  Thesesuccessful  methods  of  research  made  it  a  branch  of  study,  and  for  the  growing 
ave  also  thrown  a  flood  of  light  upon  the  Leuco-  promptness  on  the  part  of  the  profession  to  recog- 
maines  or  Physiological  Alkaloids.  The  literature  nize  and  use  the  most  enlightened  methods  for 
of  the  subjects,  already  vast,  was  before  the  I  the  benefit  of  their  patients. —  The  Southern  Prae- 
preparation  of  this  work  scattered  and  unattainable  I  iitioner,  December,  1891. 

KBMSBNf  IB  A,  M.  D.,  JPh.  D., 

Professor  of  Chemistry  in  the  Johns  Hopkins  University,  Baltimore. 

Principles  of  Theoretical  Chemistry,  with  special  reference  to  the  Constitu- 
tion of  Chemical  Compounds.  Fourth  and  thoroughly  revised  edition.  In  one  handsome 
royal  12mo.  volume  of  325  pages.     Cloth,  $2.00.     Just  ready. 

FROM  THE  PREFACE  TO  THE  FOURTH  EDITION, 

My  object  has  been  to  help  students  to  get  clear  ideas  in  regard  to  the  foundations  of 
chemistry.  That  the  treatment  has  been  regarded  with  favor  is  shown  by  the  fact  that 
four  editions  of  the  book  have  been  demanded  in  a  comparatively  short  time,  and  further 
by  the  fact  that  since  the  appearance  of  the  last  American  edition  it  has  been  translated 
into  German  and  Italian.  I  believe  that  all  changes  called  for  by  the  advance  of  the 
science  have  been  made  and  that  this  edition  will  be  found  abreast  of  the  times.  The 
chief  addition  is  a  short  chapter  on  Solutions. 

CHARLES,  T.  CBANSTOUJ^,  M.  D.,  F.  C.  5.,  M,  S,, 

Formerly  Asst.  Prof,  and  Demonst.  of  Chemistry  and  Chemical  Physics,  Queen's  College,  Belfast. 

The  Elements  of  Physiological  and  Pathological  Chemistry.     A 

Handbook  for  Medical  Students  and  Practitioners.  Containing  a  general  account  of 
Nutrition,  Foods  and  Digestion,  and  the  Chemistry  of  the  Tissues,  Organs,  Secretions  and 
Excretions  of  the  Body  in  Health  and  in  Disease.  Together  with  the  methods  for  pre- 
paring or  separating  their  chief  constituents,  as  also  for  their  examination  in  detail,  and 
an  outline  syllabus  of  a  practical  course  of  instruction  for  students.  In  one  handsome  octavo 
volume  of  463  pages,  with  38  woodcuts  and  1  colored  plate.     Cloth,  $3.50. 

Dr.  Charles  is  fully  impressed  with  the  impor- 
tance and  practical  reach  of  his  subject,  and  he 
has  treated  it  in  a  competent  and  instructive  man- 
ner. We  cannot  recommend  a  better  book  than 
the  present.  In  fact,  it  fills  a  gap  in  medical  text- 
\)ooks,  and  that  is  a  thing  which  can  rarely  be  said 


nowaaays.  Dr.  Charles  has  devoted  much  space 
to  the  elucidation  of  urinary  mysteries.  He  does 
this  with  much  detail,  and  yet  in  a  practical  and 
intelligible  manner.  In  fact,  the  author  has  filled 
his  book  with  many  practical  hints. — Medical  Rec- 
ord, December  20, 1884. 


SOFFMAJVW,  F.,  A.M.,  Fh.D.,  &  FOWFB,  F.B.,  Fh.D., 

Public  Analyst  to  the  State  of  New  York.  Prof,  of  Anal.  Chem.  in  the  Phil.  Coll.  of  Pharmacy. 

A  Manual  of  Chemical  Analysis,  as  applied  to  the  Examination  of  Medicinal 
Chemicals  and  their  Preparations.  Being  a  Guide  for  the  Determination  of  their  Identity 
and  Quality,  and  for  the  Detection  of  Impurities  and  Adulterations.  For  the  use  of 
Pharmacists,  Physicians,  Druggists  and  Manufacturing  Chemists,  and  Pharmaceutical  and 
Medical  Students.  Third  edition,  entirely  rewritten  and  much  enlarged.  In  one  very 
handsome  octavo  volume  of  621  pages,  with  179  illustrations.    Cloth,  $4.25. 

PABMISS,  FJDWABJD, 

Late  Professor  of  the  Theory  and  Practice  of  Pharmacy  in  the  Philadelphia  College  of  Pharmacy. 

A  Treatise  on  Pharmacy :  Designed  as  a  Text-book  for  the  Student,  and  as  a 
Guide  for  the  Physician  and  Pharmaceutist.  With  many  Formulae  and  Prescriptions. 
Fifth  edition,  thoroughly  revised,  by  Thomas  S.  Wiegand,  Ph.  G.  In  one  handsome 
octavo  volume  of  1093  pages,  with  256  illustrations.     Cloth,  $5.00 ;  leather,  $6.00. 

No  thorough-goingpharmacist  will  fail  to  possess  |  ods  of  combination  are  concerned,  can  afford  to 
himself  of  so  useful  a  guide  to  practice,  and  no  j  leave  this  work  out  of  the  list  of  their  works  of 
physician  who  properly  estimates  the  value  of  an  '  reference.  The  country  practitioner,  who  must 
accurate  knowledge  of  the  remedial  agents  em-  ;  always  be  in  a  measure  his  own  pharmacist,  will 
ployed  by  him  in  daily  practice,  so  far  as  their  find  it  indispensable. — Louisville  Medical  News, 
miscibility,  compatibility  and  mostefifectivemeth-  i  March  29, 1884. 

BAZFF,  CHABLFS  H.,  M.  D.,  F.  B.  C.  F., 

Assistant  Physician  at  the  London  Hospital. 
Clinical  Chemistry.     In  one  pocket-size  12mo.  volume  of  314  pages,  with  16 
illustrations.     Limp  cloth,  red  edges,  $1.50.     See  Students'  Series  of  Manuals,  page  30. 


LASSEN'S  ELEMENTARY  QUANTITATIVE 
ANALYSIS.  Translated,  with  notes  and  addi- 
tions, by  Edgab  F.  Smith,  Ph.  D  ,  Assistant  Pro- 


fessor of  Chemistry  in  the  Towne  Scientific  School, 
University  of  Penna.  In  one  12mo.  volume  of  324 
pages,  with  3G  illus.    Cloth,  S;2.00. 


Lea  Brothers  &  Co.'s  Publications — Mat.  Med.,  Therapeutics.    11 


STIJLLB,  A,,  31,  D.,  ii.  J>.,  &  MAISCS,  J,  M.,  Phar.  D,, 

Prof,  of  Mat.  Med.  and  Botany  in  Phila. 
College  of  Pharmacy,  Sec'y  to  the  Ameri- 
can Pharmaceutical  Association. 


Professor  Emeritus  of  the  Theory  and  Prac- 
tice of  Medicine  and  of  Clinical  Medicine 
in  the  University  of  Pennsylvania. 


The  National  Dispensatory. 

CONTAINING  THE  NATURAL  HISTORY,  CHEMISTRY,  PHARMACY,  ACTIONS  AND   USES  OF 

MEDICINES,  INCLUDING  THOSE  RECOGNIZED  IN  THE  PHARMACOPEIAS  OF  THE 

UNITED  STATES,  GREAT  BRITAIN  AND  GERMANY,  WITH  NUMEROUS 

REFERENCES   TO  THE  FRENCH  CODEX. 

Fourth  edition  revised,  and  covering  the  new  British  Pharmacopoeia.  In  one  mag- 
nificent imperial  octavo  volume  of  1794  pages,  with  311  elaborate  engravings.  Price 
in  cloth,  $7.25  ;  leather,  raised  bands,  $8.00 ;  half  Kussia,  $9.00.  \*This  work  will  be 
furnished  with  Patent  Beady  Reference  Thumb-letter  Index  for  $1.00  in  addition  to  the  price 
in  any  of  the  above  styles  of  binding. 


It  is  with  much  pleasure  that  the  fourth  edition 
of  this  magnificent  work  is  received.  The  authors 
and  pulDlishers  have  reason  to  feel  proud  of  this, 
the  most  comprehensive,  elaborate  and  accurate 
work  of  the  kind  ever  printed  in  this  country.  It 
is  no  wonder  that  it  has  become  the  standard  au- 
thority for  both  the  medical  and  pharmaceutical 
profession,  and  that  four  editions  have  been  re- 
quired to  supply  the  constant  and  increasing 
demand  since  its  first  appearance  in  1879.  The 
entire  field  has  been  gone  over  and  the  various 
articles  revised  in  accordance  with  the  latest 
developments  regarding  the  attributes  and  thera- 
peutical action  of  drugs.    The  remedies  of  recent 


discovery  have  received  due  attention. — Kansas 
City  Medical  Index,  Nov.  1887. 

We  think  it  a  matter  for  congratulation  that  the 
profession  of  medicine  and  that  of  pharmacy  have 
shown  such  appreciation  of  this  great  work  as  to  call 
for  four  editions  within  the  comparatively  brief 
period  of  eight  years.  The  matters  with  which  it 
deals  are  of  so  practical  a  nature  that  neither  the 
physician  nor  the  pharmacist  can  do  without  the 
latest  text-books  on  them,  especially  those  that  are 
so  accurate  and  comprehensive  as  this  one.  The 
book  is  in  every  way  creditable  both  to  the  authors 
and  to  the  publishers. — New  York  Medical  Journal, 
May  21, 1887. 


MAISCH,  JOJELJ^M.,  Phar,  JD., 

Professor  of  Materia  Medica  and  Botany  in  the  Philadelphia  College  of  Pharmacy. 

A  Manual  of  Organic  Materia  Medica ;  Being  a  Guide  to  Materia  Medica  of 
the  Vegetable  and  Animal  Kingdoms.  For  the  use  of  Students,  Druggists,  Pharmacists 
and  Physicians.  New  (fifth)  edition,  thoroughly  revised.  In  one  very  handsome  12mo. 
volume  of  544  pages,  with  270  engravings.     Cloth,  $3.00.     Just  ready. 

A  notice  of  the  previous  edition  is  appended. 


For  everyone  interested  in  materia  medica, 
Maisch's  Manual,  first  published  in  1882,  and  now 
in  its  fourth  edition,  is  an  indispensable  book. 
For  the  American  pharmaceutical  student  it  is 
the  work  which  will  give  him  the  necessary  knowl- 
edge in  the  easiest  way,  partly  because  the  text  is 
brief,  concise,  and  free  from  unnecessary  matter, 
and  partly  because  of  the  numerous  illustrations, 
which  bring  facts  worth  knowing  immediately  be- 


fore his  eyes.  That  it  answers  its  purposes  in  this 
respect  the  rapid  succession  of  editions  is  the  best 
evidence.  It  is  the  favorite  book  of  the  Ameiican 
student  even  outside  of  Maisch's  several  hundred 
personal  students.  The  arrangement  of  its  con- 
tents shows  the  practical  tendency  of  the  book. 
Maisch's  system  of  classification  is  easy  and  com- 
prehensive.— Pharmaceutische  Zeitung,  Germany, 
1890. 


EDBS,  nOBBMT  T.,  M.  2>., 

Jackson  Professor  of  Clinical  Medicine  in  Harvard  University,  Medical  Department, 

A  Text-Book  of  Therapeutics  and  Materia  Medica.    Intended  for  the 
Use  of  Students  and  Practitioners.     Octavo,  544  pages.     Cloth,  $3.50 ;  leather,  $4.50. 


It  possesses  all  the  essentials  which  we  expect 
in  a  book  of  its  kind,  such  as  conciseness,  clear- 
ness, a  judicious  classification,  and  a  reason- 
able degree  of  dogmatism.  All  the  newest  drugs 
of  promise  are  treated  of.  The  clinical  index  at 
the  end  will  be  found  very  useful.  We  heartily 
commend  the  book  and  congratulate  the  author 


on  having  produced  so  good  a  one. — N.  Y.  Medical 
Journal,  Feb.  18, 1888. 

Dr.  Edes'  book  represents  better  than  any  older 
book  the  practical  therapeutics  of  the  present 
day.  The  book  is  a  thoroughly  practical  one.  The 
classification  of  remedies  has  reference  to  their 
therapeutic  action. — Pharmaceutical  Era,  Jan.  1888. 


BBUCB,  J,  MITCSELL,  M.  !>.,  B,  jB.  C.  I*., 

Physician  and  Lecturer  on  Materia  Medica  and  Therapeutics  at  Charing  Cross  Hospital,  London. 
Materia  Medica  and  Therapeutics.     An  Introduction  to  Rational  Treatment. 
Fifth  edition.   12mo.,  591  pages.   Cloth,  $1.50.     See  Students'  Series  of  Manuals,  page  30. 

GniFFITS,  ROBBBT  EGLBSFIBLD,  M.  D. 

A  Universal  Formulary,  containing  the  Methods  of  Preparing  and  Adminis- 
tering Officinal  and  other  Medicines.  The  whole  adapted  to  Physicians  and  Pharmaceut- 
ists. Third  edition,  thoroughly  revised,  with  numerous  additions,  by  John  M.  Maisch, 
Phar.  D.,  Professor  of  Materia  Medica  and  Botany  in  the  Philadelphia  College  of  Pharmacy. 
In  one  octavo  volume  of  775  pages,  with  38  illustrations.    Cloth,  $4.50 ;  leather,  $5.50. 


HERM.A.NN'S  EXPERIMENTAL  PHARMACOL- 
OGY. A  Handbook  of  Methods  for  Determining 
the  Physiological  Action  of  Drugs.  Translated, 
with  the  Author's  permission,  and  with  exten- 
sive additions,  by  R.  M.  Smith,  M.  D.  12mo., 
199  pages,  with  32  illustrations.     Cloth,  $1.50. 


^TILLE'S  THERAPEUTICS  AND  MATERIA 
MEDICA.  A  Systematic  Treatise  on  the  Action 
and  Uses  of  Medicinal  Agents,  including  their 
Description  and  History.  Fourth  edition,  re- 
vised and  enlarged.  In  two  octavo  volumes,  con- 
taining 1936  pages.    Cloth,  $10.00 ;  leather,  $12.00. 


12     Lea  Brothers  &  Co.'s  Publications — Mat.  Med.,  Therapeutics. 


A  SYSTEM  OF  PRACTICAL  THERAPEUTICS 

BY  AMERICAN  AND  FOREIGN  AUTHORS. 


Edited  by  HOBART  AMORY  HARE,  M.  D. 


Professor  of  Therapeutics  and  Materia  Medica  in  the  Jefferson  Medical  College  of  Philadelphia, 

Assisted   by  Walter   Chrystie,   M.  D.,   Formerly  Instructor  in  Physical 
Diagnosis  in  the  University  of  Penna. 

In  a  series  of  contributions  by  seventy-eiglit  eminent  authorities.  In  three  large 
octavo  vohimes  of  about  1100  pages  each,  with  illustrations.  Vols.  I.,  II.  and  III.  just 
ready.  Price,  per  volume :  Cloth,  $5.00 ;  leather,  $6.00 ;  half  Eussia,  $7.00.  For  sale  by 
subscription  only.     Address  the  Publishers.     Full  prospectus  free  to  any  address  on  application, 

the  medical  literature  of  the  day. — Nashville  Jour- 


In  our  notices  of  the  two  preceding  volumes 
of  this  magnificent  work  we  spoke  highly  of  its 
merits  as  an  encyclopedic  reference  book,  and 
commended  it  to  the  profession  as  the  most  per- 
fect work  of  the  kind.  The  third  volume  has 
already  appeared,  following  the  other  two  in  an 
almost  incredibly  short  time,  and  in  every  respect 
the  equal  of  its  predecessors.  We  feel  that  we 
cannot  say  too  much  for  this  System.  It  is  exactly 
what  the  practitioner  needs  for  daily  reference. 
All  diseases  are  treated  of  in  their  etiology, 
pathology  and  symptomatology,  and  the  applica- 
tion of  medicines  to  their  management  fully 
given.  Every  subject  is  handled  by  a  writer  who 
has  devoted  himself  especially  to  its  considera- 
tion, so  that  the  system  is  really  a  collection  of 
monographs  by  writers  who  are  authorities  upon 
the  subjects.  In  the  list  of  authors,  of  which 
their  are  forty  for  this  volume,  we  observe  the 
names  of   some    of    the    best-known    American 


physicians,  who  have  distinguished  themselves  by 
their  works  or  their  writings  in  the  special  depart- 
ments in  which  they  have  labored.    No  one  who  I  ,  _  .    .  .  _ 
desires  to  keep  in  the  van  of  professional  advance  j  the  world. — Buffalo  Medical  aud  Surgical  Journal, 
can  afford  to  be  without  it.     We  unhesitatingly  i  August,  1892, 
commend  it  as  a  most  valuable  contribution  to  j 


nal  of  Medicine  and  Surgery,  July,  1892. 

The  scope  of  this  work  is  beyond  that  of  any 
previous  one  on  the  subject.  The  goal,  after  alJ, 
is  the  treatment  of  disease,  and  a  work  which  con- 
tributes to  its  successful  management  is  to  be 
looked  upon  as  of  vast  use  to  humanity.  It  can- 
not be  denied  that  therapeutic  resources,  whether 
the  treatment  be  confined  to  the  mere  administra- 
tion of  drugs,  or  allowed  its  more  extended  appli- 
cation to  the  management  of  disease,  have  so 
greatly  multiplied  within  the  last  few  years  as  to 
render  previous  treatises  of  little  value.  Herein 
will  be  found  the  great  value  of  ri  are's  encyclo- 
pedic work,  which  groups  together  within  a  single 
series  of  volumes  the  most  modern  methods 
known  in  the  management  of  disease,  and  espe- 
cially deals  with  important  subjects  comprehen- 
sively, which  could  not  be  done  in  a  more  limited 
treatise.  We  cannot  commend  Hare's  System 
of  Practical  Therapeutics  too  highly;  it  stands 
out  first  and  foremost  as  a  work  to  be  consulted 
by  authors,  teachers,  and  physicians,  throughout 


SCABB,  SOB  ART  AMOBT,  B.  Sc,  M,  !>., 

Professor   of  Materia  Medica  and  Therapeutics  in  the  Jefferson  Medical  College  of  Philadelphia; 
Secretary  of  the  Convention  for  the  Revision  of  the  United  States  Pharmacopoeia  of  1890. 

A  Text-Book  of  Practical  Therapeutics ;  With  Especial  Eeference  to  the 
Application  of  Remedial  Measures  to  Disease  and  their  Employment  upon  a  Rational 
Basis.  With  special  chapters  by  Dbs.  Gr.  E.  de  Schweinitz,  Edward  Martin, 
J.  Howard  Reeves  and  Barton  C.  Hirst.  New  (2d)  and  revised  edition.  In  one 
handsome  octavo  volume  of  650  pages.     Cloth,  $3.75 ;  leather,  $4.75. 

and  diseases  in  alphabetical  order,  according  to 
their  English  names;  and  a  dose  list  of  drugs 
officinal  and  unofficinal.  In  addition  to  the  gen- 
eral index,  a  copious  and  explanatory  index  of 
diseases  and  remedies  has  been  appended  which 


This  work  has  received  the  rare  distinction 
among  medical  works  of  reaching  a  second  edition 
six  months  after  its  first  appearance.  Many  new 
prescriptions  have  also  been  inserted  to  illustrate 
the  best  modes  of  applying  remedies.  Among 
other  features  of  this  practically  helpful  treatise 
which  will  make  reference  to  it  convenient  and 
profitable,  are  the  arrangement  of  titles  of  drugs 


will  render  the  contents  easily  accessible. —  The 
Medical  Age,  July  10, 1891. 


BBVNTON,  T,  LAJJDEB,  M.B,,  B.Sc,  JB\B,S.,  F.B.C.B., 

Lecturer  on  Materia  Medica  and  Therapeutics  at  St.  Bartholomew's  Hospital,  London,  etc. 

A  Text-Book  of  Pharmacology,  Therapeutics  and  Materia  Medica; 
Including  the  Pharmacy,  the  Physiological  Action  and  the  Therapeutical  Uses  of  Drugs. 
Adapted  to  the  U.  S.  Pharmacopoeia  by  Francis  H.  AVilliams,  M.  D.,  of  Harvard  Univer- 
sity Medical  School.  Third  edition.  Octavo,  1305  pages,  230  illustrations.  Cloth,  $5.50  ; 
leather,  $6.50. 


No  words  of  praise  are  needed  for  this  work,  for 
it  has  already  spoken  for  itself  in  former  editions. 
It  was  by  unanimous  consent  placed  among  the 
foremost  books  on  the  subject  ever  published  in 
any  language,  and  the  better  it  is  known  and  studied 
the  more  highly  it  is  appreciated.  The  present 
edition  contains  much  new  matter,  the  insertion 
of  which  has  been  necessitated  by  the  advances 


made  in  various  directions  in  the  art  of  therapeu- 
tics, and  it  now  stands  unrivalled  in  its  thoroughly 
scientific  presentation  of  the  modes  of  drug  action. 
No  one  who  wishes  to  be  fully  up  to  the  times  in 
this  science  can  afford  to  neglect  the  study  of  Dr. 
Brunton's  work.  The  indexes  are  excellent,  and 
add  not  a  little  to  the  practical  value  of  the  book. 
—Medical  Record,  May  25, 1889. 


FABQUSABSOW,  BOBJEBT,  31,  !>.,  F.  B.  C.  P.,  LL,  J>., 

Lecturer  on  Materia  Medica  at  St.  Mary's  Hospital  Medical  School,  London. 

A  Guide  to  Therapeutics  and  Materia  Medica.  Fourth  American, 
from  the  fourth  English  edition.  Enlarged  and  adapted  to  the  U.  S.  Pharmacopoeia.  By 
Frank  Woodbury,  M.  D.,  Professor  of  Materia  Medica  and  Therapeutics  and  Clinical 
Medicine  in  the  Medico-Chirnrgical  College  of  Philadelphia.  In  one  handsome  12mo. 
volume  of  581  pages.     Cloth,  $2.50. 


It  may  correctly  be  regarded  as  the  most  modern 
work  of  its  kind.  It  is  concise,  yet  complete. 
Containing  an  account  of  all  remedies  that  have 
ft  place  in  the  British  and  United  States  Pharma- 


copoeias, as  well  as  considering  all  non-official  but 
important  new  drugs,  it  becomes  in  fact  a  miniature 
dispensatory. — Pacific  Medical  Journal,  June,  1889. 


Lea  Brothers  &  Co.'s  Publications — Practice  of  Med. 


13 


FLINT,  AUSTIN,  M.  D.,  LZ,  D., 

Prof,  of  the  Principles  and  Practice  of  Med.  and  of  Clin.  Med.  in  Bellevue  Hospital  Medical  College,  N.  7. 

A  Treatise  on  the  Principles  and  Practice  of  Medicine.  Designed  for 
the  use  of  Students  and  Practitioners  of  Medicine.  Sixth  edition,  thoroughly  revised 
and  rewritten  by  the  Author,  assisted  by  William  H.  Welch,  M.  D.,  Professor  of 
Pathology,  Johns  Hopkins  University,  Baltimore,  and  Austin  Flint,  Jr.,  M.  D.,  LL.  D., 
Professor  of  Physiology,  Bellevue  Hospital  Medical  College,  N.  Y.  In  one  very  handsome 
octavo  volume  of  1160  pages,  with  illustrations.    Cloth,  $5.50  ;  leather,  $6.50. 


No  text-book  on  the  principles  and  practice  of 
medicine  has  ever  met  in  this  country  with  such 
general  approval  by  medical  students  and  practi- 
tioners as  the  work  of  Professor  Flint.  In  all  the 
medical  colleges  of  the  United  States  it  is  the  fa- 
vorite work  upon  Practice;  and,  as  we  have  stated 
before  in  alluding  to  it,  there  is  no  other  medical 
work  that  can  be  so  generally  found  in  the  libra- 
ries of  physicians.  In  every  state  and  territory 
of  this  vast  country  the  book  that  will  be  most  likely 
to  be  found  in  the  office  of  a  medical  man,  whether 


in  city,  town,  village,  or  at  some  cross-roads,  is 
Flint's  Practice.  We  make  this  statement  to  a 
considerable  extent  from  personal  observation,  and 
it  is  the  testimony  also  of  others.  An  examina- 
tion shows  that  very  considerable  changes  have 
been  made  in  the  sixth  edition.  The  work  may  un- 
doubtedly be  regarded  as  fairly  representing  the 
present  state  of  the  science  of  medicine,  and  as 
reflecting  the  views  of  those  who  exemplify  in 
their  practice  the  present  stage  of  progress  of  med- 
ical art. — Cincinnati  Medical  News,  Oct.  1886. 


BBISTOWB,  JOMN  SYEB,  M,  D.,  LL,  !>.,  F.  B,  S., 

Senior  Physician  to  and  Lecturer  on  Medicine  at  St.  Thomas'  Hospital,  London. 

A  Treatise  on  the  Science  and  Practice  of  Medicine.     Seventh  edi- 
tion.    In  one  large  octavo  volume  of  1325  pages.     Cloth,  $6.50 ;  leather,  $7.50. 


Dr.  Bristowe's  now  famous  treatise  appears  in 
its  seventh  edition.  It  has  long  passed  the  stage 
in  which  it  requires  critical  examination  or  com- 
mendation, and  has  thoroughly  established  itself 
as  among  the  most  complete  and  useful  of  text- 
hooks.— British  3fedical  J^oiirraa/, September  27, 1890. 

It  is  a  work  that  is  built  on  a  stable  founda- 


tion, systematic,  scientific  and  practical,  contain- 
ing the  matured  experience  of  a  physician  who 
has  every  claim  to  be  considered  an  authority, 
and  composed  in  a  style  which  attracts  the  prac- 
titioner as  much  as  the  student.  No  one  can  say 
that  this  book  has  obtained  a  success  which  was 
undeserved. —  The  Lancet,  July  12, 1890. 


MABTSSOBNE,  SENBY,  31.  D.,  LL,  D,, 

Lately  Professor  of  Hygiene  in  the  University  of  Pennsylvania. 

Essentials  of  the  Principles  and  Practice  of  Medicine.  A  Handbook 
for  Students  and  Practitioners.  Fifth  edition,  thoroughly  revised  and  rewritten.  In  one 
royal  12mo.  volume  of  669  pages,  with  144  illustrations.     Cloth,  $2.75. 


Within  the  compass  of  600  pages  it  treats  of  the 
history  of  medicine,  general  pathology,  general 
symptomatology,  and  physical  diagnosis  (including 
laryngoscope,  ophthalmoscope,  etc.),  general  ther- 
apeutics, nosology,  and  special  pathology  and  prac- 
tice. There  is  a  wonderful  amount  of  information 
contained  in  this  work,  and  it  is  one  of  the  best 
of  its  kind  that  we  have  seen. — Glasgow  Medical 
Journal,  Nov.  1882. 

An  indispensable  book.    No  work  ever  exhibited 


a  better  average  of  actual  practical  treatment  than 
this  one;  and  probably  not  one  writer  in  our  day 
had  a  better  opportunity  than  Dr.  Hartshorne  for 
condensing  all  the  views  of  eminent  practitioners 
into  a  12mo.  The  numerous  illustrations  will  be 
very  useful  to  students  especially.  These  essen- 
tials are  most  valuable  in  affording  the  means  to 
see  at  a  glance  the  whole  literature  of  any  disease, 
and  the  most  valuable  treatment. — Chicago  Medical 
Journal  and  Examiner,  April,  1882. 


BEYNOLDS,  J.  BUSSELL,  M,  D,, 

Professor  of  the  Principles  and  Practice  of  Medicine  in  University  College,  London. 
A  System  of  Medicine.  With  notes  and  additions  by  Henry  Hartshorne, 
A.  M.,  M.  D.,  late  Professor  of  Hygiene  in  the  University  of  Pennsylvania.  In  three  large 
and  handsome  octavo  volumes,  containing  3056  double-columned  pages,  with  317  illustra- 
tions. Price  per  volume,  cloth,  $5.00;  sheep,  $6.00;  half  Eussia,  raised  bands,  $6.50. 
Per  set,  cloth,  $15.00;  leather,  $18.00;  half  Russia,  $19.50.     Sold  only  by  subscription. 


COHEN,  SOLOMON  SOLIS,  M,  D,, 

Professor  of  Clinical  Medicine  and  Applied  Therapeutics  in  the  Philadelphia  Polyclinic. 

A  Handbook  of  Applied  Therapeutics.  Being  a  Study  of  Principles 
Applicable  and  an  Exposition  of  Methods  Employed  in  the  Management  of  the  Sick. 
In  one  large  12mo.  volume,  with  illustrations.     Preparing. 


STTLLE  ON  CHOLERA:  Its  Origin,  History, 
Causation,  Symptoms,  Lesions,  Prevention  and 
Treatment.  In  one  handsome  12mo.  volume  of 
163  pages,  with  a  chart.     Cloth,  Si. 25. 

WATSON'S  LECTURES  ON  THE  PRINCIPLES 
AND  PRACTICE  OP  PHYSIC.  Prom  the  fifth 
English  edition.  Edited  with  additions,  and  190 
illustrations, by  Henet  Hartshokne,  A.M.,  M.  D., 
late  Professor  of  Hygiene  in  the  University  of 
Pennsylvania.  In  two  large  octavo  volumes  of 
1840  pages.    Cloth,  S9.00;  leather,  Sll.OO. 

FLINT  ON  PHTHISIS:  ITS  MORBID  ANAT- 
OMY, ETIOLOGY,  SYMPTOMATIC   EVENTS 


AND  COMPLICATIONS,  FATALITY  AND 
PROGNOSIS,  TREATMENT  AND  PHYSICAL 
DIAGNOSIS;  in  a  series  of  Clinical  Studies.  In 
one  octavo  volume  of  442  pages.    Cloth,  $3.50. 

FLINT'S  PRACTICAL  TREATISE  ON  THE 
DIAGNOSIS,  PATHOLOGY  AND  TREATMENT 
OF  DISEASES  OP  THE  HEART.  Second  re- 
vised and  enlarged  edition.  In  one  octavo  vol- 
ume of  550  pages,  with  a  plate.    Cloth,  84. 

FLINT'S  ESSAYS  ON  CONSERVATIVE  MEDI- 
CINE AND  KINDRED  TOPICS.  In  one  very 
handsome  royal  12mo.  volume  of  210  pages 
Cloth,  $1.38. 


14  Lea  Brothers  &  Co.'s  Publications — System  of  Med. 

For  Sale  by  Subscription  Only. 


A  System  of  Practical  Medicine. 

BY  AMERICAN  AUTHORS. 

Edited  by  WILLIAM  PEPPER,  M.  D.,  LL.  D., 

PKOVOST  AND  PROFESSOR  OF  THE  THEORY  AND  PRACTICE  OF  MEDICINE  AND  OF 
CXJNICAIi  MEDICINE  IN  THE  UNIVERSITY  OF  PENNSYLVANIA, 

Assisted  by  Loins  Starr,  M.  D.,  Clinical  Professor  of  the  Diseases  of  Childxen  in  the 
Hospital  of  the  University  of  Pennsylvania. 

The  complete  work,  in  five  volumes,  containing  5573  pages,  with  198  illustrations,  is  now  ready. 
Price  per  volume,  cloth,  $5;  leather,  $6  ;  half  Russia,  raised  bands  and  open  back,  $7. 


In  this  great  work  American  medicine  is  for  the  first  time  reflected  by  its  worthiest 
teachers,  and  presented  in  the  full  development  of  the  practical  utility  which  is  its  pre- 
eminent characteristic.  The  most  able  men — from  the  East  and  the  West,  from  the 
North  and  the  South,  from  all  the  prominent  centres  of  education,  and  from  all  the 
hospitals  which  afford  special  opportunities  for  study  and  practice — have  united  in 
generous  rivalry  to  bring  together  this  vast  aggregate  of  specialized  experience. 

The  distinguished  editor  has  so  apportioned  the  work  that  to  each  author  has  been 
assigned  the  subject  which  he  is  peculiarly  fitted  to  discuss,  and  in  which  his  views 
will  be  accepted  as  the  latest  expression  of  scientific  and  practical  knowledge.  The 
practitioner  will  therefore  find  these  volumes  a  complete,  authoritative  and  unfailing  work 
of  reference,  to  which  he  may  at  all  times  turn  with  full  certainty  of  finding  what  he  needs 
in  its  most  recent  aspect,  whether  he  seeks  information  on  the  general  principles  of  medi- 
cine, or  minute  guidance  in  the  treatment  of  special  disease.  So  wide  is  the  scope  of  the 
work  that,  with  the  exception  of  midwifery  and  matters  strictly  surgical,  it  embraces  the 
whole  domain  of  medicine,  including  the  departments  for  which  the  physician  is  accustomed 
to  rely  on  special  treatises,  such  as  diseases  of  women  and  children,  of  the  genito-urinary 
organs,  of  the  skin,  of  the  nerves,  hygiene  and  sanitary  science,  and  medical  ophthalmology 
and  otology.  Moreover,  authors  have  inserted  the  formulas  which  they  have  found  most 
efficient  in  the  treatment  of  the  various  affections.  It  may  thus  be  truly  regarded  as  a 
Complete  Library  of  Practical  Medicine,  and  the  general  practitioner  possessing  it 
may  feel  secure  that  he  will  require  little  else  in  the  daily  round  of  professional  duties. 

In  spite  of  every  effort  to  condense  the  vast  amount  of  practical  information  fur- 
nished, it  has  been  impossible  to  present  it  in  less  than  5  large  octavo  volumes,  containing 
about  5600  beautifully  printed  pages,  and  embodying  the  matter  of  about  15  ordinary 
octavos.     Illustrations  are  introduced  wherever  requisite  to  elucidate  the  text. 

A   detailed  prospectus  will  be  sent   to  any  address  on  application  to  the  publishers. 

These  two  volumes  bring  this  admirable  work  !  physicians  who  are  acquainted  with  all  the  varie- 
to  a  close,  and  fully  sustain  the  high  standard  :  ties  of  climate  in  the  United  States,  the  character 
reached  by  the  earlier  volumes ;  we  have  only  of  the  soil,  the  manners  and  customs  of  the  peo- 
therefore  to  echo  the  eulogium  pronounced  upon  pie,  etc..  It  is  peculiarly  adapted  to  the  wants 
them.  We  would  warmly  congratulate  the  editor  of  American  practitioners  of  medicine,  and  it 
and  his  collaborators  at  the  conclusion  of  their  aeems  to  us  that  every  one  of  them  would  desire 
laborious  task  on  the  admirable  manner  in  which,  to  have  it.  It  has  been  truly  called  a  "Complete 
from  first  to  last,  they  have  performed  their  several  !  Library  of  Practical  Medicine,"  and  the  general 
duties.  They  have  succeeded  in  producing  a  i  practitioner  will  require  little  else  in  his  round 
work  which  will  long  remain  a  standard  work  of  of  professional  duties. — Cincinnati  Medical  News, 
reference,  to  which  practitioners  will   look   for  I  March,  1886. 

fuidance,  and  authors  will  resort  for  facts.  Each  of  the  volumes  is  provided  with  a  most 
rom  a  literary  point  of  view,  the  work  is  without  !  copious  index,  and  the  work  altogether  promises 
any  serious  blemish,  and  in  respect  of  production,  j  to  be  one  which  will  add  much  to  the  medical 
it  has  the  beautiful  tinish  that  Americans  always  !  literature  of  the  present  century,  and  reflect  great 
give  their  works. — Edinburgh  MedicalJournal,  Jan.  I  credit  upon  the  scholarship  and  practical  acumen 


1887. 

•  *  Thegreate.stdistinctively  American  work  on 
the  practice  of  medicine,  and,  indeed,  the  super- 
lative adjective  would  not  be  inappropriate  were 
even  all  other  productions  placed  in  comparison. 
An  examination  of  the  five  volumes  is  sufficient 
to  convince  one  of  the  magnitude  of  the  enter- 
prise, and  of  the  success  which  has  attended  its 
fulfilment.— T/ie  Medical  Age,  July  20, 1886. 

This  huge  volume  forms  a  fitting  close  to  the 
great  system  of  medicine  which  in  so  short  a  time 
nas  won  so  high  a  place  in  medical  literature,  and 
has  done  such  credit  to  the  profession  in  this 
country.     Among  the  twenty-tnree  contributors 


of  its  authors. —  ?7je  London  Lancet,  Oct.  3,  1885. 

The  feeling  of  proud  satisfaction  with  which  the 
American  profession  sees  this,  its  representative 
system  of  practical  medicine  issued  to  the  medi- 
cal world,  is  fully  justified  by  the  character  of  the 
work.  The  entire  caste  of  the  system  is  in  keep- 
ing with  the  best  thoughts  of  the  leaders  and  fol- 
lowers of  our  home  school  of  medicine,  and  the 
combination  of  the  scientific  study  of  disease  and 
the  practical  application  of  exact  and  experimen- 
tal knowledge  to  the  treatment  of  human  mal- 
adies, makes  every  one  of  us  share  in  the  pride 
that  has  welcomed  Dr.  Pepper's  labors.  Sheared 
of  the  prolixity  that  wearies  the  readers  of  the 


are  the  names  of  the  leading  neurolosists  in  I  German  school,  the  articles  glean  these  same 
America,  and  most  of  the  work  in  the  volume  is  of  fields  for  all  that  is  valuable.  It  is  the  outcome 
the  highest  order. — Boston  Medical  and  Surgical  .,  of  American  brains,  and  is  marked  throughout 
Journal,  July  21, 1887.  |  by  much  of  the  sturdy  independence  of  thought 

We  consider  it  one  of  the  grandest  works  on  '  and  originality  that  is  a  national  characteristic. 
Practical  Medicine  in  the  English  language.  It  is  Yet  nowhere  is  there  lack  of  study  of  the  most 
a  work  of  which  the  profession  of  this  country  can  I  advanced  views  of  the  day. — North  Carolina  Medi- 
feel   proud.     Written   exclusively  by  American  |  cal  Journal,  Sept.  1886. 


Lea  Brothers  &  Co.'s  Publications — Practice  of  Medicine.        15 


LYMAN,  MBNRY  M.,  M.  !>., 

Professor  of  the  Principles  and  Practice  of  Medicine,  Rush  Medical  College,  Ctdcago. 

The  Principles  and  Practice  of  Medicine.  For  the  Use  of  Medical  Students 
and  Practitioners.  In  one  very  handsome  octavo  vohime  of  925  pages,  with  170  illustra- 
tions.    Cloth,  $4.75 ;  leather,  |5.75.     Just  ready. 

The  author  has  undertaken  to  present  in  this  volume  not  only  the  results  of  his  long 
experience  as  a  practitioner  and  teacher,  but  to  make  it  representative  of  the  latest  state 
of  knowledge  in  its  department.  The  work  is  assured  of  wide  use  as  an  unsurpassed  guide 
for  the  student  and  likewise  for  the  practitioner. 

WSITLA,  WILLIAM,  M,  D., 

Projessor  of  Materia  Medica  and  Therapeutics  in  the  Queen's  College,  Belfast. 

A  Dictionary  of  Treatment ;  or  Therapeutic  Index,  including  Medi- 
cal and  Surgical  Therapeutics.  Kevised  and  adapted  to  the  United  States 
Pharmacopoeia.     In  one  square,  octavo  volume  of  917  pages.     Cloth,  $4.00.     Just  ready. 


Dr.  Whitla  has,  we  think,  been  fortunate  in  the 
selection  of  a  title  for  his  late&t  work.  We  have 
already  dictionaries  of  medicine  and  dictionaries 
of  surgery;  he  now  provides  us  with  a  dictionary 
of  treament.  And  reference  to  the  volume  shows 
that  it  really  is  what  it  professes  to  be.  The  sev- 
eral diseased  conditions  are  arranged  in  alphabet- 
ical order,  and  the  methods — medical,  surgical, 
dietetic,  and  climatic — by  which  they  may  be  met, 
considered.  On  every  paee  we  find  clear  and  de- 
tailed directions  for  treatment,  supported  by  the 
author's  personal  authority  and  experience,  whilst 
the  recommendations  of  other  competentobservers 
are  also  critically  examined.  The  book  abounds 
with  useful,  practical  hints  and  suggestions,  and 


the  younger  practitioner  will  find  in  it  exactly  the 
help  he  so  often  needs  in  the  treatment  botQ  of 
those  who  are  ill,  and  those  who  are  ailing.  At  the 
same  time  the  most  experienced  members  of  the 
profession  may  usefully  consult  its  pages  for  the 
purpose  of  learning  what  is  really  trustworthy  in 
the  later  therapeutic  developments.  The  Diction- 
ary is,  in  short,  the  recorded  experience  of  a  prac- 
tical scientific  therapeutist,  who  has  carefully 
studied  diseases  and  disorders  at  the  bed-side  and 
in  the  consulting-room,  and  has 'earnestly  ad- 
dressed himself  to  the  cure  and  relief  of  his 
patients.  Dr.  Whitla  is  to  be  congratulated  upon 
the  thoroughness  with  which  he  has  realised  his 
idea. —  The  Glasgow  Medical  Journal,  April,  1892. 


FOTJBEBBGILL,  J.  M.,  M,  !>.,  Bdin.,  M,  M,  C.  -P.,  Lond., 

Physician  to  the  City  of  London  Hospital  fo^  Diseases  of  the  Chest. 

The  Practitioner's  Handbook  of  Treatment ;  Or,  The  Principles  of  Thera- 
peutics.  Third  edition.    In  one  8vo.  vol.  of  661  j^ages.    Cloth,  $3.75 ;  leather,  $4.75 


To  have  a  description  of  the  normal  physiologi- 
cal processes  of  an  organ  and  of  the  methods  of 
treatment  of  its  morbid  conditions  brought 
together  in  a  single  chapter,  and  the  relations 
between  the  two  clearly  stated,  cannot  fail  to  prove 
a  great  convenience  to  many  thoughtful  but  busy 
physicians.  The  practical  value  of  the  volume  is 
greatly  increased  by  the  introduction  of  many 
prescriptions.  That  the  profession  appreciates 
that  the  author  has  undertaken  an  important  work 
and  has  accomplished  it  is  shown  by  the  demand 
for  this  third  edition. — N.  Y.  Med.  Jour.,  June  11,'87. 


This  is  a  wonderful  book.  If  there  be  such  a 
thing  as  "  medicine  made  easy,"  this  is  the  work  to 
accomplish  this  result. —  Va.  Med.  Month.,  June,'87. 

It  is  an  excellent,  practical  work  on  therapeutics, 
well  arranged  and  clearly  expressed,  useful  to  the 
student  and  young  practitioner,  perhaps  even  to 
the  old. — Dublin  Journal  of  Medical  Science,  March, 
1888. 

We  do  not  know  a  more  readable,  practical  and 
useful  work  on  the  treatment  of  disease  than  the 
one  we  have  now  before  us. — Pacific  Medical  and 
Surgical  Journal,  October,  1887. 


FINLATSON,  JAMES,  M.  D,,  Editor, 

Physician  and  Lecturer  on  Clinical  Medicine  in  the  Glasgow  Western  Infirmary,  ete. 

Clinical  Manual  for  the  Study  of  Medical  Cases.  With  Chapters 
by  Prof.  Gairdner,  Prof.  Stephenson,  Dr.  Robertson,  Dr.  Gemmell  and  Dr.  Coats.  Second 
edition.     In  one  12mo.  volume  of  682   pages,  with  158  illustrations.    Cloth,  $2.50. 


We  are  pleased  to  see  a  second  edition  of  this 
admirable  book.  It  is  essentially  a  practical 
treatise  on  medical  diagnosis,  in  which  every  sign 
and  symptom  of  disease  is  carefully  analyzed,  and 
their  relative  significance  in  the  different  affec- 
tions in  which  they  occur  pointed  out.  From  their 
synthesis  the  student  can  accurately  determine 
the  disease  with  which  he  has  to  deal.     The  book 


has  no  competitor,  nor  is  it  likely  to  have  as  long 
as  future  editions  maintain  its  present  standard  of 
excellence.  The  general  practitioner  will  find 
many  practical  hints  in  its  pages,  while  a  careful 
study  of  the  work  will  save  him  from  many  pitfalla 
in  diagnosis. — Liverpool  Medico- Chirurgical  Jour- 
nal, January,  1887. 


MVSSBB,  JOHN  H.,  M,  D., 

Assistant  Professor  of  Clinical  Medicine,  University  of  Pennsylvania,  Philadelphia. 

A  Practical  Treatise  on  Medical  Diagnosis.    For  the  Use  of  Students  and 
Practitioners.     In  one  octavo  volume  of  about  650  pages.     Preparing. 

MABBBSJECON,  S,  O.,  M,  D., 

Senior  Physician  to  and  late  Led.  on  Principles  and  Practice  of  Med.  at  Chiy^s  Hospital,  London. 
On  the  Diseases  of  the  Abdomen ;     Comprising  those  of  the  Stomach,  and 
other  parts  of  the  Alimentary  Canal,  CEsophagus,  Caecum,  Intestines  and  Peritoneum.  Second 
American  from  third  enlarged  and  revised  English  edition.     In  one  handsome  octavo 
volume  of  554  pages,  with  illustrations.     Cloth,  $3.50, 


This  valuable  treatise  on  diseases  of  the  stomach 
and  abdomen  will  be  found  a  cyclopsedia  of  infor- 
mation, systematically  arranged,  on  all  diseases  of 
the   alimentary   tract,    from    the    mouth    to  the 


rectum.  A  fair  proportion  of  each  chapter  is 
devoted  to  symptoms,  pathology,  and  therapeutics. 
— New  York  Medical  Journal,  April,  1879. 


TANNER'S  MANUAL  OF  CLINICAL  MEDICINE 
AND  PHYSICAL  DIAGNOSIS.  Third  American 
from  the  second  London  edition.  Revised  and 
enlarged  by  Tilbtjey  Fox,  M.D.  In  one  12mo. 
volume  of  362  pp.,  with  illus.    Cloth,  $1.50. 

A  TREATISE  ON  FEVER.  By  Robebt  D.  Lyons, 
K.  C.  C.    In  one  8vo.  vol.  of  354  pp.    Cloth,  $2.25. 


LECTURES  DN  THE  STUDY  OF  FEVER.  By 
A.  Hudson  ,  M.  D.,  M.  R.  I.  A.  In  one  octavo 
volume  of  808  pages.    Cloth,  82.50. 

LA  ROCHE  ON  YELLOW  FEVER,  considered  In 
its  Historical,  Pathological,  Etiological  and 
Therapeutical  Relations.  In  two  large  and  hand- 
some octavo  volumes  of  1468  pp.    Cloth,  $7.00. 


16     Lea  Brothers  &  Co.'s  Publications — Hygiene,  Electr.,  Pract. 


BAMTSOLOW,  ROBERTS,  A.  M,,  M.  D.,  XX.  X>., 

Prof,  of  Materia  Medica  and  General  Therapeutics  in  the  Jefferson  Med.  Coll.  of  Phila.,  etc. 
Medical  Electricity.     A  Practical  Treatise  on  the  Applications  of  Electricity 


to  Medicine  and  Surgery.     Third  edition, 
pages,  with  110  illustrations.     Cloth,  |2.50, 

The  fact  that  this  work  has  reached  its  third  edi- 
tion in  six  years,  and  that  it  has  been  kept  fully 
abreast  with  the  increasing  use  and  knowledge  of 
electricity,demonstrates  its  claim  to  be  considered 
a  practical  treatise  of  tried  value  to  the  profession. 
The  matter  added  to  the  present  edition  embraces 


In  one  very  handsome  octavo  volume  of  SOS 

the  most  recent  advances  in  electrical  treatment. 
The  illustrations  are  abundant  and  clear,  and  the 
work  constitutes  a  full,  clear  and  concise  manual 
well  adapted  to  the  needs  of  both  student  and 
practitioner. —  The  Medical  News,  May  14, 1887. 


YEO,  I,  BUBNET,  M,  B,,  F.  R.  C.  P.> 

Professor  of  Clinical  Therapeutics  in  King's  College,  London,  and  Physician  to  King^s  College 
Hospital. 

Food  in  Health  and  Disease.    In  one  12mo.  volume  of  590  pages.    Cloth,  $2. 

See  Series  of  Clinical  llanuals,  page  31. 


Dr.Yeo  supplies  in  a  compact  form  nearly  all  that 
the  practitioner  requires  to  know  on  the  subject  of 
diet.  The  work  is  divided  into  two  parts— food  in 
health  and  food  in  disease.  Dr.  Yeo  has  gathered 
together  from  all  quarters  an  immense  amount  of 
useful  information  within  a  comparatively  small 


compass,  and  he  has  arranged  and  digested  his 
materials  with  skill  for  the  use  of  the  practitioner. 
We  have  seldom  seen  a  book  which  more  thor- 
oughly realizes  the  object  for  which  it  was  written 
than  this  little  work  of  Dr.  Yeo. — British  Medical 
Journal,  Feb.  8, 1890. 


RICMARBSOJ^,  B.  W,,  M,B.,  XX.  !>.,  F.R.S,, 

Fellow  of  the  Royal  College  of  Physicians,  London. 
Preventive  Medicine.   In  one  octavo  volume  of  729  pages.  Cloth,  $4;  leather,  1 


Dr.  Richardson  has  succeeded  in  producing  a 
work  which  is  elevated  in  conception,  comprehen- 
sive in  scope,  scientific  in  character,  systematic  in 
arrangement,  and  which  is  written  in  a  clear,  con- 
cise and  pleasant  manner.  He  evinces  the  happy 
faculty  01  extracting  the  pith  of  what  is  known  on 
the  subject,  and  of  presenting  it  in  a  most  simple, 
intelligent  and  practical  form.  There  is  perhaps 
no  similar  work  written  for  the  general  public 
that  contains  such  a  complete,  reliable  and  instruc- 


tive collection  of  data  upon  the  diseases  common 
to  the  race,  their  origins,  causes,  and  the  measures 
for  their  prevention.  The  descriptions  of  diseases 
are  clear,  chaste  and  scholarly ;  the  discussion  of 
the  question  of  disease  is  comprehensive,  masterly 
and  fully  abreast  with  the  latest  and  best  knowl- 
edge on  the  subject,  and  the  preventive  measures 
advised  are  accurate,  explicit  and  reliable. — The 
American  Journal  of  the  Medical  Sciences,  April,  1884. 


THE  TEAR  BOOK  OF  TREATMENT  FOR  1892, 

A  Comprehensive  and  Critical  Review  for  Practitioners  of  Medi- 
cine and  Surgery.     In  one  12mo.  vol.  of  about  500  pages.    Cloth,  |1.50. 
^*^  For  special  commutations  with  periodicals  see  pages  1  and  2. 


The  "Year-Book"  is  too  well  known  and  too 
highly  appreciated  to  need  comment.  The  im- 
mense strides  taken  in  the  progress  of  medicine 
in  all  its  branches  make  it  impossible  for  anyone 
to  keep  up  with  the  times.  Hence  the  necessity 
of  the  book  in  hand.  Its  score  of  co-authors  sift 
out  what  is  useful  in  literature  and  present  it  in  a 


concise  and  readable  form.  Thus,  with  compara- 
tively little  labor,  the  busy  practitioner  gets  the 
gist  of  medical  literature  the  world  over.  Every 
branch  of  medicine  is  covered — new  remedies,  old 
ones  with  new  applications,  new  operations,  all 
receiving  attention. — Meaical  Record,  May  21, 1892. 


THE  YEAR-BOOK  OF  TREATMENT  FOR  1891. 

12mo.,  485  pages.    Cloth,  $1.50. 

THE  YEAR-  BOOKS  of  TREATMENT  for  '86,  '87  and  '90 

Similar  to  above.     12mo.,  320-341  pages.     Limp  cloth,  $1.25  each. 

SCHREIBER,  JOSEPH,  M.  2>. 

A  Manual  of  Treatment  by  Massage  and  Methodical  Muscle  Ex- 
ercise. Translated  by  Walter  Mendelson,  M.  D.,  of  New  York.  In  one  handsome 
octavo  volume  of  274  pages,  with  117  fine  engravings. 


STURGES'  INTRODUCTION  TO  THE  STUDY 
OF  CLINICAL  MEDICINE.  Being  a  Guide  to 
the  Investigation  of  Disease.  In  one  handsome 
12mo.  volume  of  127  pages.    Cloth,  $1.25. 

DAVIS'  CLINICAL  LECTURES  ON  VARIOUS 
IMPORTANT  DISEASES.  By  N.  S.  Davis, 
M.  D.  Edited  by  Feank  H.  Davis,  M.  D.  Second 
edition.    12mo.  287  pages.    Cloth,  81.75. 

TODD'S  CLINICAL  LECTURES  ON  CERTAIN 
ACUTE  DISEASES.  In  one  octavo  volume  of 
320  pages.    Cloth,  $2.50. 

PAVY'S  TREATISE  ON  THE  FUNCTION  OF  DI- 
GESTION; its  Disorders  and  their  Treatment. 
From  the  second  London  edition.  In  one  octavo 
volume  of  238  pages.    Cloth,  82.00. 

BARLOW'S  MANUAL  OF  THE  PRACTICE  OF 
MEDICINE.  With  additions  by  D.  F.  Condie, 
M.D.     1  vol.  8 vo.,  pp.  603.     Cloth,  82.50. 

CHAMBERS'  MANUAL  OF  DIET  AND  REGIMEN 
IN  HEALTH  AND  SICKNESS.  In  one  hand 
some  octavo  volume  of  302  pp.    Cloth,  $2.75. 


HOLLAND'S  MEDICAL  NOTES  AND  REFLEC 
TIONS.  1  vol.  8vo..  pp.  493.    Cloth,  $3.50. 

FULLER  ON  DISEASES  OF  THE  LUNGS  AND 
AIR-PASSAGES.  Their  Pathology,  Physical  Di- 
agnosis, Symptoms  and  Treatment.  From  the 
second  and  revised  English  edition.  In  one 
octavo  volume  of  475  pages.    Cloth,  $3.50. 

WALSHE  ON  THE  DISEASES  OF  THE  HEART 
AND  GREAT  VESSELS.  Third  American  edi- 
tion.    In  1  vol.  8vo.,  416  pp.    Cloth.  83.00. 

SLADE  ON  DIPHTHERIA;  its  Nature  and  Treat- 
ment, with  an  account  of  the  History  of  its  Pre- 
valence in  various  Countries.  Second  and  re  vised 
edition.    In  one  12mo.  vol.,  158  pp.     Cloth,  $1.25. 

SMITH  ON  CONSUMPTION ;  its  Early  and  Reme- 
diable Stages.    1  vol.  8vo.,  253  pp.    Cloth,  82.25. 

LA  ROCHE  ON  PNEUMONIA.  1  vol.  8vo.  of  490 
pages.    Cloth,  83.00. 

WILLIAMS  ON  PULMONARY  CONSUMPTION; 
its  Nature,  Varieties  and  Treatment.  With  an 
analysis  of  one  thousand  cases  to  exempli^  its 
duration.   In  one  8vo.  vol.  of  303  pp.  Cloth,  $2.50. 


Lea  Brothers  &  Co.'s  Publications — Pliys.  Diag.,  Throat,  Hist.  17 
FLINT,  AUSTIN,  M.  D.,  LI.  jD., 

Profeisor  of  the  Principles  and  Practice  of  Medicine  in  Bellevue  Hospital  Medical  College,  N.  T. 

A.  Manual  of  Auscultation  and  Percussion ;  Of  the  Physical  Diagnosis  ot 
Diseases  of  the  Luno;s  and  Heart,  and  of  Thoracic  Aneurism.  Fifth  edition. 
Edited  by  James  C.  Wilson,  M.  D.,  Lecturer  on  Physical  Diagnosis  in  the  Jefferson 
Medical  College,  Philadelphia.  In  one  handsome  royal  12mo.  volume  of  274  pages,  with 
12  illustrations.  Cloth,  $1.75. 

This  little  book  through  its  various  editions  has  !  oughness  of  Prof.  Flint's  investigations.  For  stu- 
probably  done  more  to  advance  the  science  of  I  dents  it  is  excellent.  Its  value  is  shown  both  in 
physical  exploration  of  the  chest  than  any  other  ,  the  arrangement  of  the  material  and  in  the  clear, 
dissertation  upon  the  subject,  and  now  in  its  fifth  !  concise  style  of  expression.  For  the  practitioner 
edition  it  is  as  near  perfect  as  it  can  be.  The  i  it  is  a  ready  manual  for  reference.— AbriA  Atneri- 
rapidity  with  which  previous  editions  were  sold  !  can  Practitioner,  January,  1891. 
shows  how  the  profession  appreciated  the  thor-  \ 


BUOADBENT,  W.  S.,  M.  D.,  F.  B,  C.  F., 

Physician  to  and  Lecturer  on  Medicine  at  St.  Mary's  Hospital,  London. 
The  Pulse.     In  one  12mo.  volume  of  312  pages.    Cloth,  $1.75. 
ical  Manuals,  page  31. 


See  Series  of  Clin- 


BBOWNE,  LENNOX,  F.  B.  C.  S.,  E,, 

Senior  Physician  to  the  Central  London  Throat  and  Ear  Hospital. 

The  Throat  and  Nose  and  Their  Diseases.  Fourth  and  enlarged  edition. 
In  one  imperial  octavo  volume  of  about  750  pages,  with  120  illustrations  in  color,  and  235 
engravings  on  wood.     Preparing. 

A  notice  of  the  previous  edition  is  appended. 

The  beautiful  and  typical  colored  plates  form  I  tieal  text-book  on  diseases  of  the  throat  and  nose 
a  valuable  and  instructive  atlas,  the  equal  of  which  i  extant.     We  are  glad  to  learn  that  it  is  being 
is  not  to  be  found  in  any  modern  work,  treating  |  translated  into  French  and  German. — The  Provin- 
of  these  subjects.    Mr.  Lennox   Browne  is  to  be  j  cial  Medical  Journal,  August  1, 1890. 
congratulated  on  having  produced  the  best  prac-  | 


SEILEB,  CABL,  31.  D., 

Lecturer  on  Laryngoscopy  in  the  University  of  Pennsylvania. 

A  Handbook  of  Diagnosis  and  Treatment  of  Diseases  of  the  Throat, 
Nose  and  Naso-Pharynx.  New  (4th)  edition.  In  one  handsome  royal  12mo.  volume 
of  about  400  pages,  with  101  illustrations  and  2  colored  plates.     Preparing. 

A  notice  of  the  previous  edition  is  appended. 
Few   medical  writers    surpass  this    author   in    of  topics  and  methods.   The  book  deserves  a  large 
ability  to  make  his  meaning  perfectly  clear  In  a    sale,  especially  among  general  practitioners— C/jt- 
few  words,  and  in  discrimination  in  selection,  both    cago  Medical  Journal  and  Examiner,  April,  1889. 


COHEN,  J.  SOLIS,  M,  !>., 

Lecturer  on  Laryngoscopy  and  Diseases  of  the  Throat  and  Chest  in  the  Jefferson  Medical  College. 

Diseases  of  the  Throat  and  Nasal  Passages.  A  Guide  to  the  Diagnosis  and 
Treatment  of  Affections  of  the  Pharynx,  CEsophagus,  Trachea,  Larynx  and  Nares.  Third 
edition,  thoroughly  revised  and  rewritten,  with  a  large  number  of  new  illustrations.  In 
one  very  handsome  octavo  volume.    Preparing. 


SCHAFEB,  EnWABD  A.,  F.  B,  S,, 

Jodrell  Professor  of  Physiology  in  University  College,  London, 

The  Essentials  of  Histology.    New  (second)  edition. 
of  311  pages,  with  325  illustrations.     Cloth,  $3.00.     Just  ready. 


In  one  octavo  volume 


KLEIN,  E,,  31.  n.,  F.  B.  S,, 

Joint  Lecturer  on  General  Anat.  and  Phys.  in  the  Med.  School  of  St.  Bartholomew's  Hosp.,  London. 
Elements  of  Histology.     Fourth  edition.    In  one  12mo.  volume  of  376  pages, 
with  194  illus.    Limp  cloth,  $1.75.      See  Student^  Series  of  Manuals,  page  30. 


FLINT'S  PRACTICAL  TREATISE  ON  THE 
PHYSICAL  EXPLORATION  OF  THE  CHEST 
AND  THE  DIAGNOSIS  OF  DISEASES  AF- 
FECTING THE  RESPIRATORY  ORGANS. 
Second  and  revised  edition.  In  one  handsome 
octavo  volume  of  591  pages.     Cloth,  S4,.50. 

BROWNE  ON  KOCH'S  REMEDY  IN  RELATION 
TO  THROAT  CONSUMPTION.  In  one  octavo 
volume  of  121  pages,  with  45  illustrations,  4  of 
which  are  colored,  and  17  charts.    Cloth,  $1.50. 

GROSS'  PRACTICAL  TREATISE  ON  FOREIGN 


BODIES  IN  THE  AIR-PASSAGES.  In  one 
octavo  volume  of  452  pages,  with  59  illustrations. 
Cloth,  S2.75. 

WOODHEAD'S  PRACTICAL  PATHOLOGY.  A 
Manual  for  Students  and  Practitioners.  In  one 
beautiful  octavo  volume  of  497  pages,  with  136 
exquisitely  colored  illustrations. 

PEPPER'S  SURGICAL  PATHOLOGY.  In  one 
pocket-size  12mo.  volume  of  511  pages,  with  81 
illustrations.  Limp  cloth,  red  edges,  §2.00  See 
Students'  Series  of  Manuals,  page  31. 


18     Lea  Brothers  &  Co.'s  Pcblications — Pathology,  Bacteriology. 


GIBBJES,  HEXBAGB,  M,  D., 

Fr( feasor  <'f  Pathology  in  the  University  of  Michigan,  Medical  Department. 

Practical  Pathology  and  Morbid  Histology.    In  one  very  handsome  octavo 

volume  of  314  pages,  with  60  illustrations,  mostly  photographic.     Clotb,  ^2.75. 


This  i°,  in  part,  an  expansion  of  the  little  work 
published  by  the  author  some  years  ago,  and  his 
acknowledged  skill  as  a  practical  mieroscopist  will 
give  weight  to  his  instructions.  Indeed,  m  ful- 
ness of  direct  ions  as  to  the  modes  of  investigating 
morbid  tissues  the  book  leaves  little  to  be  desired. 


The  work  is  throughout  profusely  illustrated  with 
reproductions  of  micro-photographs.  We  may 
say  that  the  practical  histologist  will  gain  much 
useful  information  from  the  book. —  The  London 
Lancet,  January  23, 1892. 


ABBOTT,  A,  C,  M,  D., 

First  Assistant,  Laboratory  of  Hygiene,  University  of  Penna.,  Philadelphia. 
The  Principles  of  Bacteriology :  a  Practical  Manual  for  Students  and  Physi- 
cians.    In  one  12mo.  volume  of  259  pages  with  32  illustrations.     Cloth,  $2.     Just  ready. 


During  the  last  decade  numerous  works  on  this 
subject  have  been  brought  before  the  profession; 
yet,  while  many  of  them  are  exhaustive  treatises, 
much  of  the  laboratory  technique  requisite  to  the 
needs  of  beginners  was  omitted  or  most  scantily 
treated.  On  reading  this  manual  of  Dr.  Abbott, 
any  one  familiar  with  the  subject  will  readily 
recognize  the  fact  that  the  book  is  not  merely  a 
compilation  from  other  works,  but   one   giving 


evidence  of  the  originality  of  the  author,  as  well 
as  complete  knowledge  of  the  practical  details  of 
bacteriology.  His  "scheme  for  the  study  of  an 
organism"  furnishes  an  excellent  guide  to  the 
student.  Of  equal  importance  is  the  chapter  on 
disinfectants,  antiseptics  and  skin  disinfection. 
It  will  form  a  valuable  addition  to  the  literature 
of  laboratory  technique  and  bacteriological  inves- 
tigation.—  The  Therapeutic  Gazette,  May  16, 1892. 


SBJVW,  NICHOLAS,  M.I>.,  Ph,I>,, 

Professor  of  Surgery  in  Rush  Medical  College,  Chicago. 
Surgical  Bacteriology.     New   (second)   edition.    In  one  handsome  octavo  of 
268  pages,  with  13  plates,  of  which  10  are  colored,  and  9  engravings.  Cloth,  $2. 

makes  it  possible  for  the  busy  practitioner,  whose 


The  book  is  really  a  systematic  collection  in  the 
most  concise  form  of  such  results  as  are  published 
in  current  medical  literature  by  the  ablest  workers 
in  this  field  of  surgical  progress ;  and  to  these  are 
added  the  author's  own  views  and  the  results  of 
his  clinical  experience  and  original  investigations. 
The  book  is  valuable  to  the  student,  but  its  chief 
value  lies  in  the  fact  that  such  a  compilation 


time  for  reading  is  limited  and  whose  sources  of 
information  are  often  few,  to  become  conversant 
with  the  most  modern  and  advanced  ideas  in  sur- 
gical pathology,  which  have  "laid  the  foundation 
for  the  wonderful  achievements  of  modern  sur- 
gery."— Annals  of  Surgery,  March,  1892. 


GBBBN^,  T.  SBNBT,  M,  !>., 

Lecturer  on  Pathology  and  Morbid  Anatomy  at  Charing-Cross  Hospital  Medical  School,  London. 

Pathology  and  Morbid  Anatomy.    Sixth  American  from  the  seventh  revised 
English  edition.    Octavo,  539  pp.,  with  167  engravings.   Cloth,  $2.75. 


The  Pathology  and  Morbid  Anatomy  of  Dr. 
Green  is  too  well  known  by  members  of  the  medi- 
cal profession  to  need  any  commendation.  There 
is  scarcely  an  intelligent  physician  anywhere  who 
has  not  the  work  in  his  library,  for  it  is  almost  an 
essential.  In  fact  it  is  better  adapted  to  the  wants 
of  general  practitioners  than  any  work  of  the  kind 
with  which  we  are  acquainted.  The  works  of 
German  authors  upon  pathology,  which  have  been 


translated  into  English,  are  too  abstruse  for  the 
physician.  Dr.  Green's  work  precisely  meets  his 
wishes.  The  cuts  exhibit  the  appearances  of 
pathological  structures  just  as  they  are  seen 
through  the  microscope.  The  fact  that  it  is  so 
generally  employed  as  a  text-book  by  medical  stu- 
dents is  evidence  that  we  have  not  spoken  too 
much  in  its  favor. — Cincinnati  Medical  News,  Oct. 
1889. 


PATNB,  JOSBJPH  F,,  M,  I).,  F.  B,  C.  P., 

Senior  Assistant  Physician  and  Lecturer  on  Pathological  Anatomy,  St.  Thomas'  Hospital,  London. 
A  Manual  of  General  Pathology.     Designed  as  an  Introduction  to  the  Prac- 
tice of  Medicine.     Octavo  of  524  pages,  with  152  illus.  and  a  colored  plate.     Cloth,  $3,50. 
Knowing,  as  a  teacher  and  examiner,  the  exact  j  cal  factors  in  those  diseases  now  with  reasonable 
needs  of  medical  students,  the  author  has  in  the  !  certainty  ascribed  to  pathogenetic  microbes.    In 


work  before  us  prepared  for  their  especial  use 
what  we  do  not  hesitate  to  say  is  the  best  introduc- 
tion to  general  pathology  that  we  have  yet  ex 


this  department  he  has  been  very  full  and  explicit, 
not  only  in  a  descriptive  manner,  but  in  the  tech- 
nique of   investigation.      The    Appendix,  giving 


amined.      A    departure    which    our   author    has  I  methods  of  research,  is  alone  worth  the  price  of  the 


taken  is  the  greater  attention  paid  to  the  causa- 
tion of  disease,  and  more  especially  to  the  etiologi- 


book,  several   times    over,  to   every   student    of 
pathology. — St.  Louis  Med.  and  Surg.  Jour.,  Jan.  '89. 


COATS,  JOSBFH,  M.  !>.,  F,  F,  F,  S., 

Pathologist  to  the  Glasgow  Western  Infirmary. 
A  Treatise  on  Pathology.     In  one  very  handsome  octavo  volume  of  829  pages, 
with  339  beautiful  illustrations.     Cloth,  $5.50 ;  leather,  $6.50. 


Medical  students  as  well  as  physicians,  who 
desire  a  work  for  study  or  reference,  that  treats 
the  subjects  in  the  various  departments  in  a  very 
thorough  manner,  but  without  prolixity,  will  cer- 
tainly give  this  one  the  preference  to  any  with 
whlcn  we  are  acquainted.  It  sets  forth  the  most 
recent   discoveries,  exhibits,    in  an   interesting 


manner,  the  changes  from  a  normal  condition 
effected  in  structures  by  disease,  and  points  out 
the  characteristics  ol  various  morbid  agencies, 
so  that  they  can  be  easily  recognized.  But,  not 
limited  to  morbid  anatomy,' it  explains  fully  how 
the  functions  of  organs  are  disturbed  by  abnormal 
conditions. — Cincirmaii  Medical  News,  Oct.  1883. 


Lea  Brothers  &  Co.'s  Publications — Nerv.  and  Ment.  Dis.,  etc     19 


ghay,  landon  carter,  m,d.. 

Professor  of  Diseases  of  the  Mind  and  Nervous  System  in  the  New  York  Polyclinic. 

A  Practical  Treatise  on  Nervous  and  Mental  Diseases.  In  one  8vo. 
jvoluine  of  about  700  pages.     Richly  illustrated.     Shortly. 

This  work  is  devoted  purely  to  the  practical  aspects  of  nervous  and  mental  diseases, 
especial  care  being  taken  to  present  the  fundamental  knowledge  essential  to  a  grasp  of  its 
subjects  and  to  cast  everything  in  the  clearest  possible  form.  The  series  of  illustrations 
is  rich  and  unique,  embracing  a  large  number  of  photographic  engravings  of  exceptional 
vividness  and  interest.  By  the  employment  of  a  style  at  once  concise  and  clear,  and  by 
careful  arrangement,  the  author  is  enabled  to  include  an  exposition  of  a  vast  and  important 
subject  in  a  condensed  and  convenient  form. 

ROSS,  JAMES,  31.  D.,  F,  R.  C.  P.,  LL.  !>,, 

Senior  Assistant  Physician  to  the  Manchester  Royal  Infirmary. 

A  Handbook  on  Diseases  of  the  Nervous    System.     In  one  octavo 

volume  of  725  pages,  with  184  illustrations.     Cloth,  |4.50 ;  leather,  $5.50. 

The  author  has  rendered  a  great  service  to  the  disposal  of  the  author,  and  of  abridging  the  de- 
profession  by  condensing  into  one  volume  the  scription  of  the  different  aspects  of  nervous  dis- 
principal  facts  pertaining  to  neurology  and  nerv-  ,  eases,  has  been  performed  with  singular  skill,  and 
ous  diseases  as  understood  at  the  present  time,  i  the  result  is  a  concise  and  philosophical  guide  to 
and  he  has  succeeded  in  producing  a  work  at  once  j  the  department  of  medicine  of  which  it  treats. 

Dr.  Ross  holds  such  a  high  scientific  position  that 
any  writings  which  bear  his  name  are  naturally 
expected  to  have  the  impress  of  a  powerful  intel- 
lect. In  every  part  this  handbook  merits  the 
highest  praise,  and  will  no  doubt  be  found  of  the 
greatest  value  to  the  student  as  well  as  to  the  prac- 
titioner.— Edinburgh  MedicalJournal,  Jan.  1887. 


brief  and  practical  yet  scientific,  without  entering 
into  the  discussion  of  theorists,  or  burdening  the 
mind  with  mooted  questions. — Pacific  Medical  and 
Surgical  Journal  and  Western  Lancet,  May,  1886. 

This  admirable  work  is  intended  for  students  of 
medicine  and  for  such  medical  men  as  have  no  time 
for  lengthy  treatises.  In  the  present  instance  the 
duty  of  arranging  the  vast  store  of  material  at  the 


HAMILTOJS^,  ALLAN  McLANB,  M,  I),, 

Attending  Physician  at  the  Hospital  for  Epileptics  and  Paralytics,  BlackwelVs  Island,  N.  T. 
Nervous  Diseases ;  Their  Description  and  Treatment.     Second  edition,  thoroughly 
revised  and  rewritten.    In  one  octavo  volume  of  598  pages,  with  72  illustrations.    Cloth,  $4. 

characterized  this  book  as  the  best  of  its  kind  in 


When  the  first  edition  of  this  good  book  appeared 
we  gave  it  our  emphatic  endorsement,  and  the 

E resent  edition  enhances  our  appreciation  of  the 
ook  and  its  author  as  a  safe  guide  to  students  of 
clinical  neurology.  One  of  the  best  and  most 
critical  of  English  neurological  journals.  Brain,  has 


any  language,  which  is  a  handsome  endorsement 
from  an  exalted  source.  The  improvements  in  the 
new  edition,  and  the  additions  to  it,  will  justify  its 
purchase  even  by  those  who  possess  the  old. — 
Alienist  and  Neurologist,  April,  1882. 


TUKE,  I)AJn:EL  MACK,  M,  I),, 

Joint  Author  of  The  Manual  of  Psychological  Medicine,  etc. 

Illustrations  of  the  Influence  of  the  Mind  upon  the  Body  in  Health 

and  Disease.     Designed  to   elucidate   the  Action  of  the  Imagination.     New  edition. 
Thoroughly  revised  and  rewritten.  In  one  8vo.  vol.  of  467  pp.,  with  2  col.  plates.   Cloth,  $3. 

It  is  impossible  to  peruse  these  interesting  chap- 
ters without  being  convinced  of  the  author's  per- 


fect sincerity,  impartiality,  and  thorough  mental 
grasp.  Dr.  Tuke  has  exhibited  the  requisite 
amount  of  scientific  address  on  all  occasions,  and 
the  more  intricate  the  phenomena  the  more  firmly 
has  he  adhered  to  a  physiological  and  rational 


method  of  interpretation.  Guided  by  an  enlight- 
ened deduction,  the  author  has  reclaimed  for 
science  a  most  interesting  domain  in  psychology, 
previously  abandoned  to  charlatans  and  empirics. 
This  book,  well  conceived  and  well  written,  must 
commend  itself  to  every  thoughtful  understand- 
ing.— New  Yo7-k  Medical  Journal,  September  6, 1884. 


CLOJJSTOW,  THOMAS  S.,  M,  !>.,  F.  R,  C.  jP.,  L.  R.  C.  S., 

Lecturer  on  Mental  Diseases  in  the  University  of  Edinburgh. 

Clinical  Lectures  on  Mental  Diseases.  With  an  Appendix,  containing  an 
Abstract  of  the  Statutes  of  the  United  States  and  of  the  Several  States  and  Territories  re- 
lating to  the  Custody  of  the  Insane.  By  Charles  F.  Folsom,  M.  D.,  Assistant  Professor 
of  Mental  Diseases,  Med.  Dep.  of  Harvard  Univ.  In  one  handsome  octavo  volume  of  541 
pages,  with  eight  lithographic  plates,  four  of  which  are  beautifully  colored.     Cloth,  $4. 

g^'Dr.  Folsom' s  Abstract  may  also  be  obtained  separately  in  one  octavo  volume  of 
108  pages.    Cloth,  $1.50,     

SAVAGE,  GEORGE  H,,  M.  !>,, 

Lecturer  on  Mental  Diseases  at  Ghty^s  Hospital,  London. 
Insanity  and  Allied  Neuroses,  Practical  and  Clinical.    In  one  12mo.  vol. 
of  551  pages,  with  18  illus.     Cloth,  $2.00.     See  Series  of  Olinical  Manuals,  page  31. 

As  a  handbook,  a  guide  to  the  practitioner  and  '  carefully  selected,  and  as  regards  treatment  sound 
student,  the  book  fulfils  an  admirable  purpose.  }  common  sense  is  everywhere  apparent.  Dr.  Sav- 
The  many  forms  of  insanity  are  described  with  ]  age  has  written  an  excellent  manual  for  the  prae- 
characteristic  clearness,  the  illustrative  cases  are  1  titioner  and  student. — Amer.Jour.ofIasan.,ApT.''85. 

PLAYFAIR,  W,  S.,  M,  D.,  F.  R.  C.  JP. 

The  Systematic  Treatment  of  Nerve  Prostration  and  Hysteria. 

one  handsome  small  12mo.  volume  of  97  pages.     Cloth,  $1.00. 


In 


BLANDFORD  ON  INSANITY  AND  ITS  TREAT- 
MENT. Lectures  on  the  Treatment,  Medical 
and  Legal,  of  Insane  Patients..  In  one  very  hand- 
some octavo  volume. 


JONES'  CLINICAL  OBSERVATIONS  ON  FUNC- 
TIONAL NERVOUS  DISORDERS.  Second 
American  Edition.  In  one  handsome  octavo 
volume  of  340  pages.    Cloth,  §3.25 


20 


Lea  Brothers  &  Co.'s  Publications — Surgery. 


MOBBBTS,  JOHN  B.,  M,  D,, 

Professor  of  Anatomy  and  Surgery  in  the  Philadelphia  Polyclinic.  Professor  of  the  Principles  and 
Practice  of  Surgery  in  the  Woman's  Medical  College  of  Pennsylvania.  Lecturer  in  Anatomy  in  the  Univer- 
sity of  Pennsylvania. 

The  Principles  and  Practice  of  Modern  Surgery.  For  the  use  of  Students 
and  Practitioners  of  Medicine  and  Surgery.  In  one  very  handsome  octavo  volume  of  780 
pages,  with  501  illustrations.     Cloth,  $4.50;  leather,  $5.50. 


This  work  is  a  very  comprehensive  manual  upon 
general  surgery,  and  will  doubtless  meet  with  a 
favorable  reception  by  the  profession.  It  has  a 
thoroughly  practical  character,  the  subjects  are 
treated  with  rare  judgment,  its  conclusions  are  in 
accord  with  those  of  the  leading  practitioners  of 
the  art,  and  its  literature  is  fully  up  to  all  the  ad- 


vanced doctrines  and  methods  of  practice  of  the 
present  day.  Its  general  arrangement  follows 
this  rule,  and  the  author  in  his  desire  to  be  con- 
cise and  practical  is  at  times  almost  dogmatic,  but 
this  is  entirely  excusable  considering  the  admira- 
ble manner  in  which  he  has  thus  increased  the 
usefulness  of  his  work. — Med.  Bee,  Jan.  17,  1891. 


ASSBTUMSTf  JOMW,  Jr.,  M,  !>., 

Barton  Prof,  of  Surgery  and  Clin.  Surgery  in  Univ.  of  Penna.,  Surgeon  to  the  Penna.  Sosp.,  Phila. 

The  Principles  and  Practice  of  Surgery.  Fifth  edition,  enlarged  and 
thoroughly  revised.  In  one  large  and  handsome  octavo  volume  of  1144  pages,  with 
642  illustrations.     Cloth,  $6 ;  leather,  $7. 


A  complete  and  most  excellent  work  on  surgery. 
It  is  only  necessary  to  examine  it  to  see  at  once 
its  excellence  and  real  merit  either  as  text-book 
for  the  student  or  a  guide  for  the  general  practi- 
tioner. It  fully  considers  in  detail  every  surgical 
injury  and  disease  to  which  the  body  is  liable,  and 


every  advance  in  surgery  worth  noting  is  to  be 
found  in  its  proper  place.  It  is  unquestionably  the 
best  and  most  complete  single  volume  on  surgery, 
in  the  English  language,  and  cannot  but  receive 
that  continued  appreciation  which  its  merits  justly 
demand. — Southern  Practitioner,  Feb.  1890. 


I>BUITT,  MOBBBT,  M,  B,  C,  S,,  etc. 

Manual  of  Modern  Surgery.  Twelfth  edition,  thoroughly  revised  by  Stan- 
liEY  Boyd,  M.  B.,  B.  S.,  F.  K..  C.  S.  In  one  8vo.  volume  of  965  pages,  with  373  illustra- 
tions.    Cloth,  $4 ;  leather,  $5. 


Druitt's  Surgery  has  been  an  exceedingly  popu- 
lar work  in  the  profession.  It  is  stated  that  50,000 
copies  have  been  sold  in  England,  while  in  the 
United  States,  ever  since  its  first  issue,  it  has  been 
used  as  a  text-book  to  a  very  large  extent.  Dur- 
ing the  late  war  in  this  country  It  was  so  highly 


appreciated  that  a  copy  was  issued  by  the  Govern- 
ment to  each  surgeon.  The  present  edition,  while 
it  has  the  same  features  peculiar  to  the  work  at 
first,  embodies  all  recent  discoveries  in  surgery, 
and  is  fully  up  to  the  times. — Cincinnati  Medical 
News,  September,  1887. 


GANT,  FBEJDBBICK  JAMES,  F.  JR.  C.  S., 

Senior  Surgeon  to  the  Royal  Free  Hospital,  London. 
The  Student's  Surgery.     A  Multum  in  Parvo.      In  one  square  octavo  volume 
of  848  pages,  with  159  engravings.     Cloth,  $3.75. 

GBOSS,  S.  D.,  M.  JO.,  LL.  J).,  J>.  C.  L.  Oxon.,  LL.  J), 
Cantab., 

Emeritus  Professor  of  Surgery  in  the  Jefferson  Medical  College  of  Philadelphia. 
A  System  of  Surgery :    Pathological,   Diagnostic,  Therapeutic  and  Operative. 
Sixth  edition,  thoroughly  revised  and  greatly  improved.      In  two  large  and  beautifully 
printed  imperial  octavo  volumes  containing  2382  pages,  illustrated  by  1623  engravings. 
Strongly  bound  in  leather,  raised  bands,  $15;  very  handsome  half  Eussia,  $16. 

BALL,  CMABLES  B.,  M.  Ch.,  Dub.,  F.  B.  C.  S.,  E., 

Surgeon  and  Teacher  at  Sir  P.  Dun's  Hospital,  Dublin. 

Diseases  of  the  Rectum  and  Anus.    In    one  12mo,  volume  of  417  pp., 
with  54  cuts,  and  4  colored  plates.     Cloth,  $2. 25.     See  Series  of  Clinical  Manuals  31. 

YOUNG,  JAMES  K.,  M.  D., 

Instructor  in  Orthopcedic  Surgery,  University  of  Pennsylvania,  Philadelphia. 

A  Manual  of  Orthopaedic  Surgery,  Suitable  for  Students  and  Prac- 
titioners.    In  one  12mo.  volume  of  about  400  pages,  fully  illustrated.    Preparing. 

BUTLIW,  SEJSTBT  T.,  F.  B.  C.  S., 

Assistant  Surgeon  to  St.  Bartholomew'' s  Hospital,  London. 

Diseases    of  the  Tongue.     In  one  12mo.  volume  of  456  pages,  with  S  colored 

plates  and  3  woodcuts.     Cloth,  $3.50.     See  Series  of  Clinical  Manuals,  page  31. 

GOULD,  A.  FEABCE,  M.  S.,  M.  B.,  F.  B.  C.  S„ 

Assistant  Surgeon  to  Middlesex  Hospital. 

Elements  of  Surgical  Diagnosis.    In  one  pocket-size  12mo.  volume  of  589 
pages.     Cloth,  $2.00.     See  Students'  Series  of  Manuals,  page  30. 

PIRRIE'S    PRINCIPLES    AND    PRACTICE  OP  one  Svo.  vol.  of  638  pages,  with  340  illustrations. 

SURGERY.    Edited   by  John  Neill,  M.  D.    In  Cloth,  83.75. 

one8vo.vol.  of784pp.with316illu8.    Cloth,  $3.75.  MILLER'S  PRACTICE  OF  SURGERY.     Fourth 

MILLER'S  PRINCIPLES  OF  SURGERY.   Fourth  and  revised  American  edition.    In  one  large  Svo. 

American  from  the  third  Edinburgh  edition.  In  vol.  of  682  pp.,  with  364  illustrations.    Cloth  ,$3.15. 


Lea  Brothers  &  Co.'s  Publications — Surgery. 


21 


ERICMSEN^,  JOHN  E,,  F,  B,  S.,  F,  B.  C,  S., 

Professor  of  Surgery  in  University  College,  London,  etc. 
The  Science  and  Art  of  Surgery ;  Being  a  Treatise  on  Surgical  Injuries,  Dis- 
eases and  Operations.     From  the  eighth  and  enlarged  English  edition.    In  two  large  8vo. 
volumes  of  2316  pages,  with  984  engravings  on  wood.     Cloth,  $9;  leather,  $11 

For  many  years  this  classic  work  has  been 
made  by  preference  of  teachers  the  principal 
text-book  on  surgery  for  medical  studenis,  while 
through  translations  into  the  leading  continental 


languages  it  may  be  said  to  guide  the  surgical 
teachings  of  the  civilized  world.    No  excellence 


of  the  former  edition  has  been  dropped  and  no 
discovery,  device  or  improvement  which  has 
marked  the  progress  of  surgery  during  the  last 
decade  has  been  omitted.  The  illustrations  are 
many  and  executed  in  the  highest  style  of  art. 
— Louisville  Medical  News,  Feb.  14, 1885. 


BBTJJ^T,  THOMAS,  F,  B,  C.  S,, 

Surgeon  and  Lecturer  on  Surgery  at  Ouy^s  Hospital,  London. 
The  Practice  of  Surgery.     Fourth  American  from  the  fourth  and  revised  Eng- 
lish edition.     In  one  large  and  very  handsome  imperial  octavo  volume  of  1040  pages,  with 
727  illustrations.     Cloth,  $6.50;  leather,  $7.50. 

The  fourth  edition  of  this  work  is  fully  abreast 
of  the  times.    The  author  handles  his  subjects 


with  that  degree  of  judgment  and  skill  which  is 
attained  by  years  of  patient  toil  and  varied  ex- 
perience. The  present  edition  is  a  thorough  re- 
vision of  those  which  preceded  it,  with  much  new 
matter  added.  His  diction  is  so  graceful  and 
logical,  and  his  explanations  are  so  lucid,  as  to 


place  the  work  among  the  highest  order  of  text- 
books for  the  medical  student.  Almost  every 
topic  in  surgery  is  presented  in  such  a  form  as  to 
enable  the  busy  practitioner  to  review  any  subject 
in  every-day  practice  in  a  short  time.  No  time  is 
lost  with  useless  theories  or  superfluous  verbiage. 
In  short,  the  work  is  eminently  clear,  logical  and 
practical.-C%ico£ro  Med.  Jour,  and  Examiner,  Apr.  '86. 


WMABTOW,  MEN  BY  B.,  M,  D., 

Demonstrator  of  Surgery  and  Lecturer  on  Surgical  Diseases  of  Children  in  the  Univ.  of  Penna. 

Minor  Surgery  and  Bandaging.    In  one  very  handsome  12mo.  volume  of 
498  pages,  with  403  engravings,  many  being  photographic.     Cloth,  $3.00. 

rious  established  operations  are  described  in  detail. 
Hence  this  work  becomes  a  most  valuable  compan- 
ion-book to  any  of  the  more  pretentious  treatises 
on  surgery,  where  simply  the  general  advice  is 
given  to  bandage,  amputate,  intubate,  operate,  etc. 
For  the  student  and  young  surgeon,  it  is  a  very 
valuable  instruction  book  from  which  to  learn  how 
to  do  what  may  be  advised,  in  general  terms,  to  be 
done.— Virginia  Medical  Monthly,  October  1891. 


This  new  work  must  take  a  first  rank  as  soon  as 
examined.  Bandaging  is  well  described  by  words, 
and  the  methods  are  illustrated  by  photographic 
drawings,  so  as  to  make  plain  each  step  taken  in 
the  application  of  bandages  of  various  kinds  to  dif- 
ferent parts  of  the  body  and  extremities— including 
the  head.  The  various  operations  are  likewise  de- 
scribed and  illustrated,  so  that  it  would  seem  easy 
for  the  tyro  to  do  the  gravest  amputation.  The  va- 


TBEVES,  FBEDEBICK,  F,  B.  C.  S,, 

Surgeon  and  Lecturer  on  Anatomy  at  the  London  Hospital. 

A  Manual  of  Operative  Surgery.     In  two  octavo  volumes  containing  1550 
pages,  with  422  original  engravings.    Complete  work,  cloth,  $9;  leather,  $11,    Just  ready. 


Mr.  Treves  in  this  admirable  manual  of  opera- 
tive surgery  has  in  each  instance  practically 
assumed  that  operation  has  been  decided  upon 
and  has  then  proceeded  to  give  the  various  opera- 
tive methods  which  may  be  employed,  with  a 
criticism  of  their  comparative  value  and  a  detailed 
and  careful  description  of  each  particular  stage 
of  their  performance.  Especial  attention  has  been 
paid  to  the  preparatory  treatment  of  the  patient 
and  to  the  details  of  the  after  treatment  of  the 
case,  and  this  is  one  of  the  most  distinctiv  among 
the  many  excellent  features  of  the  book.  We  have 
no  hesitation  In  declaring  it  the  best  work  on  the 
subject  in  the  English  language,  and  indeed,  in 
many  respects,  the  best  in  any  language.    It  can- 


not fail  to  be  of  the  greatest  use  both  to  practical 
surgeons  and  to  those  general  practitioners  who, 
owing  to  their  isolation  or  to  other  circumstances, 
are  forced  to  do  much  of  theirown  operative  work. 
We  feel  called  upon  to  recommend  the  book  so 
strongly  for  the  excellent  judgment  displayed  in 
the  arduous  task  of  selecting  from  among  the 
thousands  of  varying  procedures  those  most 
worthy  of  description ;  for  the  way  in  which  the 
still  more  diiScult  task  of  choosing  among  the 
best  of  those  has  been  accomplished;  and  for  the 
simf)le,  clear,  straightforward  manner  in  which 
the  information  thus  gathered  from  all  surgical 
literature  has  been  conveyed  to  the  reader. — 
Annals  of  Surgery,  ]\Iarch,  1892. 


By  the  Same  Author. 
The  Student's  Handbook  of  Surgical  Operations.    In  one  square  12mo. 
volume  of  508  pages,  with  94  illustrations.     Cloth,  $2.50.     Just  ready. 

A  Manual   of  Surgery.     In  Treatises  by  Various  Authors,  edited  by  Treves. 

In  three  12mo.  volumes,  containing  1866  pages,  with  213  engravings.     Price  per  set, 

cloth,  $6.     See  Students'  Series  of  Manuals,  page  30. 

the  salient  points  and  the  beginnings  of  new  sub- 
jects are  always  printed  in  extra-heavy  type,  so 
that  a  person  may  find  whatever  information  he 
may  be  in  need  of  at  a  moment's  glance. — Cin- 
cinnati Lancet-Clinic,  August  21, 1886. 


We  have  here  the  opinions  of  thirty-three 
authors,  in  an  encyclopsedic  form  for  easy  and 
ready  reference.  The  three  volumes  embrace 
every  variety  of  surgical  affections  likely  to  be 
met  with,  the  paragraphs  are  short  and  pithy,  and 


Intestinal  Obstruction.  In  one  pocket-size  12mo.  volume  of  522  pages,  with  60 
illustrations.  Limp  cloth,  blue  edges,  $2.00.     See  Series  of  Clinical  Manuals,  page  31. 

HOLMES,  TIMOTHY,  M,  A,, 

Surgeon  and  Lecturer  on  Surgery  at  St.  George's  Hospital,  London. 

A  System  of  Surgery ;  Theoretical  and  Practical.  IN  TREATISES  BY 
VARIOUS  AUTHORS.  American  edition,  thoroughly  revised  and  re-edited 
by  John  H.  Packard,  M.  D.,  Surgeon  to  the  Episcopal  Hospital,  Philadelphia,  assisted 
by  a  corps  of  thirty-three  of  the  most  eminent  American  surgeons.  In  three  large  octavo 
volumes  containing  3137  pages,  with  979  illustrations  on  wood  and  13  lithographic  plates. 
Price  per  set,  cloth,  $18.00 ;  leather,  $21.00.    Sold  only  by  subscription. 


22      Lea  Brothers  &  Co.'s  Publications — Surgery,  Frac,  Disloc. 


SMITH,  STEBSEW,  31.  J)., 

Professor  of  Clinical  Surgery  in  the  University  of  the  City  of  New  York. 

The  Principles  and  Practice  of  Operative  Surgery.  Second  and 
thoroughly  revised  edition.  In  one  very  handsome  octavo  volume  of  892  pages,  with 
1005  illustrations.     Cloth,  $4.00 ;  leather,  $5.00. 

operative  work.    It  can  be  truly  said  that  as  a  hand- 


This  excellent  and  very  valuable  book  is  one  of 
the  most  satisfactory  works  on  modern  operative 
surgery  yet  published.  Its  author  and  publisher 
have  spared  no  pains  to  make  it  as  far  as  possible 
an  ideal,  and  their  efforts  have  given  it  a  position 
prominent  among  the  recent  works  in  this  depart- 
ment of  surgery.  The  book  is  a  compendium  for 
the  modern  surgeon.  The  present  edition  is  much 
enlarged,  and  the  text  has  been  thoroughly  revised, 
so  as  to  give  the  most  improved  methods  in  asep- 
tic surgery,  and  the  latest  instruments  known  for 


book  for  the  student,  a  companion  for  the  surgeon, 
and  even  as  a  book  of  reference  for  the  physician 
not  especially  engaged  in  the  practice  of  surgery, 
this  volume  will  long  hold  a  most  conspicuous 
place,  and  seldom  will  its  readers,  no  matter  how 
unusual  the  subject,  consult  its  pages  in  vain.  Its 
compact  form,  excellent  print,  numerous  illustra- 
tions, and  especially  its  decidedly  practical  char- 
acter, all  combine  to  commend  it. — Boston  Medical 
and  Surgical  Journal,  May  10, 1888. 


SOLMES,  TIMOTHY,  M.  A., 

Surgeon  and  Lecturer  on  Surgery  at  St.  George's  Hospital,  London. 

A  Treatise  on  Surgery ;  Its  Principles  and  Practice.  From  the  fifth 
English  edition,  edited  by  T.  Pickering  Pick,  F.  E.  C.  S.  In  one  octavo  volume  of  997 
pages,  with  428  illustrations.     Cloth,  $6.00 ;  leather,  $7.00. 

To  the  younger  members  of  the  profession  and  I  for  the  general  practitioner,  teaching  those  things 
to  others  not  acquainted  with  the  book  and  its  j  that  are  necessary  to  be  known  for  the  successful 
merits,  we  take  pleasure  in  recommending  it  as  a  j  prosecution  of  the  physician's  career,  imparting 
surgery  complete,  thorough,  well- written,  fully  |  nothing  that  in  our  present  knowledge  is  eonsid- 
illustrated,  modern,  a  work  sufficiently  volumi-  |  ered  unsafe,  unscientific  or  inexpedient. — Pacific 
nous  for  the  surgeon  specialist,  adequately  concise  |  Medical  Journal,  July,  1889. 

MAMILTONf  FRANK  H.,  M.  D,,  LL,  J>., 

Surgeon  to  Bellevue  Hospital,  New  York. 

A  Practical  Treatise  on  Fractures  and  Dislocations.  New  (8th)  edi- 
tion, revised  and  edited  by  Stephen  Smith,  A.  M.,  M.  D.,  Professor  of  Clinical  Surgery 
in  the  University  of  the  City  of  New  York.  In  one  very  handsome  octavo  volume  of  832 
pages,  with  507  illustrations.     Cloth,  $5.50 ;  leather,  $6.50. 

The  work  of  Dr.  Hamilton  is  so  well  known  that  |  ject  of  such  magnitude  is  no  easy  one.  Dr.  Smith 
a  description  is  almost  unnecessary.  Its  numer-  has  aimed  to  make  the  present  volume  a  correct 
ous  editions  are  convincing  proof  if  any  is  needed,  '  exponent  of  our  knowledge  of  this  department 
of  its  value  and  popularity.    It  is  pre  eminently  ,  of  surgery.     In  examining  the  volume  one  is  at 

"  ■  '' once  struck  with  the  evidence  of  the  vast  amount 

of  labor  its  compilation  and  reconstruction  must 
have  necessitated.  The  more  one  reads  the  more 
one  is  impressed  with  its  completeness.  The  work 
has  been  accomplished,  and  has  been  done  clearly, 
concisely,  excellently  well. — Boston,  Medical  and 
Surgical  Journal,  May  2G,  1892. 


the  authority  on  fractures  and  dislocations,  and 
universally  quoted  as  such.  In  the  new  edition  it 
has  lost  none  of  its  former  worth.  The  additions 
it  has  received  by  its  recent  revision  make  it  a 
work  thoroughly  in  accordance  with  modern 
practice,  theoretically,  mechanica'ly,  aseptically. 
The  task  of  writing  a  complete  treatise  on  a  sut)- 


STIMSON,  LEWIS  A,,  B,  A,,  M.  J>., 

Professor  of  Clinical  Surgery  in  the  Medical  Faculty  of  Univ.  of  City  of  N.  Y., 
A  Manual  of  Operative  Surgery.     Second  edition.    In  one  very  handsome 
royal  12mo.  volume  of  503  pages,  with  342  illustrations.     Cloth,  $2.50. 


There  is  always  room  for  a  good  book,  so  that 
while  many  works  on  operative  surgery  must  be 
considered  superfluous,  that  of  Dr.  Stimson  has 
held  its  own.  The  author  knows  the  difficult  art 
•of  condensation.  Thus  the  manual  serves  as  a 
work  of  reference,  and  at  the  same  time  as  a 
handy  guide.  It  teaches  what  it  professes,  the 
steps  of  operations.  In  this  edition  Dr.  Stimson 
has  sought  to  indicate  the  changes  that  have  been 


effected  in  operative  methods  and  procedures  by 
the  antiseptic  system,  and  has  added  an  account 
of  many  new  operations  and  variations  in  the 
steps  of  older  operations.  We  do  not  desire  to 
extol  this  manual  above  many  excellent  standard 
British  publications  of  the  same  class,  still  we  be- 
lieve that  it  contains  much  that  is  worthy  of  imi- 
tation.— British  Medical  Journal,  Jan.  22, 1887. 


By  the  same  Author. 
A  Treatise  on  Fractures  and  Dislocations.    In  two  handsome  octavo  vol- 
umes.   Vol.  I.,  Fractures,  582  pages,  360  beautiful  illustrations.    Vol.  II.,  Disloca- 
tions, 540  pages,  with  163  illustrations.     Complete  work,  cloth,  $5.50 ;  leather,  $7.50. 
Either  volume  separately,  cloth,  $3.00 ;  leather,  $4.00. 

The  appearance  of  the  second  volume  marks  the  j  of  Dislocations  as  it  is  taught  and  practised  by  the 
completion  of  the  author's  original  plan  of  prepar-  most  eminent  surgeons  of  the  present  time.  Con- 
ing a  work  which  should  present  in  the  fullest  '  taining  the  results  of  such  extended  researches  it 
manner  all  that  is  known  on  the  cognate  subjects  j  must  for  a  long  time  be  regarded  as  an  authority 
of  Fractures  and  Dislocations.  The  volume  on  on  all  subjects  pertaining  to  dislocations.  Every 
Fractures  assumed  at  once  the  position  of  authority  |  practitioner  of  surgery  will  feel  it  incumbent  on 
on  the  subject,  and  its  companion  on  Dislocations  i  nim  to  have  it  for  constant  reference. — Cincinnati 
will  no  doubt  be  similarly  received.  The  closing  j  Medical  News,  May,  1888. 
volume  of  Dr.  Stimson's  work  exhibits  the  surgery  | 

I*ICK,  T.  PICKERING,  F,  B,  C.  S., 

Surgeon  to  and  Lecturer  on  Surgery  at  St.  George's  Hospital,  London. 

Fractures  and  Dislocations.     In  one  12mo.  volume  of  530  pages,  with  93 
illustrations.     Limp  cloth,  $2.00.     See  Series  of  Clinical  Mamicds,  page  31. 

MARSH,  HO  WARD,  F.  R.  C.  S., 

Senior  Assistant  Surgeon  to  and  Lecturer  on  Anatomy  at  St.  Bartholomew's  Hospital,  London. 
Diseases  of  the  Joints.     In  one  12mo.  volume  of  468  pages,  with  64  woodcuts 
and  a  colored  plate.     Clith,  $2.00.     See  Series  of  Clinical  Manuals,  page  31. 


Lea  Brothers  &  Co.'s  Publications — Otolog-y,  Oplitlialmology.    23 


NOBItIS,  WM,  F.,  M,  D.,  and  OLIVJEB,  CHAS,  A,,  M.  JO. 

Clin.  Prof,  of  Ophthalmology  in  Univ.  of  Pa. 
A  Text-Book  of  Ophthalmology.     In  one  octavo  volume  of  about  800  pages 
■with  illustrations.     In  press. 

BVItNETl,  CHARLES  M.,  A,  M.,  M,  !>., 

Professor  of  Otology  in  the  Philadelphia  Polyclinic ;  President  of  the  American  Otological  Society. 

The  Ear,  Its  Anatomy,  Physiology  and  Diseases.  A  Practical  Treatise 
for  the  use  of  Medical  Students  and  Practitioners.  Second  edition.  In  one  handsome 
octavo  volume  of  580  pages,  with  107  illustrations.   Cloth,  $4.00 ;  leather,  $5.00. 

We  note  with  pleasure  the  appearance  of  a  second  carried  out,  and  much  new  matter  added.  Dr. 
edition  of  this  valuable  work.  When  it  first  came 
out  it  was  accepted  by  the  profession  as  one  of 
the  standard  works  on  modern  aural  surgery  in 
the  English  language;  and  in  his  second  edition 
Dr.  Burnett  has  fully  maintained  his  reputation, 
for  the  book  is  replete  with  valuable  information 
and  suggestions.    The  revision  has  been  carefully 


Burnett's  work  must  be  regarded  as  a  very  valua- 
ble contribution  to  aural  surgery,  not  only  ork 
account  of  its  comprehensiveness,  but  because  it 
contains  the  results  of  the  careful  personal  observa- 
tion and  experience  of  this  eminent  aural  surgeon. 
— London  Lancet,  Feb.  21, 1885. 


BEBBY,  GEOBGE  A,,  M,  B.,  F,  B,  C,  S,,  Ed., 

Ophthalmic  Surgeon,  Edinburgh  Royal  Infirmary. 

Diseases  of  the  Eye.  A  Practical  Treatise  for  Students  of  Ophthalmology.  jS^ew 
(second)  edition.  In  one  octavo  volume  of  about  700  pages,  with  about  150  illustrations, 
62  of  which  are  beautifully  colored.     Preparing. 

A  notice  of  the  previous  edition  is  appended. 

This  newest  candidate  for  favor  among  ophthal- 
mological  students  is  designed  to  be  purely  clinical 
in  character  and  the  plan  is  well  adhered  to.    We 


have  been  forcibly  struck  by  the  rare  good  taste 
in  the  selection  of  what  is  essential  which  per- 
vades the  book.  The  author  seems  to  have  the 
uncommon  faculty  of  viewing  his  subject  as  a 
whole  and  seizing  the  salient  points  and  not  con- 
fusing his  reader — presumably  a  student  and  a 


novice— with  a  mass  of  details  with  no  key  to  their 
unravelling.  It  is  apparent  that  the  literature  ot 
each  subject  has  been  gone  over  in  a  very  thor- 
ough manner.  The  fact  that  he  was  writing  a 
clinical  treatise  for  beginners  and  not  an  encyclo- 
psedia  has  always  been  present  with  the  author. 
The  number  and  excellence  of  the  colored  illus- 
trations in  the  text  deserve  more  than  a  passing 
notice. — Archives  of  Ophthalmology,  Sept.  1889. 


NETTLESSir,  EDWABJD,  F,  B,  C,  S., 

Ophthalmic  Surgeon  at  St.  TTiomas'  Hospital,  London.    Surgeon  to  the  Royal  London  {Moorfieldb) 
Ophthalmic  Hospital. 

Diseases  of  the  Eye.  Fourth  American  from  the  fifth  English  edition,  thor- 
oughly revised.  With  a  Supplement  on  the  Detection  of  Color  Blindness,  by  WiL- 
I-IAM  Thomson,  M.  D.,  Professor  of  Ophthalmology  in  the  Jefferson  Medical  College. 
In  one  12mo.  volume  of  500  pages,  with  164  illustrations,  selections  from  Snellen's  test- 
types  and  formulae,  and  a  colored  plate.     Cloth,  $2.00. 


This  is  a  well-known  and  a  valuable  work.  It 
was  primarily  intended  for  the  use  of  students, 
and  supplies  their  needs  admirably,  but  it  is  as 
useful  for  the  practitioner,  or  indeed  more  so.  It 
does  not  presuppose  the  large  amount  of  recondite 
knowledge  to  be  present  which  seems  to  be  as- 
sumed in  some  of  our  larger  works,  is  not  tedious 
from  over-conciseness,  and  yet  covers  the  more 


important  parts  of  clinical  ophthalmology.  A 
supplement  is  made  to  the  present  edition  on  the 
practical  examination  of  railroad  employes  as  to 
color-blindness  and  acuteness  of  vision  and  hear- 
ing. This  is  well  written,  and  contains  good 
suggestions  for  those  who  may  be  called  on  to 
make  such  examinations. — IS'ew  York  Medical 
Journal,  December  13, 1890. 


JTTZEB,  HEJVBT  E.,  F,  B.  C.  S., 

Senior  Ass' t  Surgeon,  Royal  Westminster  Ophthalmic  Hosp. ;  late  Clinical  Ass't,  Moorfields,  London. 

A  Handbook  of  Ophthalmic  Science  and  Practice.  English  Edition. 
Handsome  Svo.  volume  of  442  pages,  with  125  woodcuts,  27  colored  plates,  selec- 
tions from  Test-types  of  Jaeger  and  Snellen,  and  Holmgren's  Color-blindness  Test. 
Cloth,  $5.50  ;  leather,  $6.50. 

It  presents  to  the  student  concise  descriptions  |  illustrations  are  nearly  all  original.  We  have  ex- 
and  typical  illustrations  of  all  important  eye  affec-  amined  this  entire  work  with  great  care,  and  it 
tions,  placed  in  juxtaposition,  so  as  to  be  grasped  represents  the  commonly  accepted  views  of  ad- 
at  a  glance.  Beyond  a  doubt  it  is  the  best  illus-  vaneed  ophthalmologists.  We  can  most  heartily 
trated  handbook  of  ophthalmic  science  which  has  commend  this  book  to  all  medical  students,  prac- 
ever  appeared.    Then,  what  is  still  better,  these    titioners  and  specialists. — Detroit  Lancet,  Jan.  '85. 


CABTEB,  B,  BBUDEJ^ELL,   &  FBOST,  W.  ADAMS, 

F.  B,  C.  S.,  F,  B.  C.  S., 

Ophthalmic  Surgeon  to  and  Lect.  on  Ophthal-  Ass't  Ophthalmic  Surgeon  and  Joint  Led. 

mic  Surgery  at  &t.  George's  Hospital,  London.  on  Oph.  Sur.,  St.  George's  Hosp.,  London. 

Ophthalmic  Surgery.  In  one  12mo.  volume  of  559  pages,  with  91  woodcuts, 
color-blindness  test,  test-types  and  dots  and  appendix  of  formulae.  Cloth,  $2.25.  See 
Series  of  Clinical  Manuals,  page  31. 


WELLS  ON  THE  EYE.    In  one  octavo  volume. 

LAURENCE  AND  MOON'S  HANDY  BOOK  OF 
OPHTHALMIC  SURGERY,  for  the  use  of  Prac- 
titioners. Second  edition.  In  one  octavo  vol- 
ume of  227  pages,  with  65  illus.    Cloth,  $2.75. 


LAWSON  ON  INJURIES  TO  THE  EYE,  ORBIT 
AND  EYELIDS :  Their  Immediate  and  Remote 
Effects.  In  one  octavo  volume  of  404  pages,  with 
92  illustrations.    Cloth,  $3.50. 


24     Lea  Brothers  &  Co.'s  Publications — Urin.  Dis.,  Dentistry,  etc. 


BOBBBTS,  SIB  WILLIAM,  M.  D., 

Lecturer  on  Medicine  in  the  Manchester  School  of  Medicine,  etc. 

A  Practical  Treatise  on  Urinary  and  Benal  Diseases,  including  TJri 
nary  Deposits.  Fourth  American  from  the  fourth  London  edition.  In  one  hand 
some  octavo  volume  of  609  pages,  with  81  illustrations.     Cloth,  $3.50 


It  may  be  said  to  be  the  best  book  in  print  on  the 
subject  of  which  it  treats.— T/je  American  Journal 
of  the  Medical  Sciences,  Jan.  1886. 

The  peculiar  value  and  finish  of  the  book  are  in 
a  measure  derived  from  its  resolute  maintenance 
of  a  clinical  and  practical  character.  It  is  an  un- 
rivalled exposition  of  everything  which  relates 
directly  or  indirectly  to  the  diagnosis,  prognosis 
and  treatment  of  urinary  diseases,  and  possesses 


a  completeness  not  found  elsewhere  in  our  lan- 

fuage  in  its  account  of  the  different  affections. — 
'/le  Manchester  Medical  Chronicle,  July,  1885. 
The  value  of  this  treatise  as  a  guide  book  to  the 
physician  in  daily  practice  can  hardly  be  over- 
estimated. That  it  is  fully  up  to  the  level  of  our 
present  knowledge  is  a  fact  reflecting  great  credit 
upon  Dr.  Roberts,  who  has  a  wide  reputation  as  a 
busy  practitioner. — Medical  Record,  July  31, 1886. 


By  the  Same  Author. 
Diet  and  Digestion.     In  one  12mo.  volume  of  270  pp.  Cloth,  $1.50. 


Just  ready. 


PUBDT,   CHABLES  W.,  M.  D.,  Chicago, 

Bright's  Disease  and  Allied  Affections  of  the  Kidneys 

volume  of  288  pages,  with  illustrations.     Cloth,  $2. 

The  object  of  this  work  is  to  "  furnish  a  system- 
atic, practical  and  concise  description  of  the 
pathology  and  treatment  of  the  chief  organic 
diseases  of  the  kidney  associated  with  albuminu- 
ria, which  shall  represent  the  most  recent  ad- 
vances in  our  knowledge  on  these  subjects  ;"  and 
this  definition  of  the  object  is  a  fair  description  of 
the  book.    The  work  is  a  useful  one,  giving  in  a 


In  one  octavo 


short  space  the  theories,  facts  and  treatments,  and 
going  more  fully  into  their  later  developments. 
On  treatment  the  writer  is  particularly  strong, 
steering  clear  of  generalities,  and  seldom  omit- 
ting, what  text-booKs  usually  do,  the  unimportant 
items  which  are  all  important  to  the  general  prac- 
titioner.— The  Manchester  Medical  Chronicle,  Oct. 
1886. 


MOBBIS,  HENBY,  M.  B,,  F,  B.  C.  S., 

Surgeon  to  and  Lecturer  on  Surgery  at  Middlesex  Hospital,  London. 

Surgical  Diseases  of  the  Kidney.     In  one  12mo.  volume  of  554  pages,  with  40 
woodcuts,  and  6  colored  plates.  Limp  cloth,  $2.25.   See  Series  of  Glinical  Manuals,  page  31. 


In  this  manual  we  have  a  distinct  addition  to 
surgical  literature,  which  gives  information  not 
elsewhere  to  be  met  with  in  a  single  work.  Such 
a  book  was  distinctly  required,  and  Mr.  Morris 
has  very  diligently  and  ably  performed  the  task 


he  took  in  hand.  It  is  a  full  and  trustworthy 
book  of  reference,  both  for  students  and  prac- 
titioners in  search  of  guidance.  The  illustrations 
in  the  text  and  the  chromo-lithographs  are  beau- 
tifully executed. —  The  London  Lancet,  Feb.  26, 1886. 


See  Series 


LUCAS,  CLEMENT,  M,  B.,  B,  S.,  E,  B.  C.  S,, 

Senior  Assistant  Surgeon  to  Ghiy's  Hospital,  London. 
Diseases   of  the   Urethra.      In  one   12mo.  volume.     Preparing, 
of  Glinical  Manuals,  page  4. 

TSOMPSON,  SIB  MENBY, 

Surgeon  and  Professor  of  Clinical  Surgery  to  University  College  Hospital,  London. 

Lectures  on  Diseases  of  the  Urinary  Organs.  Second  American  from  the 
third  English  edition.    In  one  8vo.  volume  of  203  pp.,  with  25  illustrations.    Cloth,  $2.25. 

By  the  Same  Author. 
On  the  Pathology  and  Treatment  of  Stricture  of  the  Urethra  and 
Urinary  Fistulae.     From  the  third  English  edition.    In  one  octavo  volume  of  359 
pages,  with  47  cuts  and  3  plates.    Cloth,  $3.50. 

TSE  A3IEBICAN  SYSTEM  OF  DENTISTBY, 

In  Treatises  by  Various  Authors.  Edited  by  Wilbur  F.  Litch,  M.  D., 
D.  D.  S.,  Professor  of  Prosthetic  Dentistry,  Materia  Medica  and  Therapeutics  in  the 
Pennsylvania  College  of  Dental  Surgery.  In  three  very  handsome  octavo  volumes  con- 
taining 3160  pages,  with  1863  illustrations  and  9  full-page  plates.  Per  volume,  cloth,  $6 ; 
leather,  $7 ;  half  Morocco,  gilt  top,  $8.  The  complete  work  is  now  ready.  For  sale  by 
subscription  only. 

doubtless  it  is),  to  mark  an  epoch  in  the  history  of 
dentistry.  Dentists  will  be  satisfied  with  it  and 
proud  of  it — they  must.  It  is  sure  to  be  precisely 
what  the  student  needs  to  put  him  and  keep  him 
in  the  right  track,  while  the  profession  at  large 
will  receive  incalculable  benefit  from  it. — Odonto- 
graphic  Journal,  Jan.  1887. 


As  an  encyclopaedia  of  Dentistry  it  has  no  su- 
perior. It  should  form  a  part  of  every  dentist's 
library,  as  the  information  it  contains  is  of  the 
greatest  value  to  all  engaged  in  the  practice  of 
dentistry. — American  Jour.  Dent.  Sci.,  Sept.  1886. 

A  grand  system,  big  enough  and  good  enough 
and  handsome  enough  for  a  monument  (which 


COLEMAN,  A.,  L,  B,  C\  F.,  F,  B.  O.  S.,  Exam,  L,  2>.  S,, 

Senior  Dent.  Surg,  and  Lect.  on  Dent.  Surg,  at  St.  Bartholomew's  Hosp.  and  the  Dent.  Hosp.,  London. 

A  Manual  of  Dental  Surgery  and  Pathology.  Thoroughly  revised  and 
adapted  to  the  use  of  American  Students,  by  Thomas  C.  Stellwagen,  M.  A.,  M.  D., 
D.  D.  S.,  Prof,  of  Physiology  in  the  Philadelphia  Dental  College.  In  one  handsome  octavo 
volume  of  412  pages,  with  331  illustrations.     Cloth,  $3.25. 


It  should  be  in  the  possession  of  every  practi- 
tioner in  this  country.  The  part  devoted  to  first 
and  second  dentition  and  irregularities  in  the  per- 
manent teeth  is  fully  worth  the  price.  In  fact, 
price  should  not  be  considered  in  purchasing  such 


a  work.  If  the  money  put  into  some  of  our  so- 
called  standard  text-books  could  be  converted  into 
such  publications  as  this,  much  good  would  result. 
— Southern  Dental  Journal,  May,  1882. 


BASHAM    on    renal  DISEASES:   A  Clinical 
Guide  to  their  Diagnosis  and  Treatment.    In 


one  12mo.  vol.  of  304  pages,  with  21  illustrations. 
Cloth,  $2.00. 


Lea  Brothers  &  Co.'s  Publications — Dis.  of  Men,  Venereal,  Skin.   25 


GROSS,  SAMUEL  W.,  A,  M.,  M.  JD.,  LL.  D., 

Professor  of  the  Principles  of  Surgery  and  of  Clinical  Surgery  in  the  Jefferson  Medical  College  of  Phila. 

A  Practical  Treatise  on  Impotence,  Sterility,  and  Allied  Disorders 
of  the  Male  Sexual  Organs.  Fourth  edition,  thorouglily  revised  by  F.  R. 
Sturgis,  M.  D.,  Prof,  of  Diseases  of  the  Genito- Urinary  Organs  and  of  Venereal  Diseases, 
N.  Y.  Post  Grad.  Med.  School.  In  one  very  handsome  octavo  volume  of  165  pages, 
with  18  illustrations.     Cloth,  $1.50. 


Three  editions  of  Professor  Gross'  valuable  book 
have  been  exhausted,  and  still  the  demand  is 
unsupplied.  Dr.  Slurgis  has  revised  and  added 
to  the  previous  editions,  and  the  new  one  appears 
more  complete  and  more  valuable  than  before. 
Four  important  and  generally  misunderstood  sub- 
jects are  treated— impotence,  sterility,  ."permator- 


rhoea,  and  prostatorrhoea.  The  book  is  a  practical 
one  and  in  addition  to  the  scientific  and  very  in- 
tere.sting  discussions  on  etiology,  t-ymptoms,  etc., 
there  are  lines  of  treatment  laid  down  that  any 
practitioner  can  follow  and  which  have  met  v^ith 
success  in  the  hands  of  author  and  editor. — Medi^ 
cal  Record,  Feb.  25, 1891. 


TAYLOR,  R.  W,,  A.  M.,  M.  !>., 

Clinical  Profeswr  of  Oenito-Urinary  Diseases  in  the  College  of  Physicians  and  Surgeons,  New  York, 
Prof,  of  Venereal  and  Skin  Diseases  in  the  Vniversity  of  Vermont. 

The  Pathology  and  Treatment  of  Venereal  Diseases.  Including  the 
results  of  recent  investigations  upon  the  subject.  Being  the  sixth  edition  of  Bumstead 
and  Taylor.  Entirely  rewritten  by  Dr.  Taylor.  Large  8vo.  volume,  about  900  pages, 
with  about  150  engravings,  as  well  as  numerous  chromo-lithographs.     In  active  preparation, 

A  notice  of  the  previous  edition  is  appended. 


It  is  a  splendid  record  of  honest  labor,  wide 
research,  just  comparison,  careful  scrutiny  and 
original  experience,  which  will  always  be  held  as 
a  high  credit  to  American  medical  literature.  This 
is  not  only  the  best  work  in  the  English  language 


upon  the  subjects  of  which  it  treats,  but  also  one 
wnich  has  no  equal  in  other  tongues  for  its  clear, 
comprehensive  and  practical  handling  of  its 
themes.— ^m.  Jour,  of  the  Med.  Sciences,  Jan.  1884. 


CULVJER,  E,  M,,  M.D.,  and  MAYDEW,  J,  R.,  31,  L>. 

Pathologist  and  Assistant  Atttnding  Surgeon,  Chief  of  Clinic   Venereal  Department,   Van- 

Manhattan  Hospital,  N.  ¥.  derbitt  Clinic,  Col.  ofPhys.  and  Surgs  ,  N.  Y. 

A  Manual  of  Venereal  Diseases.    In  one  12mo.  volume  of  289  pages,  with 
33  illustrations.     Cloth,  $1.75. 


This  book  is  a  practical  treatise,  presenting  in  a 
condensed  form  the  essential  features  of  our  pres- 
ent knowledge  of  the  three  venereal  diseases, 
syphilis,  chancroid  and  gonorrhea.  We  have  ex- 
amined this  work  carefully  and  have  come  to  the 
conclusion  that  it  is  the  most  concise,  direct  and 
able  treatise  that  has  appeared  on  the  subject  of 
venereal  diseases  for  the  general  practitioner  to 


adopt  as  a  guide.  The  general  practitioner  needs 
a  few  simple,  concise  and  clearly  presented  laws, 
in  the  execution  of  which  he  cannot  fail  either  to 
cure  or  prevent  the  ravages  of  the  maladies  in 
question  and  the  direful  results  which  their  pro- 
pagation entails.— £t(^ato  Medical  and  Surgical 
Journal,  May,  1892. 


iJOR-S^ILf    r.  f    Prof,  to  the  Faculty  of  Medicine  of  Paris,  and  Physician  to  the  Lourcine  Hosp. 

Syphilis,  its  Morbid  Anatomy,  Diagnosis  and  Treatment.  Specially 
revised  by  the  Author,  and  translated  with  notes  and  additions  by  J.  Henry  C.  Simes, 
M.  D.,  Demonstrator  of  Pathological  Histology  in  the  Univ.  of  Pa.,  and  J.  William 
White,  M.  D.,  Lecturer  on  Venereal  Diseases,  Univ.  of  Pa.  In  one  handsome  octavo 
volume  of  461  pages,  with  84  very  beautiful  illustrations.  Cloth,  $3.75. 
The  anatomy,  the  histology,  the  pathology  and    perusal  without  the  feeling  that  his  grasp  of  the 

wide  and  important  subject  on  which  it  treats  is 
a  stronger  and  surer  one. — The  London  Practi- 
tioner, Jan.  1882. 


the  clinical  features  of  syphilis  are  represented  in 
this  work  in  their  best,  most  practical  and  most 
instructive  form,  and  no  one  will  rise  from  its 


HTITCSINSOJS^,  JOJ^ATSAIf,  F.  R,  S.,  F.  R.  C.  S., 

Consulting  Surgeon  to  the  London  Hospital. 
Syphilis.     In  one  12mo.  volume  of  542  pages,  with  8  chromo-lithographs.     Cloth, 
$2.25.     See  Series  of  Clinical  Manuals,  page  31. 


Those  who  have  seen  most  of  the  disease  and 
those  who  have  felt  the  real  difficulties  of  diagno- 
sis and  treatment  will  most  highly  appreciate  the 
facts  and  suggestions  which  abound  in  these 
pages.  It  is  a  worthy  and  valuable  record,  not 
only  of  Mr.  Hutchinson's  very  large  experience 


and  power  of  observation,  but  of  his  patience  and 
assiduity  in  taking  notes  of  his  cases  and  keep- 
ing them  in  a  form  available  for  such  excellent 
use  as  he  has  put  them  to  in  this  volume. — London 
Medical  Record,  Nov.  12, 1887. 


GROSS,  S.  J>.,  M,  !>.,  LL,  jD.,  L>.  C,  L„  etc, 

A  Practical  Treatise  on  the  Diseases,  Injuries  and  Malformations 
of  the  Urinary  Bladder,  the  Prostate  Gland  and  the  Urethra.  Third 
edition,  thoroughly  revised  by  Samuel  W.  Gross,  M.  D.  In  one  octavo  volume  of  574 
pages,  with  170  illustrations.     Cloth,  $4.50. 

JPYE-SMITH,  JP.  H.,  M,  2>„  F,  R,  S,, 

Physician  to  Guy's  Hospital,  London. 

A  Handbook  of  Diseases  of  the  Skin.  By  Philip  H.  Pye-Smith,  M.  D  , 
F.  E.  S  ,  Physician  to  Guy's  Hospital,  London.  In  one  octavo  volume  of  450  pages, 
with  illustrations.    Preparing. 


HILLIER'S  HANDBOOK  OF  SKIN  DISEASES; 
for  Students  and  Practitioners.  Second  Ameri- 
can edition.  In  one  12mo.  volume  of  353  pages, 
with  plates.    Cloth,  $2.25. 

HILL  ON  SVPHILIS  AND  LOCAL  CONTAGIOUS 
DISORDERS.  In  one  8vo  vol.  of  479  p.  Cloth,  $3.25. 

LEE'S  LECTURES  ON  SYPHILIS  AND  SOME 


WILSON'S  STUDENT'S  BOOK  OF  CUTANEOUS 
MEDICINE  AND  DISEASES   OF  THE  SKIN. 
In  one  handsome  small  octavo  volume  of  535 
pages.    <  loth,  $3.50. 
FORMS    OF     LOCAL     DISEASE     AFFECTING 
PRINCIPALLY    THE    ORGANS    OF    GENERA- 
TION.   In  one  8to.  vol.  of  246  pages.    Cloth,  $2.25. 


26 


Lea  Brothers  &  Co.'s  Publications — Venereal,  Skin. 


TAYLOR,  BOBJSBT  W„  A.M.,  M.JD., 

Clinical  Professor  of  Oeni'o  Urinarv  Diseases  in  the  College  of  Physicians  and  Surgeons,  New  York; 
Surgeon  to  the  Department  of  Venereal  and  Shin  Diseases  of  the  New  York  Hospital;  Presi- 
dent of  the  American  Dermatological  Association. 

A  Clinical  Atlas  of  Venereal  and  Skin  Diseases:  Including  Diagnosis, 
Prognosis  and  Treatment.  In  eight  large  folio  parts,  measuring  14  x  18  inches,  and 
comprising  58  beautifully  colored  plates  with  213  figures,  and  431  pages  of  text  with  85 
engravings.  Complete  work  just  ready.  Price  per  part,  $2.50.  Bound  in  one  volume, 
half  Russia,  $27  ;  half  Turkey  Morocco,  $28.  For  sale  by  subscription  only.  Specimen 
plates  sent  on  receipt  of  10  cents.     A  full  prospectus  sent  to  any  address  on  application. 


It  would  be  hard  to  use  words  which  would  per- 
spicuously enough  convey  to  the  reader  the  great 
value  of  this  Clinical  Atlas.  This  Atlas  is  more 
conniplete  even  than  an  ordinary  course  of  clinical 
lectures,  for  in  no  one  college  or  hospital  course 
is  it  at  all  probable  that  all  of  the  diseases  herein 
represented  would  be  seen.  It  is  also  more  ser- 
viceable to  the  majority  of  students  than  attend- 
ance upon  clinical  lectures,  for  most  of  the 
students  who  sit  on  remote  seats  in  the  lecture 
hall  cannot  see  the  subject  as  well  as  the  office 


studentcan  examine  these  true  to-life  chromo-lith- 
ographs.  Comparing  the  text  to  a  lecturer,  it  la 
more  satisfactory  in  exactness  and  fulness  than 
he  would  be  likely  to  be  in  lecturing  over  a  single 
case.  Indeed,  this  Atlas  is  invaluable  to  the  gen- 
eral practitioner,  for  it  enables  the  eye  of  the 
physician  to  make  diagnosis  of  a  given  case  of 
skin  manifestation  by  comparing  the  case  with 
the  picture  in  the  ^</as,  where  will  be  found  also 
the  text  of  diagnosis,  pathology,  and  full  sections 
on  treatment.—  Virginia  Medical  Monthly,  Dec.  1889. 


JACKSON,  GEORGE  THOMAS,  M.n., 

Professor  of  Der7natology,  Woman\  Medical  College  of  the  New  York  Infirmary. 

The  Keady-Referenee  Handbook  of  Diseases  of  the  Skin.  In  one 
■  12mo.  volume  of  544  pages,  with  50  illustrations.     Cloth,  $2.75.     Just  ready. 

This  volume  is  devoted  to  the  art  of  dermatology,  to  the  practice  of  this  department  of 
medicine  in  its  latest  development.  No  attempt  has  been  made  to  discuss  debatable  ques- 
tions, and  pathology  and  etiology  do  not  receive  as  full  consideration  as  symptomatology, 
diagnosis  and  treatment.  The  alphabetical  arrangement  of  the  different  diseases  has  been 
adopted  as  conducive  to  the  greatest  possible  convenience  in  use.  The  pages  are  illus- 
trated with  a  large  number  of  engravings,  many  being  photographic  and  vivid  reproduc- 
tions of  actual  cases.  A  handsome  lithographic  frontispiece  adds  to  the  beauty  and 
usefulness  of  a  volume  for  which  a  wide  recognition  is  assured. 


MARDAWAY,  W.  A.,  M.  D-, 

Professor  of  Skin  Diseases  in  the  Missouri  Medical  College,  St.  Louis. 
Manual  of  Skin  Diseases.     With  Special  Reference  to  Diagnosis  and  Treat- 
ment.    For  the  use  of  Students  and  General  Practitioners.     12mo.,  440  pp.    Cloth,  $3. 


Dr.  Hardaway's  large  experience  as  a  teacher 
and  writer  has  admirably  fitted  him  for  the  diffi- 
cult task  of  preparing  a  book  which,  while  suffi- 
ciently elementary  for  the  student  is  yet  suffi- 
ciently thorough  and  comprehensive  to  serve  as  a 
book  of  reference  for  the  general  practitioner.    It 


embraces  all  essential  points  connected  with  the 
diagnosis  and  treatment  of  diseases  of  the  skin, 
and  we  have  no  hesitation  in  commending  it  as 
the  best  manual  that  has  yet  appeared  in  this 
department  of  Medicine.— Jburnai  of  Cutaneous 
and  Genito-  Urinary  Diseases. 


SYnE,  J.  NEVINS,  A.  M.,  M.  D., 

Professor  of  Dermatology  and  Venereal  Diseases  in  Rush  Medical  College,  Chicago. 

A  Practical  Treatise  on  Diseases  of  the  Skin.  For  the  use  of  Students  and 
Practitioners.  Second  edition.  In  one  handsome  octavo  volume  of  676  pages,  with 
2  colored  plates  and  85  beautiful  and  elaborate  illustrations.  Cloth,  $4.50;  leather,  $5.50. 

His  treatise  is  like  his  clinical  instruction, 
admirably  arranged,  attractive  in  diction,  and 
strikingly  practical  throughout.  No  clearer  de- 
scription of  the  various  primary  and  consecutive 


lesions  of  the  skin  is  to  be  met  with  anywhere. 
Dr.  Hyde  has  shown  himself  a  comprehensive 
reader  of  the  latest  literature,  and  has  incorpo- 
rated into  his  book  all  the  best  of  that  which 


the  past  years  have  brought  forth.  The  prescrip- 
tions and  formulse  are  given  in  both  common  and 
metric  systems.  Text  and  illustrations  are  good, 
and  colored  plates  of  rare  cases  lend  additional 
attractions.  Altogether  it  is  a  work  exactly  fitted 
to  the  needs  of  a  general  practitioner,  and  no  one 
will  make  a  mistake  in  purchasing  it. — Medical 
Press  of  Western  New  York,  June,  1888. 


JAMIESOW,  W.  ALLAN,  M.  !>., 

Lecturer  on  Diseases  of  the  Skin,  School  of  Medicine,  Edinburgh. 
Diseases  of  the   Skin.     A   Manual  for  Students  and  Practitioners;       Third 
edition,  revised  and  enlarged.      In  one  octavo  volume  of  656  pages,  with  woodcut  and 
nine  double-page  chromo  lithographic  illustrations.     Cloth,  $6.00.     Just  ready. 


In  common  with  other  special  departments  in 
medicine,  that  of  dermatology  is  rapidly  approach- 
ing an  exactness  in  diagnosis  and  treatment  which 
fairly  places  it  at  the  front  among  the  specialties. 


This  volume  by  Dr.  Jamieson  is  a  valuable  one  for 
practitioners  and  students,  as  it  is  both  full  and 
concise  witliout  being  unwieldy  and  voluminous. — 
The  Jour,  of  the  Amer.  Med.  Asso.,  March  19, 1892. 


FOX,  T.,  M.  D.,  F.R.  C.  JP.,  and  FOX,  T.  C,  B.A.,  M.R.  C.S., 

Physician  to  the  Department  for  Skin  Diseases,  Physician  for  Diseases  of  the  Skin  to  the 

Universiti/  College  Hospital,  London.  Westminster  Hospital,  London. 

An  Epitome  of  Skin  Diseases.     With  Formulae.     For  Students  and  Prac- 
titioners.    Third  edition,  revised  and  enlarged.    In  one  12mo.  vol.  of  238.pp.   Cloth,  $1.25. 

for  all  one  has  to  know  is  the  name  of  the  disease, 


We  cordially  recommend  Fox's  Epitome  to  those 
whose  time  is  limited  and  who  wish  a  handy 
manual  to  lie  upon  the  table  for  instant  reference. 
Its  alphabetical  arrangement  is  suited  to  this  use, 


and  here  are  its  description  and  the  appropriate 
treatment  at  hand,  ready  for  instant  application. 


Lea  Brothers  &  Co.'s  Publications — Dis.  of  Women. 


27 


The  American  Systems  of  Gynecology  and  Obstetrics. 

Systems  of  Gynecology  and  Obstetrics,  in  Treatises  by  American 
Authors.  Gynecology  edited  by  Matthew  D.  Mann,  A.M.,  M.  D.,  Professor  of  Obstetrics 
and  Gynecology  in  the  Medical  Department  of  the  University  of  Buffalo;  and  Obstet- 
rics edited  by  Bakton  Cooke  Hirst,  M.  D.,  Associate  Professor  of  Obstetrics  in  the 
University  of  Pennsylvania,  Philadelphia.  In  four  very  handsome  octavo  volumes,  con- 
taining 3612  pages,  1092  engravings  and  8  plates.  Complete  work  now  ready.  Per  vol- 
ume: Cloth,  $5.00;  leather,  §6.00;  half  Russia,  $7.00.  For  sale  by  subscription  only. 
Address  the  Publishers.     Full  descriptive  circular  free  on  application. 

LIST  OF   CONTRIBUTORS. 


WILLIAM  H.  BAKER,  M.  D., 
ROBERT  BATTEY,  M.  D., 
SAMUEL  C.  BUSEY,  M.  D., 
JAMES  C.  CABIERON,  M.  D., 
HENRY  C.  COE,  A.  M..  M.  D., 
EDWARD  P.  DAVIS,  M.  D., 
G.  E.  De  SCHWEINITZ,  M.  D., 
E.  C.  DUDLEY,  A.  B.,  M.  D., 
B.  McE.  EMMET,  M.  D., 
GEORGE  J.  ENGELMANN,  M.  D., 
HENRY  J.  GARRIGUES,  A.  M.,  M.  D., 
WILLIAM  GOODELL,  A.  M.,  M.  D., 
EGBERT  H.  GRANDIN,  A.  M.,  M.  D., 
SAMUEL  W.  GROSS,  M.  D., 
ROBERT  P.  HARRIS,  M.  D., 
GEORGE  T.  HARRISON,  M;  D., 
BARTON  C.  HIRST,  M.  D. 
STEPHEN  Y.  HOWELL,  M.  D., 
A.  REEVES  JACKSON,  A.  M.,  M.  D., 
W.  W.  JAGGARD,  M.  D., 
EDWARD  W.  JENKS,  M.  D.,  LL.  D., 
These  volumes  are  the  contributions  of  the  most 
eminent  gentlemen  of  this  country  in  these  de- 
partments of  the  profession.   Each  contributor  pre- 
sents a  monograph  upon  his  special  topic,  so  that 
everything  in  the  way  of  history,  theory,  methods, 
and  results  is  presented  to  our  fullest  need.    As  a 
work  of  general  reference,  it  will  be  found  remarka- 
bly full    and    instructive    in    every    direction    of 
inquiry. —  The  Obstetric  Crazei^;*,  September,  1889. 

One  is  at  a  loss  to  know  what  to  say  of  this  vol- 
ume, for  fear  that  just  and  merited  praise  may  be 
mistaken  for  flattery.  The  papers  of  Drs.  Engel- 
mann,  Martin,  Hirst,  Jaggard  and  Reeve  are  incom- 
parably beyond  anything  that  can  be  found  in 
obstetrical  works. — Journal  of  the  American  Medical 
Association,  Sept.  8, 1888. 

In  our  notice  of  the  "System  of  Practical  Medi- 
cine by  American  Authors,"  we  made  the  follow- 
ing statement: — "It  is  a  work  of  which  the  pro- 
fession in  this  country  can  feel  proud.  Written 
exclusively  by  American  physicians  who  are  ac- 
quainted with  all  the  varieties  of  climate  in  the 


HOWARD  A.  KELLY,  M.  D., 
CHARLES  CARROLL  LEE,  M.  D., 
WILLIAM  T.  LUSK,  M.  D.,  LL.  D., 
J.  HENDRIE  LLOYD,  M.  D., 
MATTHEW  D.  MANN,  A.  M.,  M.  D., 
H.   NEWELL   MARTIN,  F.  R.  S.,   M.  D., 
RICHARD  B.  MAURY,  M.  D., 
CD.  PALMER,  M.  D., 
ROSWELL  PARK,  M.  D., 
THEOPHILUS  PARVIN,  M.  D.,  LL.  D., 
R.  A.  F.  PENROSE,  M.  D.,  LL.  D., 
THADDEUS  A.  REAMY,  A.  M.,  M.  D., 
J.  C.  REEVE,  M.  D., 
A.  D.  ROCKWELL,  A.  M.,  M.  D., 
ALEXANDER  J.  C.  SKENE,  M.  D., 
J.  LEWIS  SMITH,  M.  D., 
STEPHEN  SMITH,  M.  D., 
R.  STANSBURY  SUTTON,  M.  D..  LL.  D., 
T.  GAILLARD  THOMAS,  M.  D.,  LL.  D., 
ELY  VAN  DE  WARKER,  M.  D., 
W.  GILL  WYLIE,  M.  D. 
United  States,  the  character  of  the  soil,  the  man- 
ners and  customs  of  the  people,  etc.,  it  is  pecul- 
iarly adapted  to  the  wants  of  American  practition- 
ers of  medicine,  and  it  seems  to  us  that  every  one 
of  them  would  desire  to  have  it."     Every  word 
thus  expressed  in  regard  to  the  "American  Sys- 
tem of  Practical  Medicine"  is  applicable  to  the 
"System  of    Gynecology  by  American  Authors." 
It,  like  the  other,  has   been  written  exclusively 
by  American  physicians  who  are  acquainted  with 
all  the  characteristics  of  American  people,  who  are 
well  informed  in  regard  to  the  peculiarities  of 
American  women,  their  manners,  customs,  modes 
of  living,  etc.     As  every  practising  physician  is 
called  upon  to  treat  diseases  of  females,  and  as 
they  constitute  a  class  to  which  the  famil5'  phy- 
sician must  give  attention,  and  cannot  pass  over 
to  a  specialist,  we  do  not  know  of  a  work  in  any 
department  of  medicine  that  we  should  so  strongly 
recommend  medical  men  generally  purchasing. — 
Cincinnati  Med.  News,  July,  1887. 


BMMET,  TMOMAS  ADDIS,  M.  D.,  LL.  2>., 

Surgeon  to  the  Woman^s  Hospital,  New  York,  etc. 

The  Principles  and  Practice  of  Gynaecology ;  For  the  use  of  Students  and 
Practitioners  of  Medicine.  Third  edition,  thoroughly  revised.  In  one  large  and  very 
handsome  octavo  volume  of  880  pages,  with  150  illustrations.     Cloth,  $5 ;    leather,  $6. 

We  are  in  doubt  whether  to  congratulate  the 
author  more  than  the  profession  upon  the  appear- 
ance of  the  third  edition  of  this  well-known  work. 
Embodying,  as  it  does,  the  life-long  experience  of 


one  who  has  conspicuously  distinguished  himself 
as  a  bold  and  successful  operator,  and  who  has 
devoted  so  much  attention  to  the  specialty,  we 
feel  sure  the  profession  will  not  fail  to  appreciate 


the  privilege  thus  offered  them  of  perusing  the 
views  and  practice  of  the  author.  His  earnestness 
of  purpose  and  conscientiousness  are  manifest. 
He  gives  not  only  his  individual  experience  but 
endeavors  to  represent  the  actual  state  of  gynse- 
cological  science  and  art. — British  Medical  Jour- 
nal, May  16, 1885. 


UDIS,  ARTHTfn  TF.,  M,  J>.,  Lond.,  F,R.  C.JP.,  M,B.  C.S,, 

Assist.  Obstetric  Physician  to  Middlesex  Hospital,  late  Physician  to  British  Lying-in  Hospital. 
The  Diseases  of  Women.     Including  their  Pathology,  Causation,  Symptoms, 
Diagnosis  and  Treatment.     A  Manual  for  Students  and  Practitioners.     In  one  handsome 
octavo  volume  of  576  pages,  with  148  illustrations.     Cloth,  $3.00 ;  leather,  $4.00. 

The  special  qualities  which  are  conspicuous 
are  thoroughness  in  covering  the  whole  ground, 
clearness  of  description  and  conciseness  of  state- 


ment. Another  marked  feature  of  the  book  is 
the  attention  paid  to  the  details  of  many  minor 
surgical  operations  and  procedures,  as,  for 
instance,  the  use  of  tents,  application  of  leeches, 
and    use    of    hot   water    injections.      These    are 


among  the  more  common  methods  of  treat- 
ment, and  yet  very  little  is  said  about  them  in 
many  of  the  text-books.  The  book  is  one  to  be 
warmly  recommended  especially  to  students  and 
general  practitioners,  who  need  a  concise  but  com- 
plete resume  of  the  whole  subject.  Specialists,  too, 
will  find  many  useful  hints  in  its  pages. — Boston 
Med.  and  Surg.  Journ.,  March  2,  1882. 


HODGE  ON  DISEASES  PECULIAR  TO  WOMEN. 
Incl  uding  Displacements  of  the  Uterus.  Second 
edition,  revised  and  enlarged.  In  one  beauti- 
fully printed  octavo  volume  of  519  pages,  with 
original  illustrations.    Cloth,  $4.50. 


WEST'S  LECTURES  ON  THE  DISEASES  OF 
WOMEN  Third  American  from  the  third  Lon- 
don edition.  In  one  octavo  volume  of  543  pages. 
Cloth,  S3.75;  leather,  S4.75.        » 


28 


Lea  Brothers  &  Co.'s  Publications — Diseases  of  Women. 


THOMAS,  T.  GAILLAItl),  and  MJJNnB,  PAVL  F., 

31,  2).,  ZL.  D.,  M,  J>., 

Emeritus  Professor  of  Diseases  of  Women  in  the  College  Professor  of  Gynecology  in  the  Kew    York 

of  Physicians  and  Surgeons,  N.  ¥.  Polyclinic. 

A  Practical  Treatise  on  the  Diseases  of  Women.  New  (sixth)  edition, 
thoroughly  revised  and  rewritten  by  Dr.  Munde.  In  one  large  and  handsome  octavo 
volume  of  82-4  pages,  with  347  illustrations,  of  which  201  are  new.     Cloth,  $5 ;  leather,  $6. 


Probably  no  treatise  ever  written  by  an  Ameri- 
can author  on  a  medical  topic  has  been  ascepted 
by  more  practitioners,  as  a  standard  text-book,  or 
read  with  pleasure  and  profit  by  more  medical 
students  than  Thomas  on  the  diseases  of  women. 
Is'ext  to  the  indescribable  charm  of  listening  to 
Dr.  Thomas'  lectures  and  clinics,  which  have  in 
them  the  element  of  a  captivating  and  inspiring 
personality— which  must  be  heard  and  felt  to  be 
properly  appreciated — is  this  volume,  which  in 


ly  and  scientiSc  statement  must  remain  what  it 
long  has  been,  a  standard  text-book  both  for  prac- 
titioner and  student,  at  home  and  abroad,  and  an 
enduring  pride  to  American  gynecologists.  In  a 
field  by  no  means  neiv  or  wanting  in  honorable 
achievement.  Dr.  Munde  has  added  to  his  already 
enviable  reputation  by  the  manner  in  which  ha 
has  acquitted  himself  in  an  undertaking  at  once 
so  delicate  and  difficult  and  for  which  he  will 
receive,  at  the  hands  of  the  profession,  their  ac- 


classic  excellence,  elegance  of  diction  and  scholar-  i  knowledgment. — The  Brooklyn  Med.  Jour.,  Mar.  '92. 


TAIT,  LA  WSOJV,  F.  jB.  C,  S., 

Professor  of  Gyncecology  in  Queen^s  College,  Birmingham;  late  President  of  the  British  Chjne- 
cological  Society ;  Fellow  American  Gynecological  Society. 

Diseases  of  Women  and  Abdominal  Surgery.    In  two  octavo  volumes. 
Volume  I.,  554  pages,  62  engravings  and  3  plates.     Cloth,  $3.     Volume  II.,  preparing. 

The  plan  of  the  work  does  not  indicate  the  regu-  Much  of  the'  text  is  abundantly  illustrated  (vith 
lar  system  of  a  text  book,  and  yet  nearly  every-  cases,  which  add  value  in  shovring  the  results  of 
thing  of  disease  pertaining  to  the  various  organs  the  suggested  plans  of  treatment.  We  feel  eon- 
receives  a  fair  consideration.  The  description  of  fident  that  few  gynecologists  of  the  country  will 
diseased  conditions  is  exceedingly  clear,  and  the  fail  to  place  the  work  in  their  libraries. — The 
treatment,  medical  or  surgical,  is  very  satisfactory.  ,  Obstetric  Gazette,  March,  1890. 


SUTTON,  J.  BLAND,  F.  It.  C.  S., 

Assistant  Surgeon  to  the  Middlesex  Hospital,  London. 

Surgical  Diseases  of  the  Ovaries  and  Fallopian  Tubes,  including 
Tubal  Pregnancy.  In  one  crown  octavo  volume  of  544  pages  with  119  engravings 
and  5  colored  plates.     Cloth,  $3.     Just  ready. 

To  gynecologists  the  name  of  Mr.  Satton  has  1  that  the  writer  has  to  say  is  stated  in  a  clear, 
long  been  familiar  as  that  of  a  conscientious  I  practical  way.  The  author's  style  is  singularly 
worker  in  pelvic  pathology,  as  well  as  a  compara-  |  concise — almost  epigrammatic.  Statements  which 
tive  anatomist  of  wide  reputation.  The  present  in  a  less  weighty  authority  might  appear  too  dog- 
volume  contains  the  substance  of  valuable  papers  ,  matic  gather  force  by  the  positive  manner  In 
which  have  been  scattered  throughout  journals  I  which  they  are  made.  AVe  have  no  hesitation  in 
and  society  reports  during  the  past  five  or  six  pronouncing  it  the  best  monograph  of  the  kind 
years,  and  deserves  the  careful  attention  of  gen-  which  has  yet  aopeared. — Medical  Record,  New 
eral  readers  as  well  as  of  specialists.    Everything    York,  May  21, 1892. 


nAVENPOUT,  F.   jff.,  3L  D,, 

Assistant  in  Gynecology  in  the  Medical  Department  of  Harvard  University,  Boston. 

Diseases  of  Women,  a  Manual  of  Non-Surgical  Gynaecology.  De- 
signed especially  for  the  Use  of  Students  and  General  Practitioners.  New  (second) 
edition.  In  one  handsome  12mo.  volume  of  314  pages,  with  107  illustrations.  Cloth, 
$1.75.     Just  ready. 


The  admirable  tact  of  the  author  has  given  us  a 
most  excellent  book.  By  omitting  surgical  gyn- 
ecology and  conditions  of  rare  occurrence,  as  well 
as  discussions  on  rare  and  disputed  points  and 
pathological  anatomy,  much  space  has  been  saved. 
Much  attention  has  been  paid  to  the  description 
and  elucidation  of  seemingly  minor  but  actually 
very  important  points  which  are  not  found  in 
ordinary  text-books.  The  pages  devoted  to  meth- 
ods of  examination  are  deserving  of  the  highest 


commendation,  as  well  as  those  devoted  to  a  de- 
scription of  instruments  and  general  methods  of 
treatment.  While  not  over-elaborate,  they  are 
explicit  and  markedly  practical.  The  whole 
work  is  in  fact  eminently  jjractical,  being  devoted 
•almost  exclusively  to  symptomatology  and  treat- 
ment. It  is  upon  the  latter  sttbject  that  the  value 
of  the  book  chiefly  lies. — Gaillard's  Medical  Jour- 
nal, August,  1802. 


MAY,    CHARLES  H.,  3L  2)., 

Late  House  Surgeon  to  Mount  Sinai  Hospital,  New  York. 
A  Manual  of  theDiseases  of  Women.   Being  a  concise  and  systematic  expo- 
sition of  the  theory  and  practice  of  gynecology.      Second  edition,  edited  by  L.  S.  Eau, 
M.  D.,  Attending  Gynecologist  at  the  Harlem  Hospital,  N.  Y.     In  one  12mo.  volume  of 
360  pages,  with  31  illustrations.     Cloth,  $1.75. 

This  is  a  manual  of  gynecology  in  a  very  con- 
densed form,  and  the  fact  that  a  second  edition 
has  been  called  for  indicates  that  it  has  met  with 


a  favorable  reception.  It  is  intended,  the  author 
tells  us,  to  aid  the  student  who  after  having  care- 
fully perused  larger  works  desires  to  review  the 
subject,  and  he  adds  that  it  may  be  useful  to  the 
practitioner  who  wishes  to  refresh  his  memory 


rapidly  but  has  not  the  time  to  consult  larger 
works.  We  are  much  struck  with  the  readiness 
and  convenience  with  which  one  can  refer  to  any 
subject  contained  in  this  volume.  Carefully  com- 
piled indexes  and  ample  illustrations  also  enrich 
the  work.  This  manual  will  be  found  to  fulfil  its 
purposes  very  satisfactorily.'— T/ie  Physician  and 
Surgeon,  June,  1890. 


Lea  Brothers  &  Co.'s  Publications — Obstetrics,  Dis.  of  Worn.   29 


PARVIN,  TSBOPMILVS,  M.  I).,  ZL.  !>., 

Prof,  of  Obstetrics  and  the  Diseases  of  Women  and  Children  in  Jefferson  Med.  Coll.,  Phila. 
The  Science  and  Art  of  Obstetrics.     Second  edition.     In  one  handsome  8vo. 
volume  of  701  pages,  with  239  engravings  and  a  colored  plate.     Cloth,  $4.25 ;  leather,  $5.25. 

obstetric  literature  can  be  found  a  work  which  is 


The  second  edition  of  this  work  is  fully  up  to  the 
present  state  of  advancement  of  the  obstetric  art. 
The  author  has  succeeded  exceedingly  well  in 
incorporating  new  matter  without  apparently  in- 
creasing the  size  of  his  work  or  interfering  with 
tlie  smoothness  and  grace  of  its  literary  construc- 
tion. He  is  very  felicitous  in  his  descriptions  of 
conditions,  and  proves  himself  in  ttiis  respect  a 
scholar  and  a  master.     Karely  in  the  range  of 


80  comprehensive  and  yet  compact  and  practical. 
In  such  respect  it  is  essentially  a  text  book  of  the 
first  merit.  The  treatment  of  the  subjects  gives  a 
real  value  to  the  work — the  individualities  of  a 
practical  teacher,  a  skilful  obstetrician,  a  close 
thinker  and  a  ripe  scholar. — Medical  Record,  Jan. 
17, 1891. 


PZATFAIB,  W.  S.,  M.  !>.,  F.  M.  C,  F., 

Professor  of  Obstetric  Medicine  in  King's  College,  London,  etc. 

A  Treatise  on  the  Science  and  Practice  of  Midwifery.  Fifth  Amer- 
ican, from  the  seventh  English  edition.  Edited,  with  additions,  by  Robert  P.  Harris, 
M.  I).  In  one  handsome  octavo  volume  of  664  -pages,  with  207  engravings  and  5  plates. 
Cloth,  $4.00 ;  leather,  $5.00. 


Truly  a  wonderful  book ;  an  epitome  of  all  ob- 
stetrical knowledge,  full,  clear  and  concise.  In 
thirteen  years  it  has  reached  seven  editions.  It 
is  perhaps  the  most  popular  work  of  its  kind  ever 
presented  to  the  profession.  Beginning  with  the 
anatomy  and  physiology  of  the  organs  concerned, 
nothing  is  left  unwritten  that  the  practical  ac- 
coucheur should  know.  It  seems  that  every 
conceivable  physiological  or  pathological  condi- 


tion from  the  moment  of  conception  to  the  time 
of  complete  involution  has  had  the  author's 
patient  attention.  The  plates  and  illustrations, 
carefully  studied,  will  teach  the  science  of  mid- 
wifery. The  reader  of  this  boolc  will  have  before 
him  the  very  latest  and  best  of  obstetric  practice, 
and  also  of  all  the  coincident  troubles  connected 
therewith. — Southern  Practitioner,  Dec.  1889. 


In  one  12mo.  volume  of  450 


KING,  A,  F,  A.,  M.  D., 

Professor  of  Obstetrics  and  Diseases  of  Women  in  the  Medical  Department  of  the  Columbian  UniveV' 
sity,  Washington,  D.  C,  and  in  the  University  of  Vermont,  etc. 

A  Manual  of  Obstetrics.    New  (Fifth)  edition 
pages,  with  150  illustrations.     Cloth,  $2  50.     Junt  ready. 
A  notice  of  the  previous  edition  is  appended. 
Dr.  King,  in  the  preface  to  the  first  elition  of 
this  manual,  modestly  states  that  "its  purpose  is 
to  furnish  a  good  groundwork  to  the  student  at 


the  beginning  of  his  obstetric  studies."  Its  pur- 
pose is  attained;  it  will  furnish  a  good  ground- 
work to  the  student  who  carefully  reads  it;  and 
further,  the  busy  practitioner  should  not  scorn  the 
volume  because  written  for  students,  as  it  con- 
tains much  valuable  obstetric  knowledge,  some 
of  which  is  not  found  in  more  elaborate  text- 
books. The  chapters  on  the  anatomy  of  the 
female  generative  organs,  menstruation,  fecunda- 


tion, the  signs  of  pregnancy,  and  the  diseases  ot 
pregnancy,  are  all  excellent  and  clear;  but  it  is  in 
the  description  of  labor,  both  normal  and  abnor- 
mal, that  Dr.  King  is  at  his  best.  Here  his  style 
is  so  concise,  and  the  illustrations  are  so  good, 
that  the  veriest  tyro  could  not  fail  to  receive  a  clear 
conception  of  labor,  its  complications  and  treat- 
ment. Of  the  141  illustrations  it  may  be  safely 
said  that  they  aWillnstrate,  and  that  the  engraver's 
work  is  excellent.  From  every  standpoint  we  can 
most  heartily  recommend  thebook  both  to  practi- 
tioner and  student. —  The  Medical  News,  Dec.  7, 1889. 


BARNES,  ROBERT,  Jf.  D.,   and   FANCOURT,  M,  D,, 

Phys.  to  the  General  Lying-in  Hasp.,  Lond.  Obstetric  Phys.  to  St.  Thomas'  Hosp.,  Lond. 

A  System  of  Obstetric  Medicine  and  Surgery,  Theoretical  and  Clin- 
ical. For  the  Student  and  the  Practitioner.  The  Section  on  Embryology  by  Prof.  Milnes 
Marshall.     In  one  8vo.  volume  of  872  pp.,  with  231  illustrations.    Cloth,  $5 ;  leather,  $6. 


The  immediate  purpose  of  the  work  is  to  furnish 
a  handbook  of  obstetric  medicine  and  surgery 
for  the  use  of  the  student  and  practitioner.  It  is 
not  an  exaggeration  to  say  of  the  book  that  it  is 
the  best  treatise  in  the  English  language  yet 
published,  and  this  will  not  be  a  surprise  to  those 
who  are  acquainted  with  the  work  of  the  elder 
Barnes.     Every  practitioner  who  desires  to  have 


the  best  obstetrical  opinions  of  the  time  in  a 
readily  accessible  and  condensed  form,  ought  to 
own  a  copy  of  the  book. — Journal  of  the  American 
Medical  Association,  June  12, 188G. 

The  Authors  have  made  a  text-book  which  is  in 
every  way  quite  worthy  to  take  a  place  beside  the 
best  treatises  of  the  period. — New  York  Medical 
Journal,  July  2, 1887. 


DUNCAN,  J,  3IATTMEWS,  M.I),,  LL,  D.,  F.  R.  S.  E.,  etc. 

Clinical  Lectures  on  the  Diseases  of  Women ;  Delivered  in  Saint  Bar- 
tholomew's Hospital.     In  one  handsome  octavo  volume  of  175  pages.     Cloth,  $1.50. 


They  are  in  every  way  worthy  of  their  author , 
indeed,  we  look  upon  them  as  among  the  most 
valuable  of  his  contributions.  They  are  all  upon 
matters  of  great  interest  to  the  general  practitioner. 
Some  of  them  deal  with  subjects  that  are  not,  as  a 


rule,  adequately  handled  in  the  text-books ;  others 
of  them,  while  bearing  upon  topics  that  are  usually 
treated  of  at  length  in  such  works,  yet  bear  such  a 
stamp  of  individuality  that  they  deserve  to  be 
widely  read.— iV.  Y.  Medical  Journal,  March,  1880. 


WINCKEL,  F, 

A  Complete  Treatise  on  the  Pathology  and  Treatment  of  Childbed. 

For  Students  and  Practitioners.     Translated,  with  the  consent  of  the  Author,  from  the 
second  German  edition,  by  J.  R,  Chadwick,  M.  D.    Octavo  484  pages.    Cloth,  $4.00. 


30 


Lea  Brothers  &  Co.'s  Publications — Obstetr,  Ois.  CMldm. 


SMITH,  J.  LEWIS,  M.  D,, 

Clinical  Professor  of  Diseases  of  Children  in  the  Belleoue  Hospital  Medical  College,  N.  7. 

A  Treatise  on  the  Diseases  of  Infancy  and  Childhood.  New  (seventh) 
edition,  thoroughly  revised  and  rewritten.  In  one  handsome  octavo  volume  of  881 
pages,  with  51  illustrations.     Cloth,  $4.50  ;  leather,  $5.50. 

We  have  always  considered  Dr.  Smith's  book  as  1  author  in  the  front  rank  of  medical  teachers. — 
one  of  the  very  best  on  the  subject.  It  has  always  I  The  American  Journal  of  'the  Medical  Sciences,  Dec. 
been  practical — a  field   book,  theoretical  where  I  1891. 

theory  has  been  deduced  from  practical  experi-  !  It  has  long  been  known  as  one  of  the  ablest  and 
ence.  He  takes  his  theory  from  the  bedside  and  [  most  trustworthy  books  on  the  subject,  and  the 
the  pathological   laboratory.    The  very  practical    latest  edition  is  likely  to  add  to  its  fame.— ^din- 


character  of  this  book  has  always  appealed  to  us 
It  is  characteristic  of  Dr.  Smith  in  all  his  writings 
to  collect  whatever  recommendations  are  found  in 
medical  literature,  and  his  search  has  been  wide. 
One  seldom  fails  to  find  here  a  practical  suggestion 
after  search  in  other  works  has  been  in  vain.  In 
the  seventh  edition  we  note  a  variety  of  changes 
in  accordance  with  the  progress  of  the  times.  It 
still  stands  foremost  as  ihe  American  text-book. 
The  literary  style  could  not  be  excelled,  its  advice 
is  always  conservative  and  thorough,  and  the 
evidence  of  research  has  long  since  placed  its 


burgh  Medical  Journcl,  August,  1892 

lii  the  present  edition  we  notice  that  many  of 
the  chapters  have  been  entirely  rewritten.  Full 
notice  is  taken  of  all  the  recent  advances  that 
have  been  rnade.  Many  diseases  not  previously 
treated  of  have  received  special  chapters.  The 
work  is  a  very  practical  ore.  Especial  care  has 
been  taken  that  the  directions  for  treatment  shall 
be  particular  and  full.  In  no  other  work  are  such 
cart  ful  instructions  given  in  the  details  of  infant 
hygiene  and  the  artificial  feeding  of  infants. — 
Montreal  Medical  Journal,  Feb.  1891. 


ZAJVDIS,  HENRY  G.,  A,  M,,  M,  D., 

Professor  of  Obstetrics  aiid  the  Diseases  of  Women  in  Starling  Medical  College,  Columbus,  O. 

The  Management  of  Labor,  and  of  the   Lying-in  Period.     In 

handsome  12mo.  volume  of  334  pages,  with  28  illustrations.     Cloth,  $1.75. 


The  author  has  designed  to  place  in  the  hands 
of  the  young  practitioner  a  book  in  which  he  can 
find  necessary  information  in  an  instant.    As  far 


as  we  can  see,  nothing  is  omitted.  The  advice  is 
sound,  and  the  procedures  are  safe  and  practical. 
Centralblatt  fUr  Gynakologie,  December  4, 1886. 


HEMMAN,   G,  ERNEST,  M,  B,,  F,  B.  C.  JP., 

Obitetric  Physician  to  the  London  Hospital. 

First  Lines  in  Midwifery :  a  Guide  to  Attendance  on  Natural  Labor 
for  Medical  Students  and  Midwives.    In  one  12mo.  volume  of  198  pages  ^vith 


80  illustrations.     Cloth,  $1.25.     Jvst  ready. 

This  work  is  designed  to  give  such  elementary 
knowledge  as  may  be  needed  by  a  midwife  or 
student  in  the  care  of  their  first  cases  of  normal 
labor,  and  it  presents  that  knowledge  in  a  clear 
and  practical  way. —  The  American  Journal  of  Ob- 
stetrics, April,  1892. 

This  is  a  little  book,  intended  for  the  medical 


See  Student's  Series  of  Manuals,  below, 
student  and  the  educated  midwife.  The  work 
is  written  in  a  plain,  .simple  style,  and  is  as 
much  as  possible  devoid  of  technical  terms.  It 
will  prove  valuable  to  the  beginner  in  midwifery 
and  could  be  read  with  advantage  by  the  majority 
of  practitioners,  old  and  young. — The  Medical 
Fortnightly,  April  15, 1892. 


OWEN,  EH  MUNI),  M,  B,,  F,  B.  C,  S., 

Surgeon  to  the  Children's  Hospital,  Chreat  Ormond  St.,  London. 


Surgical  Diseases  of  Children. 

chromo-lithographic  plates  and  85  woodcuts 
page  31. 

One  is  immediately  struck  on  reading  this  book 
with  its  agreeable  style  and  the  evidence  it  every- 
where presents  of  the  practical  familiarity  of  its 
author   with    his   subject.      The   book   may   be 


In  one  12mo.  volume  of  525  pages,  with  4 
Cloth,  $2.     See  Series  of  Clinical  Manuals, 

honestly  recommended  to  both  students  and 
practitioners.  It  is  full  of  sound  information, 
pleasantly  given. — Annals  of  Surgery,  May,  1886. 


STUHENT'S  SERIES  OF  MANUALS. 

A  Series  of  Fifteen  Manuals,  for  the  use  of  Students  and  Practitioners  of  Medicine  and  Surgery, 
written  by  eminent  Teachers  or  Examiners,  and  issued  in  pocket-size  12mo  volumes  of  300-540  pages, 
richly  illustrated  and  at  a  low  price.  The  following  volumes  are  now  ready:  Lrrr's  Manual  of  Chem- 
istry, ^2;  Hebman's  First  Lines  in  Midwifery,  $1.25;  Teeves'  Manual  of  Surg^eri/,  by  various  writers,  in 
three  volumes,  per  set,  .?6;  each,  S2;  Bell's  Comparative  Anatomy  and  Physiology,  82;  Goitld's  Surgical 
Diagnosis,  82;  B.OBE,B.jBoy''6  Physiological  Physics,  $2;  Brvce's  Materia  Medica  and  Therapeutics  (4th  edi- 
tion), Si. 50;  Powee's  Human  Physiology  (2d  edition),  $1.50;  Clarke  and  Lockwood's  Dissectors'  Man- 
ual, S1.50;  Ralfe's  Clinical  Chemistry,  $1.50;  Tu'eyeb'  Surgical  Applied  Anatomy,  $2;  Pefver's  Surgical 
Pathology,  82;  and  Klein's  Elements  of  Histology  (4th  edition),  81.75.  The  following  is  in  press: 
Peppee's  Forensic  Medicine.    For  separate  notices  see  index  on  last  page. 


CONDIE'S  PRACTICAL  TREATISE  ON  THE 
DISEASES  OF  CHILDREN.  Sixth  edition,  re- 
vised and  augmented.  In  one  octavo  volume  of 
779  Baees.     Cloth.  85.25  ;  leather.  8fi.25 

LEISHMAN'S  SYSTEM  OF  MIDWIFERY,  IN- 
CLUDING THE  DISEASES  OF  PREGNANCY 
AND  THE  PUERPERAL  STATE.  Fourth  edi- 
tion.   Octavo. 

WEST  ON  SOME  DISORDERS  OF  THE  NERV- 
OUS SYSTEM  IN  CHILDHOOD.  In  one  small 
12mo.  volume  of  127  pages.    Cloth,  81.00. 

PARRY  ON  EXTRA-UTERINE  PREGNANCY' 
Its  Clinical  History,  Diagnosis,  Prognosis  and 
Treatment.     Octavo,  272  pages.     Cloth,  82.50. 

CHURCHILL  ON  THE  PUERPERAL  FEVEB 
AND  OTHER  DISEASES  PECULIAR  TO  WO- 
MEN.    In  one  8vo.  vol.  of  464  pages.    Cloth,  82.60. 

TANNER  ON  PREGNANCY.  Octavo,  490  pages, 
colored  plates.  16  cuts.    Cloth.  84.25, 


ASHWELL'S  PRACTICAL  TREATISE  ON  THE 
DISEASES  PECULIAR  TO  WOMEN.  Third 
American  from  the  third  and  revised  London 
edition.    In  one  8vo.  vol.,  pp.  520.    Cloth,  83.50. 

MEIGS  ON  THE  NATURE,  SIGNS  AND  TREAT- 
MENT OF  CHILDBED  FEVER.  In  one  8vr. 
volume  of  346  pages.     Cloth.  82.00. 

RAMSBOTHAM'S  PRINCIPLES  AND  PRAC- 
TICE OF  OBSTETRIC  MEDICINE  AND 
SURGERY.  In  reference  to  the  Process  of 
Parturition.  A  new  and  enlarged  edition,  thor- 
oughly revised  by  the  Author.  With  additions 
by  W.  V.  Keating,  M.  D.,  Professor  ot  Obstf  tries, 
etc.,  in  the  Jefferson  Medical  College  of  Phila- 
delphia. In  one  large  and  handsome  imperial 
octavo  volume  of  640  pages,  with  64  full  page 
plates  and  43  woodcuts  in  the  text,  containing  in 
all  nearly  200  beautiful  figures.  Strongly  bound 
in  leather,  with  raised  bands,  87. 


Lea  Brothers  &  Co.'s  Publications — Med.  Juris.,  Miscel.  31 

SERIES  OF  CLINICAE  MANUALS, 

In  arranging  for  this  Series  it  has  been  the  design  of  the  publishers  to  provide  the  profession  with 
a  collection  of  authoritative  nionogiaphs  on  important  clinical  subjects  in  a  cheap  anci  portable  form. 
The  volumes  contain  about  55')  pages  and  are  freely  illustrated  by  chromo-lithographs  and  wood- 
cuts. The  following  volumes  are  now  ready:  Yeo  on  Fuodin  Health  and  Disease,  S'2;  Bboadbent  on 
the  PwJ^e,  $1.75;  Carter  A  Frost's  Ophthalmic  Surgery,  $2  25;  Hutchinson  on  Syphilis,  $-2.25;  Ball  on 
the  Rectum  and  Adus,  $2.25;  Marsh  on  the  Joints,  $2;  Owen  on  Surgical  Diseases  of  Children,  $2; 
Mobris  on  Surgical  Diseases  of  the  Kidney,  $2.25;  Pick  on  Fractures  and  Dislocations,  $2 ;  Butlin  on 
the  Tongue,  $i  50;  Tn^vis  on  Intestinal  Obstructiun,$2;  and  Sa\age  on  Insanity  and  Allied  Netiroses,  $2. 
The  following  is  in  active  preparation:  Lucas  on  Diseases  of  the  Urethra.  For  separate  notices  see 
index  on  last  page.  

TAYLOR,  ALFREn  S.,  M.  jD., 

Lecturer  on  Medical  Jurisprudence  and  Chemistry  in  Ouy's  Hospital,  London. 

A  Manual  of  Medical  Jurisprudence.  New  American  from  the  twelfth 
English  edition.  Thoroughly  revised  by  Claek  Bell,  Esq.,  of  the  New  York  Bar.  In 
one  octavo  volume  of  about  800  pages,  with  56  illustrations.  Just  ready.  Cloth,  $4.50; 
leather,  $5.50. 

This  work  is  the  authority  recognized  not  only  by  the  medical  profession  but  also  by  the 
Courts  of  all  English-speaking  countries.  The  ])resent  (9th)  American  edition,  being  based 
on  the  nth  English  edition,  has  had  the  benefit  of  successive  revisions  by  the  foremost 
medical  experts,  and  finally  by  a  legal  authority  who  has  made  the  subject  an  especial  study 
from  the  staudi^oint  of  American  practice. 

By  the  Same  Author. 
Poisons  in  Relation  to  Medical  Jurisprudence  and  Medicine.    Third 

American,  from  the  third  and  revised  English  edition.     In  one  large  octavo  volume  of  788 
pages.     Cloth,  $5.50 ;  leather,  $6.50. 

PEPPER,  AUGUSTUS  J.,  M.  S,,  M.  B.,  F.  R.  C.  S,, 

Examiner  in  Forensic  Medicine  at  the  University  of  London. 

Forensic  Medicine.    In  one  pocket-size  12mo.  volume.    Preparing.    See  Student^ 

Series  of  Manuals,  below. 

LEA,  HENRY  C,  LL,  J>. 

The  Formulary  of  the  Papal  Penitentiary.  In  one  8vo  volume  of  221 
pages  with  a  frontispiece.     Shortly. 

By  the  same  Author. 
Chapters  from  the  Religious  History  of  Spain. — In  one  12mo.  volume 

of  522  pages.     Cloth,  $2.50. 


The  width,  depth  and  thoroughness  of  research 
whi(  h  have  earned  lir.  Lea  a  high  European  place 
as  the  ablest  historian  the  Inquisition  has  yet 
found  are  hers  applied  to  some  side-issues  of  that 
great  subject.  We  have  only  to  say  of  this  volume 
that  it  worthily  complements  the  author's  earlier 
studies  in  ecclesiastical  history.  His  extensive 
and  minute  learning,  much  of  it  from  inedited 
manuscripts  in  Mexico,  appears  on  every  page. — 
Lond m  Antiquary,  Jan.  1891. 

After  attentively  reading  the  work  one  does  not 
know  whethertheauthor  is  a  Catholic,  a  Protestant 


or  a  free-thinker.  This  moderation  deprives  the 
indictment  of  none  of  its  force.  The  facts  and 
the  documents,  of  which  the  number  and  novelty 
attest  a  patient  erudition,  are  grouped  in  luminous 
order  and  produce  on  the  reader  an  effect  all  the 
more  powerful  in  that  it  seems  the  less  designed. 
When  we  add  that  the  style  is  in  every  way  excel- 
lent, that  it  is  clear,  sober  and  precise,  we  do  full 
justice  to  a  work  which  reflects  the  highest  honor 
on  the  talents  of  the  writer  and  on  the  method  ol 
the  modern  school  of  history. — Revue  Critique 
d'Histoire  et  de  Litterature,  Paris,  Jan.  1891. 


By  the  same  Author. 
Superstition  and  Force :  Essays  on  The  Wager  of  Law,  The  Wager  of 
Battle,    The  Ordeal  and  Torture.     Revised  and  enlarged  edition.     In  one  hand- 
some royal  12mo.  volume  of  about  600  pages.     New  (fourth)  edition.     In  press. 

By  the  Same  Author. 
Studies  in  Church  History.    The  Rise  of  the  Temporal  Power — Ben- 
efit of  Clergy — Excommunication — The  Early  Church  and  Slavery.    Sec- 
ond and  revised  edition.      In  one  royal  octavo  volume  of  605  pages.     Cloth,  $2.50. 

complex  or  conflicting  forces. — Boston  Traveller. 
It  is  some  years  since  we  read  the  first  edition 
of  this  work  by  BIr.  Lea,  and  the  impression  made 
by  it  on  u?  at  the  time  is  confirmed  by  reperusal 
of  it  in  this  enlarged  and  improved  form;  namely, 
that  it  is  a  book  of  great  research  and  accuracy, 
fall  of  varied  information  on  very  interesting 
phases  of  church  life  and  history.  It  discusses 
eaoh  subject  with  a  rare  fulness  of  dates  and  in- 
stances, and  a  curious  conscientiousness  of  veri- 
fication and  citation  of  axLthoiitiea.— Edinburgh 
Scotsman. 


The  author  is  preeminently  a  scholar;  he  takes 
up  every  topic  allied  with  the  leading  theme  and 
traces  it  out  to  the  minutest  detail  with  a  wealth 
of  knowledge  and  impartiality  of  treatment  that 
compel  adni'ration.  The  amount  of  information 
compressed  into  the  book  is  extraordinary,  and 
the  profuse  citation  of  authorities  and  references 
makes  the  work  particularly  valuable  to  the  student 
who  desires  an  exhausti7e  review  from  original 
sources.  In  no  other  single  volume  is  the  develop- 
ment of  the  primitive  church  traced  with  so  much 
clearness  and  with  so  definite  a  perception  of 


By  the  Same  Author. 
An  Historical  Sketch  of  Sacerdotal  Celibacy  in  the  Christian 
Church.  Second  edition,  enlarged.  In  one  octavo  volume  of  685  pages.  Cloth,  $4.50. 
This  subject  has  recently  been  treated  with  very  I  more  light  on  the  moral  condition  of  the  Middle 
great  learning  and  with  admirable  impartiality  by  Ages,  and  none  which  is  more  fitted  to  dispel  the 
an  American  author,  Mr.  Henry  C.  Lea,  in  his  His-  \  gross  illusions  concerning  that  period  which  posi- 
tory  of  Sacerdotal  Celibacy,  which  is  certainly  one  j  tlve  writers  and  writers  of  a  certain  ecclesiastical 
of  the  most  valuable  works  that  America  has  pro-  ,  school  have  conspired  to  sustain. — Lecky's  History 
duced.  Since  the  great  history  of  Dean  Milman,  j  of  European  Morals,  Chap.  V. 
I  know  no  work  in  English  which  has  thrown  ' 


ft 

5 
d 

a 
© 


© 

M 


ft 


© 
© 


y 

s 


Abbott's  Bacteriology  ' 

.AJlen's  AnaMmy       "    . 

American  Journal  of  the  Medical  Sciences 

American  Systems  of  Gynecology  and  Obstetrics 

American  System  of  Practical  Medicine , 

American  System  of  Dentistry 

A  shhurst's  Surgery        .... 

Ashwell  on  Diseases  of  Women 

Attfield's  Chemistry 

Ball  on  the  Rectum  and  Anus 

Barlow's  Practice  of  Medicine 

Barnes'  System  of  Obstetric  Medicine 

Bartholow  on  Electricity 

Basham  on  Eenal  Diseases    . 

Bell's  Comparative  Anatomy  and  Physiology 

Bellamy's  Surgical  Anatomy 

Berry  on  the  Eye  .... 

Billings'  National  Medical  Dictionary     . 

Blandford  on  Insanity 

Bloxam's  Chemistry      .... 

Bristowe's  Practice  of  Medicine 

Broadbent  on  the  Pulse 

Browne  on  Koch's  Remedy  . 

Bro^-ne  on  the  Throat,  Nose  and  Ear 

Bmce's  Materia  Medica  and  Therapeutics 

Brunton's  Materia  Medica  and  Therapeutics 

Bryant's  Practice  of  Surgery  . 

Bumstead  and  Taylor  on  Venereal.    See  Taylor. 

Burnett  on  the  Ear 

Bntlin  on  the  Tongue    . 

Carpenter  on  the  Use  and  Abuse  of  Alcohol 

Carpenter's  Human  Physiology 

Carter  <fe  Frost's  Ophthalmic  Surgery 

Chambers  on  Diet  and  Regimen 

Chapman's  Human  Physiology 

Charles'  Physiological  and  Pathological  Chem. 

Churchill  on  Puerperal  Fever 

Clarke  and  Lockrwood's  Dissectors'  Manual 

Classen's  Quantitative  Analysis 

Cleland's  Dissector        .... 

Clouston  on  Insanity    . 

Clowes'  Practical  Chemistry 

Coats'  Pathology 

Cohen  on  the  Throat 

Cohen's  Applied  Therapeutics 

Coleman's  Dental  Surgery 

CondJe  on  Diseases  of  Chfldren 

Cornil  on  Syphilis  .... 

Cullerier  &  Bumstead  on  Venereal 

Culver  &  Hayden  on  Venereal  Diseases  . 

Dalton  on  the  Circulation 

Dalton's  HumanPhysiology 

Davenport  on  Diseases  of  Women 

Davis'  Clinical  Lectures 

Draper's  Medical  Physics 

Druitt's  Modern  Surgery 

Duncan  on  Diseases  of  Women 

Dungllsons  Medical  Dictionary 

Edes'  Materia  Medica  and  Therapeutics 

Edis  on  Diseases  of  Women   . 

Ellis' Demonstrations  of  Anatomy 

Emmet's  Gynaecology 

Erichsen's  System  ol'Stirgery 

Farquharson's  Therapeutics  and  Mat.  Med. 

Finlayson's  Clinical  Diagnosis 

Flint  on  Auscultation  and  Percussion 

Flint  on  Phthisis  .... 

Flint  on  Respiratory  Organs 

Flint  on  the  Heart 

Flint's  Essays       ..... 

Flint's  Practice  of  Medicine 

Folsom's  Laws  of  U.  S.  on  Custody  of  Insane 

Foster's  Physiologj'       .... 

Fothergill's  Handbook  of  Treatment 

Fownes'  Elementary-  Chemistry 

Fox  on  Diseases  of  llie  Skin  .  ...       26 

Frankland  and  Japp's  Inorganic  Chemistry 

Fuller  on  the  Lungs  and  Air  Passages     .  .       16 

Gant's  .Student's  Surgers'       ...  .20 

GIbbes'  Practical  Pathology  ...       18 

Gould's  Surgical  Diagnosis     .  .  .  .  20,  30 

Gray's  Anatomy     .        .  .  .  .  .5 

Gray  on  Nervous  and  Mental  Diseases     .  .       19 

Green's  Pathology  and  Morbid  Anatomy  .       18 

Greene's  Medical  Chemistry  ....         9 

Griffith's  Universal  Formulary       ...       11 
Gross  on  Foreign  Bodies  in  Air-Passages  .       17 

Gross  on  Imjiotence  and  Sterility    .  .  .       25 

Gross  on  Unnarv  Organs  .  .       25 

Gross  System  of  Surgery  .  .       20 

Habershon  on  the  Abdomen  .  .       15 

Hamilton  on  Fractures  and  Dislocations  .       22 

Hamilton  on  Nervous  Diseases       ...       19 
Hare's  Practical  Therapeutics         .  .  .12 

Hare's  System  of  Practical  Therapeutics  .       12 

Hardaway  on  the  Skin  ....       26 

Hartshorne's  Anatomy  and  Physiology  .  .         6 

Hartshorne's  Conspectus  of  the'Med.  Sciences 
Hartshorne's  Essentials  of  Medicine         .  .       13 

Herman's  First  Lines  in  Midwifery        .  .       30 

Hermann's  Experimental  Pharmacology  .       11 

Hill  on  .Syphilis  ......       25 

Hillier's  Handbook  of  Skin  Diseases         .  .       25 

Hirst  &  Piersol  on  Human  Monstrosities 
Hoblyn's  Medical  Dictionary  ...         4 

Hodge  on  Women  ....       27 

Hoffmann  and  Power's  Chemical  Analysis       .       10 
Holden's  Landmarks    .....         5 

Holland's  Medical  Notes  and  Reflections  .       16 

Holmes'  Principles  and  Practice  of  Surgery     .       22 
Holmes'  System  of  Burgerj'  .  .  .21 

Homer's  Anatomy  and  Histology 
Hndson  on  Fever  .  ...       15 

Hutchinson  on  Svphills  .  .  .  25,-31 

Hyde  on  the  Diseases  of  the  Skin    .  .  .26 

Jackson  on  the  Skin    .  .  .26 

Jamieson  on  the  Skin  ....       26 

Jones  (C.  Handheld)  on  Nervous  Disorders       .       16 


27 
15 
24 
20 
29 

9 
20,31 
16 
29 
16 
24 
7,30 

6 
23 

4 
19 

9 

13 

17,31 

17 

17 

11,30 

12 

21 

25 

23 

20,31 


23,31 
16 

8 
10 
30 
6,30 
10 

6 
19 

8 
18 
17 
13 
24 
30 
25 
25 


Juler's  Ophthalmic  Science  and  Practice 

King's  Manual  of  Obstetrics  . 

Klein's  Histology 

Landis  on  Labor 

La  Roche  on  Pneumonia,  Malaria,  etc.    . 

La  Roche  on  Yellow  Fever    . 

Laurence  and  Moon's  Ophthalmic  Surgery 

Lawson  on  the  Ej'e,  Orbit  and  Eyelid 

Lea's  Chapters  from  Religious  History  of  Spain 

Lea's  Sacerdotal  Celibacy 

Lea's  Studies  in  Church  History 

Lea's  Superstition  and  Force 

Lee  on  Syphilis    .  .  .  . 

Lehmann  s  Chemical  Physiology    . 

Leishman's  Midwiferj' 

Lucas  on  Diseases  of  the  Urethra   . 

Ludlow's  Manual  of  Examinations 

Luff's  Manual  of  Chemistry 

Lyman's  Practice  of  Medicine 

Lyons  on  Fev  er  . 

Maisch's  Organic  Materia  Medica  . 

Marsh  on  the  Joints 

May  on  Diseases  of  Women    . 

Medical  News      ..... 

Medical  News  Visiting  List  . 

Medical  News  Physicians'  Ledger  . 

Meigs  on  Childbed  Fever        .  , 

Miller's  Practice  of  Surgery   . 

Miller's  Principles  of  Surgery 

Morris  on  Diseases  of  the  Kidney  . 

Musser's  Medical  Diagnosis  . 

National  Dispensatorj^ 

National  Medical  Dictionary 

Nettleship  on  Diseases  of  the  Eye  .  • 

Norris  and  Oliver  on  the  Eye 

Owen  on  Diseases  of  Children 

Parrlsh's  Practical  Pharmacy  .  . 

Parry  on  Extra-Uterine  Pregnancy  • 

Parvin's  Midwifery       .  ... 

Pa-yj'  on  Digestion  and  its  Disorders 

Paj-ne's  General  Pathology    . 

Pepper's  System  of  Medicine 

Pepper's  Forensic  Medicine  . 

Pepper's  Surgical  Pathology 

Pick  on  Fractures  and  Dislocations 

Pirrie's  System  of  Surgery    . 

Playfair  on  Nerve  Prostration  and  Hysteria 

Playfalr's  Midwifery     .... 

Power's  Human  Physiology  . 

Purdy  on  Bright's  Disease  and  Allied  A  fiectiona 

Pj-e-Smith  on  the  Skin 

Quiz  Series  .... 

Ralfe's  Clinical  Chemistry 

Ramsbotham  on  Parturition 

Remsen's  Theoretical  Chemistry    . 

Reynolds' System  of  Medicine 

Richardson's  Preventive  Medicine  . 

Roberts  on  Diet  and  Digestion 

Roberts  on  Urinary  Diseases 

Roberts'  Compend  of  Anatomy 

Roberts'  Surgery  .  ,  .         , 

Robertson's  Phj'siological  Physics 

Ross  on  Nervous  Diseases 

Savage  on  Insanity,  including  Hysteria  . 

Schafer's  Essentials  of  Histology, 

Schrelber  on  Massage   . 

Seller  on  the  Throat,  Nose  and  Naso-Pharynx 

Senn's  Surgical  Bacteriology 

Series  of  Clinical  Manuals      .  .      '     . 

Simon's  Manual  of  Chemistry 

Slade  on  Diphtheria      .... 

Smith  (Edward)  on  Consumption   . 

Smith  (J.  Lewis)  on  Children 

Smith's  Operative  Surgery 

Stille  on  Cholera 

Stilie  &  Maisch's  National  Dispensatory 

Still6's  Therapeutics  and  Materia  Medica 

Stimson  on  Fractures  and  Dislocations 

Stimson's  Operative  Surgery 

Students'  Quiz  Series     .... 

Students'  Series  of  Manuals   . 

Sturges'  Clinical  Medicine 

Sutton  on  the  Ovaries  and  Fallopian  Tubes 

Tait's  Diseases  of  Women  and  Abdom.  Surgery 

Tanner  on  Signs  and  Diseases  of  Pregnancy 

Tanner's  Manual  of  Clinical  Medicine 

Taylor's  Atlas  of  Venereal  and  Skin  Diseases 

Taylor  on  Venereal  Diseases 

Taylor  on  Poisons  .... 

Taylor's  Medical  Jurisprudence 

Thomas  <fe  Munde  on  Diseases  of  Women 

Thompson  on  Stricture 

■Thompson  on  Urinarj'  Organs 

Todd  on  Acute  Diseases 

Treves' Manual  of  Surgery    . 

Treves'  Operative  Surgery    . 

Treves'  Students  Handbook  of  Surg.  Operations,    21 

"Treves' Surgical  Applied  Anatomy  .  .6,30 

Treves  on  Intestinal  Obstruction    .  .  .21,31 

Tuke  on  the  Influence  of  Mind  on  the  Body      .       19 

Vaughan  &  Novy's  Ptomaines  and  Leucomaines    10 

Visiting  List,  The  Medical  News     .  ' 

AValshe  on  the  Heart    . 

Watson's  Practice  of  Physic  . 

Wells  on  the  Eye 

West  on  Diseases  of  Women 

West  on  Nervous  Disorders  in  Childhood 

Wharton's  Minor  Surgery  and  Bandaging 

Whitla's  Dictionary  of  Treatment 

Williams  on  Consumption     . 

Wilson's  Handbook  of  Cutaneous  Medicine 

Wilson's  Human  Anatomy   .  .  .  •       _S 

Winckel  on  Pathol,  and  Treatment  of  Childbed       ^9 

Wohler's  Organic  Chemistry  .  .  •       ,Z 

Wood  head's  Practical  Pathology    .  .  .       1" 

Year-Books  of  Treatment  for  86,  '87,  '90,  'f  1,  '92.       '_ 

Yeo  on  Food  in  Health  and  Disease  .  .  1°>* 

Young's  Orthopsedic  Surgery  .  .  .29 


23 
29 
17,30 
30 
16 
15 
23 
23 
31 
31 
31 
31 

■a 

7 

30 

24,30 

4 

9,30 

15 

15 

11 

22,31 

Z8 

1 

■6 

3 

30 

20 

20 

24,31 

15 

11 

4 

23 

23 

30,31 

10 


16 
18 
14 
30,31 
17,30 
2-2,31 
20 
19 
29 
7.30 
24 
25 
2 
10,30 
30 
10 
13 
16 
24 
24 
7 
20 
7,30 
19 
19,31 
17 
16 
17 
18 
30 
8 
16 
16 
30 
22 
13 
11 
11 
22 
22 
2 
30 
16 
28 
23 
30 
15 
26 
25 
31 
31 
28 
24 
24 
16 
21,30 
21 


